探讨腹腔镜全系膜切除术（TME）联合经肛门内括约肌切除保肛术（ISR）治疗超低位直肠癌的临床疗效。

选择2009年1月至2012年6月42例超低位直肠癌患者采用腹腔镜TME联合ISR术治疗。按TME原则完全游离切除直肠后，经肛门内括约肌切除，完成超低位直肠癌保肛手术。对患者的临床资料、术后并发症及随访结果进行分析。

42例患者均顺利完成手术，无中转开腹或者改行Mile's术式，13例行回肠预防性造口，2例发生吻合口瘘，经保守治疗治愈。所有患者术后肛门括约肌功能比较满意，无围手术期死亡。随访9~40个月，1例于术后15个月发生肝脏多发转移再次入院进一步治疗。

对于术前评估早中期超低位直肠癌，特别是肿瘤没有侵犯肛门内括约肌，采用腹腔镜TME联合IRS术是安全可行的，提高了保肛成功率，提高患者术后生活质量且局部复发率低。

To investigate the effect of laparoscopic total mesorectal excision (TME) combined with intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.

Forty-two patients with ultra-low rectal cancer were given laparoscopic TME combined with ISR from January 2009 to June 2012. According the principle of TME, firstly the resection of the rectum was completed, and then the operation was carried out through the internal anal sphincter. The clinical data, postoperative complications and follow-up result were collected for all patients.

All operations were successful, with no one being transferred to open procedure or laparoscopic Mile's. Among them, 13 were given preventive ileostomy. Anastomotic leakage occurred in 2 patients and was cured by conservative therapy; all patients were satisfied with the postoperative anal sphincter function. There was no death during the operation. During the 9-40-month follow up, one patient was rehospitalized for further treatment because of the occurrence of liver metastasis cancer after fifteenth months.

It is feasible for the appropriate patients with ultra-low rectal cancer, diagnosed in early and middle stage and without cancer invading the external sphincter, to undergo laparoscopic TME combined with ISR. It raises the possibility of anal preservation, improve their postoperative quality of life and decreases incidence of local tumor recurrence.