In laparoscopic and robot-assisted ultra-low sphincter-saving surgeries for rectal cancer, preserving sexual function, preventing anastomotic leakage, anastomotic stricture, and low anterior resection syndrome (LARS) is critical to ensuring a good postoperative quality of life. The primary strategy for preventing postoperative sexual dysfunction is the meticulous preservation of the autonomic nerves, particularly the neurovascular bundles in the prostate area, guided by precise anatomical dissection. Partial preservation of the Denonvilliers fascia during total mesorectal excision (TME) not only helps protect the anterior mesorectum but also safeguards the neurovascular bundles. To prevent anastomotic leakage, it is essential to achieve clear oncologic margins, ensure a robust blood supply to both the proximal and distal margins, maintain a tension-free anastomosis, and avoid thermal or radiation injury whenever possible. In elderly patients with metabolic diseases, persistent descending mesocolon, or those undergoing neoadjuvant chemoradiotherapy, selective preservation of the left colic artery may be considered. Additionally, reinforcing the anastomosis with sutures at the 'dog-ear' site, closing the pelvic peritoneum, and placing a transanal tube for drainage are beneficial strategies. Early identification of anastomotic leakage and timely intervention to ensure drainage can prevent delayed leakage, strictures, and the structural sequelae of anastomotic failure. To minimize fecal dysfunction, selective exemption from radiotherapy may be beneficial for mid-to-high rectal cancer, while for low rectal cancer, reconstruction of J-pouch reservoirs, end-to-side anastomosis, and transverse coloplasty can help reduce the incidence of severe low anterior resection syndrome. Additionally, for low rectal cancer following neoadjuvant therapy, a selective rectum-preserving strategy that avoids major surgery can effectively prevent these complications.
腹腔镜和机器人辅助直肠癌超低位保肛手术时，保留性功能，预防吻合口漏和吻合口狭窄以及低位前切除综合征是保证患者术后生活质量的关键。预防术后性功能障碍的关键在于膜解剖指导下手术全程保护自主神经，特别是神经血管束前列腺部。采取部分保留Denonvilliers筋膜的全直肠系膜切除术，既能避免直肠前方系膜的破损，又能防止神经血管束的损伤。手术获得肿瘤学安全切缘、保障近切端及远切端血运好、无张力以及尽量避免热损伤与放射损伤，是吻合成功、预防吻合口漏的关键；对高龄合并代谢性疾病、降结肠系膜旋转不良和行新辅助放化疗者，可考虑选择性保留左结肠动脉，缝合加固吻合口“狗耳部”、缝合关闭盆底腹膜，留置肛管引流。及时发现早发型吻合口漏并及时通畅引流等治疗，可避免吻合口迟发型漏和吻合口狭窄等结构性愈合不良。在预防排粪功能障碍方面，中高位直肠癌选择性豁免放疗、采用J型储袋、端侧吻合和结肠成形等重建，可能会降低重度低位前切除综合征的发生率。低位直肠癌新辅助治疗后选择性采用保直肠策略，豁免大手术，可从根本上避免上述并发症发生。.