郁宝铭教授直肠癌根治性切除手术基本上可分为两大类,一类为永久性腹部结肠造口术,另一类为保肛手术。手术方式众多本身就说明各种术式均有其优缺点和特有的适应证,唯有正确选择才能取得各种术式的最佳疗效。因此,我认为任何片面强调某一术式的优点,企图取代其它术式的结果往往会适得其反。除局部切除术外,两类术式的切除范围向上部分是相同的,不同的是向下部分。根据近代的认识,肿瘤远端肠段的切除长度应>2cm,一般以3cm为宜。在切除肿瘤及其远端3cm正常肠段后,肛直肠环(肛提肌)是否还健全、完整则是决定能否选用保肛手术的首要条件。其次,肠外结构或脏器有无肿瘤侵犯,特别是盆壁,因为如果癌肿不能完全切除,局部复发将影响吻合口,是不能轻易选作保肛手术的。在这类病例,如能在术前放疗后再手术,或先作Hartmann术,术后放疗,2～3年后 Professor Yu Baoming radical resection of rectal cancer surgery can be divided into two categories, one for the permanent abdominal colostomy, and the other for sphincter preserving surgery. Many surgical procedures show that each surgical procedure has its advantages and disadvantages and unique indications. Only the correct choice can achieve the best effect of various surgical procedures. Therefore, I think that any one-sided emphasis on the advantages of a certain surgical method, attempts to replace other surgical results tend to backfire. Except for local resection, the upper part of the resection range of the two types of surgery is the same, except for the lower part. According to the modern understanding, the length of the distal segment of the tumor should be >2cm, usually 3cm. After resection of the tumor and its distal 3 cm normal bowel segment, whether the anorectal ring (levator ani) is still sound and complete is the primary condition for deciding whether or not to use an anal operation. Second, there is no tumor invasion of the extra-intestinal structures or organs, especially the pelvic wall, because if the cancer cannot be completely removed, local recurrence will affect the anastomosis, and it cannot be easily selected as an sphincter-preserving operation. In such cases, if it is possible to perform surgery before radiotherapy, or first perform Hartmann surgery, postoperative radiotherapy, after 2 to 3 years