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Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.直肠癌是常见的消化道恶性肿瘤，其主要治疗策略是以手术为核心的综合治疗。排粪、排尿与性功能障碍是全直肠系膜切除术（TME）后常见的并发症，严重影响患者生活质量。保护盆腔自主神经的TME手术可以有效降低上述问题的发生率。术中神经监测（IONM）可以协助术者在术中有效地识别并保护盆腔自主神经，是一种颇有前景的方式，但目前技术标准尚不统一，临床应用尚不普及。本综述整理了国内外IONM在直肠癌手术以及盆腔相邻器官手术中的研究，介绍了神经电刺激结合海绵体、膀胱、尿道、直肠内压监测及肌电反应监测等IONM的技术方法。提出目前研究面临的方法学不统一、专用设施缺乏等问题，并对这一领域未来的发展方向进行展望。.

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.近30年来，随着能量平台、器械平台、显像平台三大手术平台的发展，微创外科有了突飞猛进的提升。以结直肠癌手术为例，手术方式的五要素都有着不同程度的发展：手术入路经历了"从大到小"的过程；切除范围从单纯肠段切除到根治术或扩大根治术，再到注重保留器官功能的手术；随着对正常淋巴引流方向和肿瘤淋巴转移特点的认知，淋巴结清扫愈趋规范；消化道重建从手工缝合到全腔镜下吻合，再到功能性吻合概念的提出；标本取出从经腹壁大切口，到腹腔镜小切口，再到经自然腔道。这些术式的演变都依赖于技术平台与设备的进步及对新理念的认知。未来微创平台一定是为保障最优化术式顺利实施为方向，平台更为安全化、一体化、多功能化、智能化；未来微创术式一定是以追求患者最大获益为目标，术式更为科学化、功能化、舒适化、多样化；而术式的革新又推动了平台的发展，二者相辅相成，互相促进。.

Lateral lymph node metastasis is an important pathway for metastasis of low rectal cancer, which is also one of the most important risk factors for bad prognosis. Numerous evidences from evidence-based medicine demonstrate that both preoperative and postoperative chemoradiotherapy cannot eradicate lateral lymph node metastasis. Since selective resection of lateral lymph nodes with tumor residue after chemoradiotherapy can significantly decrease local recurrence rate and improve cancer prognosis, it is the only treatment modality for these patients to achieve disease-free survival. However, because of the narrow space, complicated anatomy and dense vessels and nerves of lateral area around rectum, lateral lymph node dissection (LLND) has many problems, such as long operation time, excessive intraoperative bleeding, piecemeal resection of lymphoid issue and high morbidity of postoperative complications, which restrict the clinical promotion of LLND. With the development in the study of fascia anatomy, surgeons are gradually familiarized with the perirectal fascia. Partitioning rectal lateral space and performing LLND based on fascia orientation can provide clear surgical plane and dissection boundary. Furthermore, it can avoid insufficient and excessive resection. Moreover, resecting tissue along fascia structure can avoid entering lymph tissue and prevent dissemination of malignant cells. Meanwhile, it can reduce exudation and bleeding, and present better pelvic autonomic nerve preservation. LLND based on fascia orientation is more in line with the concept of modern anatomy, more efficient both in tumor radical resection and function protection, and contributes to the promotion and quality control of LLND.侧方淋巴结转移是低位直肠癌的重要转移途径，也是直肠癌患者预后不良的重要因素之一。众多循证医学证据表明：围手术期放化疗并不能彻底杀灭转移的侧方淋巴结；对放化疗后仍然残留的侧方转移淋巴结进行清除，可以显著减少局部复发，改善预后，是这部分患者实现无瘤生存的唯一途径。然而，直肠侧方区域空间狭小，解剖结构复杂，血管神经密集，使侧方淋巴结清扫面临手术时间长、术中出血量多、标本难以整块切除以及术后并发症发生率高等问题，限制了侧方淋巴结清扫在临床的普及和推广。随着筋膜解剖研究的深入，直肠周围筋膜结构逐渐为临床医师所熟悉。对直肠侧方空间进行分区，以筋膜为导向行侧方淋巴结清扫，可以建立明确的手术操作平面和清扫范围边界，避免清扫范围的不足和过度，有助于将侧方淋巴结清扫这一术式标准化；沿筋膜结构进行游离，避免进入淋巴组织，可以预防转移癌细胞的扩散；同时也有助于减少渗出和出血，对盆腔自主神经予以更好的保护。筋膜导向的侧方清扫更加符合现代解剖学理念，有更好的肿瘤根治和功能保护效果，同时有助于侧方清扫手术的普及推广和质量控制。.

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.有效的早期筛查和一级预防是降低我国结直肠癌发病率和死亡率的主要措施之一。粪便DNA检测作为一种近几年兴起的非侵入性结直肠肿瘤筛查方法，是通过检测粪便中脱落的肠道细胞中的变异基因来判断结直肠肿瘤，其中多靶点粪便DNA检测技术是应用最广泛的一种检测手段。国外针对这一新兴技术开展的多项研究均表明，多靶点粪便DNA检测具有较高的灵敏度，且其随着技术的不断完善与发展逐渐应用于临床。而在国内，多靶点粪便DNA检测尚处于起步阶段，有待更多来自中国人群的试验验证。与传统的结直肠癌筛查方法相比，粪便DNA检测技术兼具无创无痛、安全方便等优势，但该检测方法同样存在费用高昂、特异性较差等问题。多靶点粪便DNA检测符合精准医学诊疗模式，能够很大程度上弥补传统肠癌筛查手段的不足，对肠癌筛查手段的整体提升起到了重要的推动作用。本文通过概括国内外相关研究，总结粪便DNA检测技术的优缺点并探讨其应用价值。.