腹腔镜技术已成为低位进展期直肠癌保肛手术的重要微创平台。本文系统综述了腹腔镜技术在全直肠系膜切除术、盆神经保护、远端切缘处理及经肛联合入路中的应用进展。现有高质量随机对照研究显示，腹腔镜手术在5年总生存率、无病生存率及局部复发率方面不劣于开放手术，其环周切缘阳性率控制在5%~10%以内，淋巴结清扫数量无显著差异。在围手术期结局方面，腹腔镜组术中出血量显著减少（平均减少50~100 ml），术后住院时间缩短，切口感染率下降约30%~50%。然而，其在“困难骨盆”（男性、肥胖、骨盆狭窄）、新辅助放化疗后组织纤维化等特殊病例中的应用仍具挑战，中转开腹率约为5%~15%，且低位前切除综合征发生率高达60%~80%，长期功能保护尚需更多前瞻性研究验证。

Laparoscopic technique has become an important minimally invasive platform for sphincter-preserving surgery of locally advanced low rectal cancer. This paper systematically reviews the advances in the application of laparoscopic techniques in total mesorectal excision, pelvic nerve preservation, distal resection margin management, and transanal combined approaches. Available high-quality randomized controlled trials have demonstrated that laparoscopic surgery is non-inferior to open surgery with regard to 5-year overall survival rate, disease-free survival rate and local recurrence rate. Its positive circumferential resection margin rate is controlled within 5% to 10%, and no significant difference is observed in the number of harvested lymph nodes.In terms of perioperative outcomes, the laparoscopic group achieves markedly reduced intraoperative blood loss (an average reduction of 50~100 ml), shortened postoperative hospital stay, and approximately 30%~50% lower wound infection rates. Nevertheless, its application remains challenging for special cases such as patients with a difficult pelvis (male gender, obesity, narrow pelvic cavity) and those with tissue fibrosis following neoadjuvant chemoradiotherapy. The conversion-to-laparotomy rate ranges from 5% to 15%. Moreover, the incidence of low anterior resection syndrome reaches as high as 60%~80%, and further prospective studies are required to verify its long-term functional preservation effects.