纸质出版日期:2014,
网络出版日期:2014-6-20,
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直肠系膜结构解剖和腔镜下观察的对比研究[J]. 中山大学学报(医学科学版), 2014,35(3).
A Comparative Study of Laparoscopic Appearance and Anatomy of Mesorectum in Normal Males[J]. Journal of Sun Yat-sen University (Medical Sciences), 2014,35(3).
摘 要: 【目的】 通过尸体解剖和手术录像对比研究直肠系膜、Denonvilliers筋膜、直肠侧韧带、直肠系膜周围间隙等结构的解剖特点,进一步了解全直肠系膜切除(TME)解剖根据。【方法】对5具成人男性尸体标本,进行解剖;复习我科腹腔镜全直肠系膜切除治疗的10例中低位直肠癌男性患者手术录像资料。进行尸体和腔镜下直肠系膜结构的对比研究。 【结果】盆脏筋膜包绕直肠周围脂肪结缔组织、淋巴组织、供应直肠血管回流血管和神经等形成直肠系膜。而盆脏筋膜与盆壁筋膜之间有层疏松结缔组织,在直肠后方明显。直肠侧方盆腔自主神经分支形成致密类筋膜结构———侧韧带,而直肠前方位于Denonvilliers筋膜的后方,呈环周状包绕直肠的固有筋膜。【结论】大多数情况下,除了侧方的侧韧带,行TME正确的层面是无血管的疏松结缔组织层。游离过程应紧贴直肠系膜,保证系膜完整性,减少盆腔自主神经损伤。
Abstract: 【Objective】 To futher understand of the anatomical basis of totalmesorectal excision, by comparative study of the laparoscopic appearance and theanatomic characteristic of mesorectum, denonvilliers fascia, lateral rectal ligament and surroundingtissues of mesorectum. 【Methods】 Autopsy of 5 specimens of adult males were performed.Meanwhile, 10 cases of videos of laparoscopic TME for rectal cancer were observedand studied. 【Results】 The rectum was surrounded by a layer of pelvic fascia whichcontains the blood vessels, draining lymph vessels, and the lymph node of the rectum.This was referred to as the mesorectum. There was loose mesh structure between pelvicvisceral fascia and parietal fascia, especially obvious behind rectum. In eitherlateral side of the lower part of the rectum, there were constant dense connectivebundles which was lateral ligament of the rectum. The constant component of thelateral ligament of the rectum was the rectal branches from the pelvic plexus, runningbetween rectal visceral fascia and pelvic parietal fascia. Denonvilliers fasciawas located in front of rectum and surrounded proper fascia of rectum. 【Conclusions】Theoptimal surgical plane for TME should be the layer of avascular connective tissueexcept where it is crossed by the lateral ligament. Sharp dissection should be performedby pursuing the outer surface of the mesorectum in order to maintain the integrityof mesorectum, radical effect of resection and nerve preservation.
直肠系膜解剖全直肠系膜切除术对比研究
mesorectumanatomyTMEcomparative study
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