从盆腔筋膜的外科解剖来理解直肠全系膜切除术的层次  

Understanding the planes of total mesorectal excision through surgical anatomy of pelvic fascia

作　　者：林谋斌[1] 金志明[1] 尹路[1] 丁文龙[2] 陈伟国[1] 倪俊声[1] 朱正纲[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科,200025 [2]上海交通大学医学院解剖教研室

出　　处：《中华胃肠外科杂志》2008年第4期308-311,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市科委基金资助项目（074119602）

摘　　要：目的探讨直肠系膜与盆腔筋膜和神经的关系，以明确直肠全系膜切除术合理的切除平面。方法对24具尸体的盆腔进行解剖。结果直肠周围的层次是连续的，可以分为2段3层，2段指耻骨联合至坐骨棘和坐骨棘至骶岬；3层分别为脏筋膜、膀胱腹下筋膜和壁筋膜。在膀胱腹下筋膜与脏筋膜之间存在盆丛及其膀胱、子宫神经分支，而在脏、壁筋膜之间存在腹下神经和盆内脏神经。结论直肠全系膜切除术的层次在直肠后方为脏、壁筋膜之间，而在直肠侧方实际上位于脏筋膜和膀胱腹下筋膜之间。侧后方的腹下神经、侧前方的盆丛及其分支是正确层次的标记。Objective To study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision. Methods Twenty-four pelvises （12 males and 12 females） harvested from cadavers were studied by dissection. Results There were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastrie fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia. Conclusions The posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastxic fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

关 键 词：直肠 盆腔 应用解剖 直肠全系膜切除 筋膜 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R657.1[医药卫生—基础医学]