直肠全系膜切除术中安全平面的解剖学观察  

Anatomical observation of the ＇holy plane＇ for total mesorectal excision

作　　者：王世栋[1] 邓雪飞[1] 韩卉[1] 常家聪[2] 曹先东[2] 张铭 

机构地区：[1]安徽医科大学人体解剖学教研室,合肥230032 [2]安徽医科大学第一附属医院胃肠外科 [3]新西兰Otago大学解剖与结构生物系

出　　处：《中华胃肠外科杂志》2011年第1期44-47,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 明确直肠固有筋膜与周围结构的关系,寻找无血管、神经的间隙,为直肠全系膜切除术中＂安全平面＂的选择提供解剖学依据.方法 选择26例10%甲醛固定的成年男性盆腔标本进行研究,20例沿正中切开行局部解剖观察,6例行断层解剖观察.结果 直肠固有筋膜腹侧与Denonvilliers筋膜相邻,共同构成直肠膀胱隔,两者之间为无血管、神经的潜在间隙.直肠固有筋膜背侧与骶前筋膜水平走行,构成无血管、神经的骶前间隙,此间隙解剖变异较大,16例（80%）标本筋膜间隙明显,内有板层状直肠骶骨韧带走行（分层型） 4例（20%）无筋膜间隙,由肌肉样组织填充或骶前筋膜融合、增厚（融合型）.直肠固有筋膜外侧与盆腔壁层筋膜构成直肠外侧间隙,间隙内可见直肠侧韧带和盆腔神经丛,依据神经丛与直肠固有筋膜的关系分为紧密融合型（17例,85%）和疏松连接型（3例,15%）.结论 直肠腹侧的＂安全平面＂介于直肠固有筋膜与Denonvilliers筋膜之间,后外侧位于直肠固有筋膜与壁层筋膜之间.Objective To provide anatomic evidence for identification of ＂holy plane＂ between fascia propria and its adjacent fascias in total mesorectal excision. Methods A total of 26 pelvic specimens of adult male preserved in 10% formalin solution were used in this study. Twenty pelvises were employed for topographic anatomy, six for sectional anatomy. Results Rectovesical septum was formed by the ventral part of the fascia propria and Denonvilliers＇ fascia, with no blood vessel and nerve coursed between two layers. Dorsal part of the fascia propria parallelled with the presacral fascia,with no blood vessel and nerve coursed between two layers in 80% of the pelvises. However, anatomic variations was encountered occasionally--with muscle-like tissue or fusion of presacral fascia interposed between them for 20%. The lateral space of rectum was between lateral part of the fascia propria and parietal fascia which witnessed pelvic nerve plexus and lateral ligament of the rectum traveling. Pelvic nerve plexus was categorized as two types according the relation between fascia propria and nerve plexus：fusion type accounting for 85% and rarefaction type for 15%. Conclusion ＇Holy plane＇ is sandwiched between the fascia propria and its adjacent fascia-ventrally Denonvilliers fascia,dorsally presacral fascia and laterally parietal fascia.

关 键 词：直肠固有筋膜 直肠全系膜切除术 安全平面 局部解剖 断层解剖 

分 类 号：R735.37[医药卫生—肿瘤]