Denonvilliers筋膜的应用解剖学研究  

The anatomical study on Denonvilliers＆#39; fascia and its implication in rectal surgery

作　　者：严雪冰 彭佳远[2] 朱庆超[2] 尹路[3] 林谋斌[3] 金志明[2] 

机构地区：[1]苏州大学第一附属医院普外科,江苏省215006 [2] 上海交通大学附属第六人民医院普外科 [3] 上海交通大学附属瑞金医院普外科

出　　处：《中华普通外科杂志》2014年第2期108-111,共4页Chinese Journal of General Surgery

基　　金：上海科学技术委员会基金资助项目（124119a7202）

摘　　要：目的 明确Denonvilliers筋膜的局部解剖学特点,探讨其对于直肠癌手术的意义.方法 选择30例成人骨盆标本（男17例,女13例）从正中矢状面切开并进行局部解剖,取Denonvilliers筋膜进行免疫组织化学检查. 结果 所有男性标本均可以见到Denonvilliers筋膜,分前后两叶,前叶紧贴膀胱底部、精囊腺、输精管和前列腺.Denonvilliers筋膜顶部起于膀胱直肠凹腹膜返折处,向下止于盆膈的会阴筋膜,向两侧消失融合于盆壁筋膜.所有女性标本均未明确见到此筋膜,只是在阴道直肠沟内可以解剖出一层薄且透明的膜样结构.男性标本左侧骨盆Denonvilliers筋膜最大高度（3.2±0.3） cm,右侧骨盆Denonvilliers筋膜最大高度（3.3±0.3）cm,左右两侧比较差异无统计学意义（t =0.965,P＞0.05）.Denonvilliers筋膜中未见淋巴结,中央部分极少有神经分布,而其两侧分布了较密集的神经.结论 熟悉Denonvilliers筋膜中特殊的解剖学和病理学特点对临床直肠手术中减少神经损伤具有指导意义.Objective To clarify the anatomical and pathlogical implications of Denonvilliers＆#39; fascia.Method In this study,thirty pelvic specimens （17 males and 13 females） were incised through the median sagittal plane and carried for regional anatomy study; Denonvilliers＆#39; fascia was identified by immunohistochemistry.Results Denonvilliers＆#39; fascia could be found in all male specimens：it had an anterior leaf and a posterior leaf,with the anterior one attaching to seminal vesicle,seminiferous duct,prostate and the bottom of bladder firmly.The fascia originated at the fold of the peritoneum and ended at the perineum fascia,fusing into the pelvic parietal fascia laterally.It was not obvious in females,only to find a thin and transparent membrane between vagina and rectum.The maximum height of Denonvilliers＆#39; fascia in left pelvis was （3.2 ± 0.3） cm,compared with （3.3 ± 0.3） cm in the right pelvis （t =0.965,P 〉 0.05）.Immunohistochemistry study revealed that there was no lymph node in the fascia and its lateral parts were enriched of nerve fibers,which were few in its middle part.Conclusions The unique anatomical and pathlogical characteristics of Denonvilliers＆#39; fascia are of vital importance to the avoidance of nerve injury during rectal surgery.

关 键 词：筋膜 解剖学 局部 结直肠外科手术 创伤 神经系统 

分 类 号：R735.37[医药卫生—肿瘤] R322[医药卫生—临床医学]