直肠系膜结构解剖和腔镜下观察的对比研究  

A Comparative Study of Laparoscopic Appearance and Anatomy of Mesorectum in Normal Males

作　　者：黄江龙[1] 郑宗珩[1] 卫洪波[1] 方佳峰[1] 张实[1] 陈羽青[1] 

机构地区：[1]中山大学附属第三医院胃肠外科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2014年第3期407-411,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金重点项目(10251008901000011);广东省医学科研基金(B2013127);广州市科技计划项目(2011J4100105)

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。[Objective] To futher understand of the anatomical basis of total mesorectal excision,by comparative study of the laparoscopic appearance and the anatomic characteristic of mesorectum,denonvilliers fascia,lateral rectal ligament and surrounding tissues of mesorectum.[Methods] Autopsy of 5 specimens of adult males were performed.Meanwhile,10 cases of videos of laparoscopic TME for rectal cancer were observed and studied.[Results] The rectum was surrounded by a layer of pelvic fascia which contains 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 pelvic visceral fascia and parietal fascia,especially obvious behind rectum.In either lateral side of the lower part of the rectum,there were constant dense connective bundles which was lateral ligament of the rectum.The constant component of the lateral ligament of the rectum was the rectal branches from the pelvic plexus,running between rectal visceral fascia and pelvic parietal fascia.Denonvilliers fascia was located in front of rectum and surrounded proper fascia of rectum.[Conclusions] The optimal surgical plane for TME should be the layer of avascular connective tissue except where it is crossed by the lateral ligament.Sharp dissection should be performed by pursuing the outer surface of the mesorectum in order to maintain the integrity of mesorectum,radical effect of resection and nerve preservation.

关 键 词：直肠系膜 解剖 全直肠系膜切除术 对比研究 

分 类 号：R735.37[医药卫生—肿瘤]