括约肌间切除术的病理和功能学解剖基础  

Pathologic and functional anatomy basis of intersphincteric resection

作　　者：臧怡雯[1] 项建斌[1] Zang Yiwen;Xiang Jianbin(Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]复旦大学附属华山医院普通外科,上海200040

出　　处：《中华胃肠外科杂志》2019年第10期937-942,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：直肠肛门周围区域是一个相对复杂的盆底结构,其精准解剖是低位直肠癌括约肌间切除术(ISR)的基础和前提。随着盆底外科学和微创手术的发展,我们可以更全面地认识ISR手术的解剖入路、手术层次、切除范围以及重建策略,在遵循根治性切除肿瘤原则的同时,最大程度保留完整的肛门功能,尤其对括约肌间隙和联合纵肌结构的深入理解,有助于ISR手术中在肛管复合体更精准地游离操作。然而,由于肛门直肠区域解剖学尚存争议,笔者通过文献复习并结合团队临床实践经验和应用解剖学体会,对ISR手术相关解剖学结构,包括直肠周围筋膜、直肠尿道肌、肛尾韧带和Hiatal韧带、肛提肌、内括约肌与内括约肌神经、外括约肌、联合纵肌、以及括约肌间隙与手术入路选择等方面进行阐述,希冀提高ISR手术的肿瘤学和功能学疗效。The anorectum is a complex region, whose anatomic structure is the basis and premise of intersphincteric resection (ISR) for low rectal cancer. With the development of pelvic surgery and minimally invasive surgery, the anatomic approaches, surgical planes, extent of excision and reconstruction strategies of ISR have been better understood. Surgeons can furthest preserve anal function as well as adhere to the principles of radical resection. However, the anatomy of the anorectum has not been fully understood. We hope further exploration of the anal canal anatomy, including the perirectal fascia, rectourethral muscle, anococcygeal ligament, hiatal ligament, levator ani muscle, internal and externals phincter, intersphincteric nerves, conjointed longitudinal muscle, intersphincteric spaces and the surgical approaches, by reviewing relevant literatures combined with the experiences of our clinical practice and applied anatomy, will help to improve the accuracy of the surgeries and increase the oncologic and functional outcomes of ISR.

关 键 词：直肠肿瘤 低位 括约肌间切除术 应用解剖 

分 类 号：R735[医药卫生—肿瘤]