基于膜解剖理念的保留邓氏筋膜全直肠系膜切除术  

Total mesorectal excision with preservation of Denonvilliers'fascia(iTME)based on membrane anatomy

作　　者：卫洪波[1] 方佳峰[1] Wei Hongbo;Fang Jiafeng(Department of Gastrointestinal Surgery,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510630,China)

机构地区：[1]中山大学附属第三医院胃肠外科,广州510630

出　　处：《中华胃肠外科杂志》2020年第7期666-669,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：中山大学5010项目(2015016);吴阶平医学基金会临床科研专项资助基金(320.2710.1808);教育部高校基本科研业务费(18ykpy04)。

摘　　要：全直肠系膜切除术(TME)成为中低位直肠癌手术的金标准已近30年,然而因TME术中神经损伤导致的术后排尿及性功能障碍至今仍未得到明显改善。基于膜解剖的理念,我们对直肠前方的重要膜解剖结构——邓氏筋膜进行了细致而系统的研究,从解剖、生理、组织、手术实践等多方面,验证了保留邓氏筋膜对TME术中神经保护及术后排尿和性功能障碍预防的重要作用;并通过邓氏筋膜术中标记线及手术入路的解剖研究,明确了保留邓氏筋膜全直肠系膜切除术(iTME)的可操作性。据此,我们开展了一项大型多中心随机对照研究,中期研究结果显示,与传统TME相比,iTME在不影响短期肿瘤根治效果的前提下,能更好地降低男性中低位直肠癌患者术后排尿及性功能障碍发生率。我们相信,基于膜解剖的iTME随机对照试验最终研究成果,将为直肠癌手术理念的更新提供夯实的循证医学证据。Total mesorectal excision(TME)has been advocated as the golden standard of mid-low rectal cancer surgery for nearly 30 years.However,the complication of postoperative urinary and sexual dysfunctions due to intraoperative nerve injury has yet to be improved.Based on the concept of membrane anatomy,we carried out a systematic study on the important membrane anatomical structure anterior to the rectum--Denonvilliers'fascia.From multiple aspects including anatomy,physiology,histochemistry and surgical practice,we verified the importance of Denonvilliers'fascia for TME surgery in prevention of intraoperative nerve injury and postoperative urogenital dysfunction.Moreover,based on anatomical study of the surgical marker line of Denonvilliers'fascia(Wei's line)and surgical plane,we proved that total mesorectal excision with preservation of Denonvilliers'fascia(iTME)was feasible and practical.Therefore,we conducted a large multicentric randomized controlled trial(RCT).The mid-term result demonstrated that compared with traditional TME surgery,iTME was more effective in reducing the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer,without sacrifice of short-term tumor radical outcome.We believe that the final RCT result of iTME,based on membrane anatomy,will provide solid evidence for the update of concepts of rectal cancer surgery.

关 键 词：膜解剖 邓氏筋膜 保留 全直肠系膜切除术 随机对照试验 

分 类 号：R735.37[医药卫生—肿瘤]