邓氏筋膜解剖的研究现状及其在直肠癌手术神经保护中的意义  

Anatomy research on Denonvilliers fascia and its significance in nerve-preservation rectal cancer surgery

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 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》2021年第4期301-305,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81971378、81901471);中山大学5010项目(2015016);广州市科技计划珠江新星项目(201806010007)。

摘　　要：术中盆腔自主神经损伤导致的排尿及性功能障碍,已成为直肠癌手术最常见的并发症,严重影响患者术后生活质量。如何在保证直肠癌手术根治性的基础上,最大程度保护神经及术后泌尿生殖功能,成为近年来研究的焦点。笔者对与盆腔自主神经保护关系密切的重要解剖结构——邓氏筋膜开展了一系列系统研究,从解剖、生理、组织、手术实践等多方面,阐明了邓氏筋膜对直肠癌术中盆腔自主神经及术后泌尿生殖功能保护的重要作用。同时,基于开展的大型多中心随机对照研究中期结果,本团队证实,保留邓氏筋膜的创新全直肠系膜切除术(iTME)能在不牺牲肿瘤根治性的前提下,有效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。在此,我们对国内外关于邓氏筋膜解剖的研究进展作文献复习,并结合我们的研究成果,阐述邓氏筋膜在直肠癌手术神经保护中的意义及研究前景。Urinary and sexual dysfunctions due to intraoperative pelvic autonomic nerve injury have become the most common complications of rectal cancer surgery,seriously affecting postoperative quality of life.How to protect the nerve and urogenital function while ensuring radical resection for rectal cancer has become the focus of research.We previously carried out a series of systematic studies on Denonvilliers fascia,an important anatomical structure closely related to protection of pelvic autonomic nerve,and demonstrated the importance of Denonvilliers fascia in preservation of intraoperative pelvic autonomic nerve and protection of postoperative urogenital function from aspects of anatomy,physiology,tissue,operation practice and so on.Meanwhile,based on the interim results of our multicenter randomized controlled study,we confirmed that total mesorectal excision with preservation of Denonvilliers fascia(innovative TME,iTME)could effectively reduce the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer,without sacrificing oncologic outcome.In this article,combined with our research results,we review the literature on anatomy research progress of Denonvilliers fascia to demonstrate the significance and research prospect of Denonvilliers fascia in the pelvic autonomic nerve preservation surgery for rectal cancer.

关 键 词：直肠肿瘤 邓氏筋膜 盆腔自主神经 保留邓氏筋膜的创新全直肠系膜切除术(iTME) 排尿功能障碍 性功能障碍 

分 类 号：R735.37[医药卫生—肿瘤] R322.45[医药卫生—临床医学]