基于膜解剖理论的直肠癌侧方淋巴结清扫术的应用解剖分析  

Applied anatomy of lateral lymph node dissection for rectal cancer based on the theory of fascia anatomy

作　　者：刘海龙 王加琪 林谋斌 Liu Hailong;Wang Jiaqi;Lin Moubin(Department of General Surgery,Yangpu Hospital,Tongji University,Shanghai 200090,China;Institute of Gastrointestinal Surgery and Translational Medicine,School of Medicine,Tongji University,Shanghai 200090,China)

机构地区：[1]同济大学附属杨浦医院普通外科,上海200090 [2]同济大学医学院胃肠外科和转化医学研究所,上海200090

出　　处：《结直肠肛门外科》2023年第1期27-32,共6页Journal of Colorectal & Anal Surgery

基　　金：上海市医学创新研究专项(20Y11908300);上海市卫生健康委员会卫生行业临床研究专项(202040122)。

摘　　要：直肠癌侧方淋巴结清扫术因手术风险大、并发症多,其在临床的开展一直饱受争议。本文基于盆腔“四筋膜、三间隙”理论,从整体认识的角度阐述手术所涉及的相关筋膜的解剖学定义,指出神经、血管与筋膜及间隙的解剖学关系,进而依据膜→间隙(层次)的手术方法提出侧方淋巴结清扫的模式化操作流程。从膜解剖的角度理解侧方淋巴结清扫术的解剖学基础,准确定位神经、血管并进行模式化手术操作,可以简化手术操作、减少功能损伤,有助于推动直肠癌侧方淋巴结清扫术在临床的开展。Lateral lymph node dissection(LLND) is a controversial operation due to the complexity of this procedure and the complications it induces. Based on the theory of “four fasciae & three spaces” of pelvic, we demonstrate the anatomical definition of operation-related fasciae in terms of integrity, clarify the anatomical relationship between nerves and vessels with fasciae and spaces, and standardize the operation procedure of LLND according to the fascia-to-space surgical approach. Understanding the anatomical basis of LLND from the perspective of fascia anatomy, locating the nerves and vessels precisely, and carrying out modular operation procedure could simplify operation and reduce functional injury, which helps to promote the development of LLND for rectal cancer in clinical practice.

关 键 词：直肠癌 侧方淋巴结清扫术 膜解剖 模式化手术操作 

分 类 号：R735.37[医药卫生—肿瘤]