三角分离模型在腹腔镜下直肠癌根治手术解剖层面显露中的应用  

Application of Triangle Separation Model in Anatomical Exposure of Laparoscopic Radical Resection of Rectal Cancer

作　　者：王伟 黄亮 WANG Wei;HUANG Liang(Department of General Surgery,Linyi Cancer Hospital,Linyi 276000,China;Department of Colorectal and Anal Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510600,China)

机构地区：[1]山东省临沂市肿瘤医院普通外科,山东临沂276000 [2]中山大学附属第六医院结直肠肛门外科,广州510600

出　　处：《南昌大学学报（医学版）》2023年第2期74-79,共6页Journal of Nanchang University：Medical Sciences

摘　　要：直肠癌全系膜切除术(total mesorectal excision,TME)手术的关键是识别并进入Toldt间隙,手术全程需维持在该间隙中。文章提出的“三角分离模型”是将受到牵拉的Toldt间隙视为立体结构,正确识别手术过程中Toldt间隙的不断变化的分离点,由点到线,由线到面,沿着正确的手术平面进行分离操作。文章以行腹腔镜下直肠癌根治术(Dixon)的49岁女性直肠癌患者为例,术中根据该模型选择手术入路进入Toldt间隙,完成直肠周围各层筋膜分离,顺利完成手术。该模型不仅能简化手术操作,便于青年医师学习和掌握,还能最大程度地降低系膜残留,减少直肠周围血管、神经、输尿管等损伤的机会,最终提高TME的手术质量。The key of total mesorectal resection(TME)for rectal cancer is to identify and enter the Toldt space,in which the operation should be maintained throughout the surgical process.The“triangle separation model”proposed in this paper is to regard the pulled Toldt space as a three-dimensional structure,which can correctly distinguish the dynamic changes of the space and separate it from a point to a line and from a line to a plane during the operation.The article took a 49-year-old female rectal cancer patient who underwent laparoscopic radical resection of rectal cancer(Dixon)as an example.According to the model,the operation was successfully completed by selecting the right surgical approach to enter the correct Toldt space and separating all layers of fascia around the rectum.The model can simplify surgical operation,easily to be learned and mastered by young surgeons,minimize the mesenteric residues,reduce the chance of injury of blood vessels,nerves and ureters around the rectum,and improve the quality of TME surgery.

关 键 词：直肠癌根治手术 三角分离模型 腹腔镜 

分 类 号：R735.34[医药卫生—肿瘤]