基于膜解剖理念的直肠癌根治手术新分型  

Classification system of radical surgery for rectal cancer based on membrane anatomy

作　　者：李阿建 王加琪 刘海龙 林谋斌 Li Ajian;Wang Jiaqi;Liu Hailong;Lin Moubin(Department of General Surgery,Yangpu Hospital of Tongji University,Shanghai 200090,China;Institute of Gastrointestinal Surgery and Translational Medicine,Tongji University School of Medicine,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：《中华胃肠外科杂志》2023年第7期625-632,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(81874201);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：目前的直肠癌根治手术尚没有建立分型体系,不能依据肿瘤的临床分期选择相应的手术方式,因而难以达到个体化治疗的目的。本文基于盆腔膜解剖的“四筋膜、三间隙”理论,并结合该理论和宫颈癌根治术Querleu-Morrow分型的膜解剖基础,依据直肠侧方的切除范围,提出了基于膜解剖的直肠癌根治手术新分型,将直肠癌根治术分为ABCD四型,并依据自主神经的保留与否增加了相应的亚型。其中A型为保留泌尿生殖筋膜的全直肠系膜切除(TME)、B型为经典TME,C型为扩大TME,D型为侧方扩大切除术。本直肠癌根治手术分型统一了盆腔膜解剖名词,验证了利用“四筋膜、三间隙”理论对直肠癌手术进行分型的可行性,旨在为今后制定统一规范的盆腔肿瘤根治手术分型体系奠定理论基础。Because the classification system of radical surgery for rectal cancer has not been established,it is impossible to select the appropriate surgical method according to the clinical stage of the tumor.In this paper,we explained the theory of"four fasciae and three spaces"of pelvic membrane anatomy and then combined this theory with the membrane anatomical basis of Querleu-Morrow classification for radical cervical cancer resection.Based on this theory and the membrane anatomy of Querleu-Morrow classification of radical cervical cancer resection,we proposed a new classification system of radical rectal cancer surgery based on membrane anatomy according to the lateral lymph node dissection range of the rectum.This system classifies the surgery into four types(ABCD)and defines corresponding subtypes based on whether the autonomic nerve was preserved.Among them,type A surgery is total mesorectal excision(TME)with urogenital fascia preservation,type B surgery is classical TME,type C surgery is extended TME,and type D surgery is lateral extended resection.This classification system unifies the anatomical terminology of the pelvic membrane,validates the feasibility of using the"four fasciae and three fascial spaces"theory to classify rectal cancer surgery,and lays the theoretical foundation for the future development of a unified and standardized classification of radical pelvic tumor surgery.

关 键 词：直肠肿瘤 根治术 分型 新 解剖 膜解剖 

分 类 号：R735.37[医药卫生—肿瘤]