腹腔镜低位直肠癌手术全程膜解剖理论基础与操作难点  

The oretical basis and operative difficulties of whole-course membrane anatomy in laparoscopic low rectal cancer surgery

作　　者：施赟杰 王颢 Shi Yunjie;Wang Hao(Department of Anorectal Surgery,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院肛肠外科,上海200433

出　　处：《结直肠肛门外科》2024年第2期142-146,共5页Journal of Colorectal & Anal Surgery

基　　金：上海申康医院发展中心第二轮《促进市级医院临床技能与临床创新三年行动计划》研究型医师创新转化能力培训项目(SHDC2023CRD023)。

摘　　要：直肠全系膜切除(total mesorectal excision,TME)是腹腔镜低位直肠癌手术中必须遵循的“金标准”。遵循“膜解剖”的手术理念是实现低位直肠癌TME的基础。笔者团队提倡低位直肠癌“全程膜解剖分离”,手术游离始终保持在器官脏、壁筋膜之间的“神圣平面”中进行,确保手术的规范与根治性。遵循“全程膜解剖分离”原则,可以减少术中和术后并发症的发生,并且保证肿瘤根治效果。本文就腹腔镜低位直肠癌手术中253组淋巴结的清扫、结肠脾曲游离、直肠周围间隙的膜解剖与神经保护、超低位直肠癌极限保肛术式及其他手术相关问题进行探讨。Total mesorectal excision(TME)is the“golden standard”that must be followed in laparoscopic surgery for low rectal cancer.Adhering to the surgical concept of“membrane anatomy”is the foundation for achieving TME in low rectal cancer.Our team advocates the surgical separation of“whole-course membrane anatomy”for low rectal cancer,with the surgical dissection always maintained in the“holy plane”between the visceral and parietal fasciae of the organs,which ensures the standardization and radicality of the surgery.Following the principle of“whole-course membrane anatomy”surgical separation can reduce intraoperative and postoperative complications and ensure the effect of tumor radical resection.This article discusses hotspots and difficulties such as the dissection of 253 lymph node groups,freedom of the splenic flexure of the colon,membrane anatomy and nerve protection in the perirectal space,extreme sphincter-preserving surgery for very low rectal cancer,and other surgical related issues that require special attention during surgery in laparoscopic low rectal cancer surgery.

关 键 词：直肠癌 直肠全系膜切除 膜解剖 

分 类 号：R735.3[医药卫生—肿瘤]