卫氏线引导的保留邓氏筋膜直肠癌根治术(iTME)的实施标准及应用现状  

Operation standard and application status of radical rectal cancer resection with preservation of Denonvilliers’fascia(iTME)navigated with Wei’s Line

作　　者：方佳峰[1] 卫洪波[1] FANG Jiafeng;WEI Hongbo(Department of Gastrointestinal Surgery,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,P.R.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：《中国普外基础与临床杂志》2024年第5期518-522,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金项目(项目编号:81971378);广州市科技计划项目(项目编号:2024A03J0763);广东省自然科学基金项目(项目编号:2022A1515012653)。

摘　　要：自1982年,全直肠系膜切除术(total mesorectal excision,TME)理念被提出并开展后,直肠癌术后局部复发率显著下降,远期生存率提升,因此TME已成为中低位直肠癌手术的金标准。然而,TME术中盆腔自主神经损伤导致的术后排尿及性功能障碍发生率居高不下,亟需探明解决。笔者团队多年来经过解剖学、组织学、生理学等系统研究,证实TME术中在邓氏筋膜前方游离直肠前壁,并切除部分邓氏筋膜是神经损伤的根源;相反,TME术中在邓氏筋膜后方游离并完整保留邓氏筋膜是可行且必要的,并通过解剖学研究,首次发现邓氏筋膜术中标记线—卫氏线,率先提出了卫氏线引导的保留邓氏筋膜直肠癌根治术(innovative TME,iTME)。通过开展多中心临床研究,证实与传统TME手术相比,iTME患者术后排尿及性功能障碍率显著下降,且肿瘤学指标无差异,提示对特定分期的中低位男性直肠癌患者,iTME手术是更优的选择。本文系统性回顾了iTME的研究历程及实施标准,并对iTME的应用现状及未来作一总结展望。Since the concept of total mesorectal excision(TME)was proposed and carried out in 1982,the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased,thus TME has become the gold standard for middle and low rectal cancer surgery.However,the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high,which needs to be investigated and solved.Over the years,through systematic studies of anatomy,histology and physiology,we have confirmed that dissection anterior to Denonvilliers’fascia for the anterior wall of rectum,and thus partial resection of Denonvilliers’fascia,were the leading cause of nerve injury during TME operation.On the contrary,dissection posterior to Denonvilliers’fascia and entire preservation of Denonvilliers’fascia are feasible and necessary.Moreover,through anatomical study,Wei’s Line,the surgical marker line of Denonvilliers’fascia is discovered for the first time,and thus innovative TME(iTME)navigated with Wei’s Line is proposed.The multi-center clinical study has confirmed that compared with traditional TME surgery,the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly,with comparable oncologic outcomes,suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages.This study systematically reviews the research process and operation standard of iTME,and summarizes the application status and future prospects of iTME.

关 键 词：卫氏线 邓氏筋膜 保留邓氏筋膜直肠癌根治术 直肠恶性肿瘤 泌尿生殖功能 

分 类 号：R73[医药卫生—肿瘤]