中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (10): 1188-1195.DOI: 10.19538/j.cjps.issn1005-2208.2023.10.25

• 讲座 • 上一篇    下一篇

基于膜解剖理论的全直肠系膜切除层面显露与筋膜辨识

白明瀚，孙凌宇，郑宏群，管贺龙，孙一铭   

  1. 哈尔滨医科大学附属第四医院肿瘤外科，黑龙江哈尔滨150000
  • 出版日期:2023-10-01 发布日期:2023-10-24

  • Online:2023-10-01 Published:2023-10-24

摘要： 外科解剖学由器官解剖、血管解剖，向膜解剖时代发展。膜解剖是系膜与系膜床的解剖，强调通过筋膜间的平面完整切除系膜。全直肠系膜切除（TME）是膜解剖手术的典范，是中低位直肠癌手术治疗的金标准。TME手术的总体要求是通过一定的解剖标志进入正确的手术游离层面，保证直肠系膜的完整、环周切缘阴性、保留泌尿及生殖功能等。术者应深入理解TME手术相关的膜解剖名词及解剖标志，术中准确辨识直肠系膜筋膜、腹下神经前筋膜、Denonvilliers筋膜、直肠骶骨筋膜等筋膜结构，建议遵循模块化手术原则、三角牵拉原则和“由点及线、由线及面”的切开原则，以提高腹腔镜TME手术质量。

关键词: 全直肠系膜切除, 膜解剖, 泌尿生殖筋膜, 直肠骶骨筋膜, Denonvilliers筋膜

Abstract: The method of exposing surgical anatomical plane and the identification of fascia structure in total mesorectal excision based on membrane anatomy theory        BAI Ming-han，SUN Ling-yu，ZHENG Hong-qun，et al. Department of Oncology，the Fourth Affiliated Hospital of Harbin Medical University，Harbin 150000，China
Corresponding author：SUN Ling-yu，E-mail：lingyu5758@163.com
Abstract    Surgical anatomy is evolving from organ anatomy and vascular anatomy to membrane  anatomy. Membrane anatomy involves the relationship between the mesentery and the mesentery bed. Complete excision of the mesentery through the plane between the fascia can be achieved based on the theory of membrane anatomy. Total mesorectal excision (TME) is a typical surgical procedure of membrane anatomy surgery and considered as the gold standard for surgical treatment of middle to low third rectal cancer. The general requirement of TME surgery is to dissect between the correct surgical layers through the identification of certain anatomical markers and ensure the integrity of the mesorectum，the negative circumferential margins，as well as the preservation of urinary and reproductive functions. In order to improve the quality of laparoscopic TME surgery, the surgeons should have a deep understanding of membrane anatomy terms and anatomical markers related to TME surgery, identify fascia structures accurately, and follow some principles during surgery, such as modular surgical principle, triangle drawing principle and dissecting “from point to line，from line to plane”.

Key words: total mesorectal excision, membrane anatomy, urogenital fascia, rectosacral fascia, Denonvilliers fascia