中国实用外科杂志

中国实用外科杂志

• 外科新技术 • 上一篇    下一篇

直肠癌经肛门全直肠系膜切除解剖层面及盆腔神经保护

申占龙1，叶颖江1，Sam Atallah2，谢启伟1，姜可伟1，王    杉1   

  1. 1 北京大学人民医院胃肠外科，北京 100044；2 Center for colon& rectal surgery，Florida hospital
  • 出版日期:2015-08-01 发布日期:2015-07-27

  • Online:2015-08-01 Published:2015-07-27

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摘要：

直肠癌经肛门全直肠系膜切除（taTME）是利用经肛门内镜显微手术（TEM）或经肛门微创手术（TAMIS）中“由下而上”的操作路径并遵守全直肠系膜切除（TME）原则的经肛门腔镜手术。taTME的最大优势之一是解决了既往TME对中下段直肠系膜周围间隙暴露不佳而造成的盆腔神经副损伤。taTME手术路径可以更直接地进入低位直肠系膜周围间隙，并清晰显露终末神经丛而进行保护。taTME在直肠中下段游离的解剖层面及盆腔神经易损伤区域，对增加taTME手术的安全性、降低盆腔神经损伤发生率和器官功能保护具有临床指导意义。

关键词: 经肛门全直肠系膜切除, 经肛门微创手术

Abstract:

Anatomic plane of transanal total mesorectal excision (taTME) for rectal cancer and the new perspective in the protection of pelvic nerves        SHEN Zhan-long*，YE Ying-jiang，Atallah Sam，et al. *Department of Gastroenterological Surgery，Peking University People’s Hospital，Beijing 100044，China
Corresponding author：YE Ying-jiang，E-mail：yeyingjiang@pkuph.edu.cn
Abstract    Transanal total mesorectal excision (taTME) for rectal cancer is a kind of minimally invasive surgery transanally from bottom to up based on the platform of TEM (total endoscopic microsurgery) and TAMIS (transanal minimally invasive surgery). taTME might solve the problem of the nerve injure due to the insufficient vision of lower part of mesorectum. taTME procedure can get into the peripheral space of lower mesorectum directly and protect pelvic nerves from injury. Understanding the risk area of pelvic nerve injury and anatomic plane of the lower part of rectum plays an important role in enhancing the surgical safety，protect the pelvic nerve injury and organic function during the taTME.

Key words: transanal total mesorectal excision, transanal minimally invasive surgery