直肠全系膜切除术的前方切除平面

【摘 要】目的 探讨直肠全系膜切除术前方合理的切除平面。 方法 上海交通大学医学院附属瑞金医院对24具尸体的盆腔进行解剖。结果 Denonvilliers筋膜的厚度变化明显，其与精囊的结合比与直肠的结合更为紧密。Denonvilliers筋膜的两侧与盆丛相邻，在5(5/12)具男性尸体中， Denonvilliers筋膜前方有两侧盆丛的交通支。结论 对于非直肠前方的肿瘤，可以采取Denonvilliers筋膜后方的切除平面，以减少自主神经功能损伤。

Anterior plane of rectal mobilization in total mosorectal excision

Anterior plane of rectal mobilization in total mosorectal excision LIN Mou-bin*, YIN Lu, CHEN Wei-guo, et al. *Department of Surgery, Ruijin Hospital, Medical School of Shanghai Jiaotong University , Shanghai 200025,China. Corresponding author: Yin Lu, E-mail:yindalu@yahoo.com.cn Abstract Objective To clarify the appropriate anterior plane in total mesorectal excision. Methods 24 pelvises harvested from embalmed cadavers were studied by dissection in Shanghai Jiaotong University School of Medicine. Results The appearance of Denonvilliers’ fascia varies considerably. Denonvilliers’ fascia was more closely applied to the seminal vesicles than the rectum. Denonvilliers’ fascia ends at the pelvic plexus, and in some cases, the communicating branches of bilateral pelvic plexuses run in front of Denonvilliers’ fascia. Conclusion In circumstances in which the anterior circumferential margin is not threatened, the appropriate anterior plane is behind Denonvilliers’ fascia for reliable preservation of autonomic nerves.