低位直肠癌根治术中Denonvilliers筋膜切除的争议

结直肠癌是人类消化系统常见的恶性肿瘤之一,严重威胁着人类的身体健康,其治疗措施仍是以外科为主的综合治疗。然而结直肠癌术后出现的排尿和性功能障碍发生率一直居高不下,严重影响了病人术后的生活质量。目前外科学界对于直肠前方手术层面Denonvilliers筋膜保留与否仍存在争议。该文就直肠癌术中Denonvilliers筋膜保留的必要性依据进行详细阐述,并就如何完成保留Denonvilliers筋膜直肠癌根治术进行详细讲解。笔者认为:Denonvilliers筋膜是独立的解剖学结构,其周围具有丰富的神经丛,一旦切除该筋膜易造成排尿和性功能障碍,因此不应在直肠癌根治术中进行一并切除。该筋膜的后方存在较为稀疏的结缔组织间隙,该间隙与直肠后间隙相贯通,沿此间隙进行手术更符合全直肠系膜切除的手术原则。然而对于直肠前壁肿瘤病人,或肿瘤已侵直肠前方系膜时,Denonvilliers筋膜应一并切除以保证手术的根治性。

Controversy on Denonvilliers fascia preserving necessity in mid-low rectal cancer

Colorectal cancer is one of the most common malignant tumors in human digestive system,which poses a serious threat to human health.However,the incidence of urinary and sexual dysfunction after colorectal cancer surgery is still high,which seriously affects the quality of life.At present,there are still controversies in nessesity of Denonvilliers preservation.This article elaborates on the necessity basis of Denonvilliers fascia preservation during rectal cancer surgery,and explains in detail how to complete Denonvilliers fascia-sparing radical resection of rectal cancer.We believe that Denonvilliers fascia is an independent anatomical structure with rich nerve plexus around it.Once this fascia is removed,it is easy to cause urination and sexual dysfunction,so it is removed together in radical resection of rectal cancer.There is a sparse connective tissue space behind this fascia,which communicates with the retrorectal space,and surgery along this space is more in line with the surgical principles of TME.However,for patients with anterior rectal wall tumors,or when the tumor has invaded the anterior rectum,Denonvilliers fascia should be removed together to ensure the radicality of the operation.