直肠系膜的形态学特点及其临床意义

目的：以直肠系膜为中心，探讨直肠癌手术切除术的最佳的解剖层次。方法：应用尸体标本27例、新鲜尸体标本10例、临床取材标本10例，分别进行解剖、测量及灌注。结果：直肠系膜是由直肠周围包裹在盆脏筋膜周围之内的脂肪组织、神经、血管、淋巴管等组成。直肠系膜上端与乙状结肠系膜相连续，下端与直肠肛管相连接，盆腔内的生殖管道，髂内血管，盆自主神经及盆腔侧壁的肌肉均为壁层筋膜覆盖，外面是一层光滑的盆脏筋膜，长8～10cm，宽6～8cm，直视下清晰可见脂肪、毛细血管等。结论：直肠系膜是被盆筋膜脏层完整地包裹着的脂肪、血管和淋巴即称为直肠系膜，是一独立的解剖单位；从常规病理可见直肠系膜是由脂肪、血管和淋巴组织组成；MRI及VCH上直肠系膜清晰可见。

Morphologic features and clinical application of mesorectum

Objective: To study the characteristics of mesoretum and explore optimal anatomic layers of it during the excision of rectal cancer. Methods: 27 antiseptic, 10 fresh, and 10 biopsy specimens of pelvic cavity were collected, perfused and performed anatomic observation and measurement. Results: Mesorectum consisted of adipose tissues surrounding visceral pelvic fascia which including numerous nerves, veins and lymph vessels. The upper part of it was continuous with mesentery of sigmoid colon, and the lower part with anal canal. In addition, visceral pelvic fascia covered the genital organs, internal iliac artery and vein, pelvic nerves, and the muscles pf pelvic wall respectively. The surface of mesorectum was smooth, with the length of 8~10 cm, the width of 6~8 cm. The fat tissues and blood capillaries of mesorectum can be identified easily. Conclusions: Mesorectum, as a part of visceral pelvic fascia, consists of adipose tissue, blood vessels and lymph vessels. It is an independent anatomic structure, and easy to be identify under MRI, or VCH.