保留部分Denonvilliers筋膜的全直肠系膜切除术:肿瘤学和功能学的平衡

直肠前间隙的分离是全直肠系膜切除术(TME)的难点,原因是完整保留Denonvilliers筋膜难以保证直肠前方固有筋膜的完整;不保留Denonvilliers筋膜,又可能伤及血管神经束。如何解决此矛盾是当前直肠癌手术的难点与重点。近年来,膜解剖理念的兴起与发展,为研究者认识并设计最佳手术径路提供新视角。笔者重点论述Denonvilliers筋膜膜解剖的研究进展,并结合笔者中心的研究结果,探讨保留部分Denonvilliers筋膜状态下行直肠前间隙分离的径路和技巧。

Partial preservation of Denonvilliers fascia during total mesorectal excision:a balance between oncologic outcomes and functional results

Dissection of the pre-rectal space is a challenging point in total mesorectal excision(TME).The reason is that it is difficult to ensure the integrity of the anterior proper fascia while preserving Denonvilliers fascia.In conversely,it is also difficult to resect Denonvilliers fascia without damaging the neurovascular bundles.It is the difficulty and focus of rectal cancer surgery to solve this contradiction.In recent years,TME based on the fascial anatomy provides a new perspective for researchers to design the best surgical approach for accurate peri-rectal dissection.In this paper,the authors focus on the fascia anatomical research progress of Denonvilliers fascia,and discuss the surgical approaches and techniques of partial preservation of Denonvilliers fascia during TME based on their own clinical experiences.