机器人和腹腔镜全直肠系膜切除术中Denonvilliers筋膜解剖的意义及技巧
发布时间：2018-10-09 14:14
【摘要】：直肠前间隙的分离一直是机器人和腹腔镜全直肠系膜切除(TME)的难点。基于膜解剖原理,系统地认识Denonvilliers筋膜及血管神经束(NVB)的相关解剖,有助于外科医师在保证肿瘤根治的前提下,尽量保护相关自主神经。在行TME时,应行个体化的Denonvilliers筋膜部分切除。进行直肠前方分离时,应在腹膜反折上方1 cm弧形切开膜桥,进入Denonvilliers筋膜前间隙。此后男性在距两侧精囊腺底部0.5 cm,女性距腹膜反折约5 cm,相当于两侧NVB内侧,呈倒"U"形弧形切开离断Denonvilliers筋膜前叶,进入Denonvilliers筋膜后间隙,向下继续分离。
[Abstract]:The separation of anterior rectal space has always been a difficulty in robotic and laparoscopic total mesorectal excision of (TME). Based on the principle of membrane anatomy, the related anatomy of Denonvilliers fascia and (NVB) of vascular and nerve bundles is systematically understood, which is helpful for surgeons to protect the related autonomic nerves on the premise of tumor radical cure. Individual Denonvilliers fascia resection should be performed during TME. In anterior rectal separation, the membrane bridge should be cut 1 cm above the peritoneal reflex and enter the anterior space of the Denonvilliers fascia. After that, the male was about 5 cm, from the base of the seminal vesicle to the base of the seminal vesicle, and the female was equivalent to the medial side of the bilateral NVB. The anterior lobe of the Denonvilliers fascia was cut off in an inverted "U" shape, entered the posterior space of the Denonvilliers fascia, and continued to separate downward.
【作者单位】： 福建医科大学附属协和医院结直肠外科;
【基金】：国家临床重点专科建设资助项目(卫办医政函[2012]649号)
【分类号】：R735.37;TP242
本文编号：2259642
[Abstract]:The separation of anterior rectal space has always been a difficulty in robotic and laparoscopic total mesorectal excision of (TME). Based on the principle of membrane anatomy, the related anatomy of Denonvilliers fascia and (NVB) of vascular and nerve bundles is systematically understood, which is helpful for surgeons to protect the related autonomic nerves on the premise of tumor radical cure. Individual Denonvilliers fascia resection should be performed during TME. In anterior rectal separation, the membrane bridge should be cut 1 cm above the peritoneal reflex and enter the anterior space of the Denonvilliers fascia. After that, the male was about 5 cm, from the base of the seminal vesicle to the base of the seminal vesicle, and the female was equivalent to the medial side of the bilateral NVB. The anterior lobe of the Denonvilliers fascia was cut off in an inverted "U" shape, entered the posterior space of the Denonvilliers fascia, and continued to separate downward.
【作者单位】： 福建医科大学附属协和医院结直肠外科;
【基金】：国家临床重点专科建设资助项目(卫办医政函[2012]649号)
【分类号】：R735.37;TP242
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