TME相关男性直肠周围筋膜和盆自主神经的解剖学研究

发布时间：2018-10-12 13:12

【摘要】：全直肠系膜切除术(total mesorectal excision, TME)是兼顾肿瘤根治和盆自主神经保留(pelvic autonomic nerve preservation, PANT)的新技术。这种将直肠和直肠系膜从直肠周围筋膜内“整块”切除的方法,大大减少了肿瘤的局部复发率;同时,盆自主神经的保留有效地维持了男性直肠癌病人术后的排尿功能和性功能。合理的外科技术必须建立在精确的解剖学理论基础之上,TME和PANP的正确施行,有赖于对直肠周围筋膜和盆自主神经的准确而深刻的理解。然而,人们对这些解剖结构的认识还相当混乱,进而危及手术的正确施行和术后的临床效果。这种情况促使我们利用临床解剖学研究来解决这一问题,本研究利用固定尸体的局部解剖学观察,活体的腹腔镜观察,以及对活体和尸体的计算机断层扫描(computed tomography, CT)和磁共振成像(magnetic resonance imaging, MRI)等影像学观察手段,试图阐明包括直肠系膜在内的男性直肠周围筋膜和盆自主神经的解剖结构,及其相互关系。第一部分直肠周围筋膜的解剖学研究 1 目的:阐明TME相关直肠周围筋膜的层次、间隙和结构的解剖学特点。 2 材料和方法:对10个男性正中矢状半骨盆固定标本进行解剖观察。 3 结果 3.1 直肠周围的组织层次直肠周围的组织层次在矢状方向从前向后依次为:腹膜、盆筋膜脏层、神经筋膜层、盆筋膜壁层和骶骨骨膜。直肠系膜包括由盆筋膜脏层(直肠固有筋膜)包绕直肠后外侧脂肪形成的后部和作为Denonvilliers筋膜后叶的前部。在直
[Abstract]:Total mesorectal excision (total mesorectal excision, TME) is a new technique for both radical resection and pelvic autonomic nerve preservation (pelvic autonomic nerve preservation, PANT). This "whole" resection of the rectum and mesorectum from the perirectal fascia significantly reduces the local recurrence rate of the tumor; at the same time, Pelvic autonomic nerve preservation can effectively maintain the urination and sexual function of male rectal cancer patients after operation. Reasonable surgical techniques must be based on accurate anatomical theories. The correct implementation of TME and PANP depends on an accurate and profound understanding of the perirectal fascia and pelvic autonomic nerves. However, the understanding of these anatomical structures is still quite confused, which endangers the correct operation and postoperative clinical effect. This situation prompted us to use clinical anatomical studies to solve this problem. In this study, we used local anatomical observations of fixed cadavers, laparoscopic observations in vivo, As well as computed tomography (computed tomography, CT) and magnetic resonance imaging (magnetic resonance imaging, MRI) in vivo and cadavers to elucidate the anatomical structure of the perirectal fascia and pelvic autonomic nerves in men, including the mesorectum. And their interrelationships. Part I Anatomy of perirectal fascia objective: to elucidate the level of TME associated perirectal fascia. Materials and methods: 10 male median sagittal hemipelvis fixed specimens were anatomically observed. Results 3.1 perirectal tissue levels In the sagittal direction, the tissue levels around the rectum are: peritoneum, retrograde and retrograde. Pelvic fascia layer, nerve fascia layer, pelvic fascia wall layer and sacrum periosteum. The mesorectum consists of the posterior part of the pelvic fascia (rectum propria fascia) wrapped around the posterolateral fat of the rectum and the anterior part of the posterior lobe of the Denonvilliers fascia. Straight
【学位授予单位】：第一军医大学
【学位级别】：博士
【学位授予年份】：2005
【分类号】：R322

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