直肠癌TME临床应用的解剖学基础
发布时间：2019-01-20 17:42
【摘要】：由于低位直肠癌行治愈性切除后存在着较高的局部复发率及术后性功能障碍和泌尿功能的障碍,一直是困绕外科界的一大棘手问题。随着Heald等在1982年提出全直肠系膜切除术(total mesorectal excision,TME)这一新技术以来,上述问题才得以改观。目前,TME正得到越来越广泛的认可和应用,并已成为直肠癌手术的“金标准”。本课题通过对22具男性尸体的盆腔标本进行解剖、观察及测量,对与TME有关的解剖结构包括直肠系膜、Denonvilliers筋膜、Waldeyer韧带、盆腔筋膜、盆腔自主神经等进行了描述,并提供一些数据和照片,为临床医师提供参考。其结果如下: 1、直肠系膜:位于直肠后方,外覆光滑的盆脏层筋膜。长约8~10cm,厚约1.5~2.0cm。其内可见脂肪组织、血管、神经、淋巴组织等。 2、Denonvilliers筋膜:位于膀胱底部、精囊腺、输精管、前列腺与直肠之间。向下起自会阴筋膜,向上至直肠膀胱陷凹腹膜返折处。中位线高度男性平均值3.7cm。 3、Waldeyer筋膜:约在S3~S5前,由盆脏层筋膜与骶前筋膜融合成的一致密结缔纤维束带。 4、盆腔筋膜的配布:骶前的盆脏筋膜于盆侧壁向前返折覆盖盆腔神经丛与髂内血管,包裹直肠形成直肠系膜表面的筋膜,并再向前包裹膀胱、前列腺的表面。脏层筋膜在直肠后面围成潜在间隙。脏层筋膜与壁层筋膜相贴甚至融合,在骶骨前形成骶前筋膜。 5、直肠侧韧带:位于直肠的后外方,下1/3段。直肠侧韧带中位至直肠肛管平面距离:4.5±0.60cm。 6、上腹下丛:分布于腹主动脉末端及其分叉处至骶岬下约2cm处之间,成不规则的网状。
[Abstract]:Due to the existence of high local recurrence rate, postoperative sexual dysfunction and urinary dysfunction after curative resection of low rectal cancer, it has always been a thorny problem in the field of surgery. These problems have been improved since Heald et al proposed the new technique of total mesorectal excision (total mesorectal excision,TME) in 1982. At present, TME is more and more widely recognized and applied, and has become the "gold standard" for rectal cancer surgery. In this study, the pelvic specimens of 22 male cadavers were dissected, observed and measured. The anatomical structures related to TME, including mesorectum, Denonvilliers fascia, Waldeyer ligament, pelvic fascia, pelvic autonomic nerve and so on, were described. Some data and photos are provided to provide reference for clinicians. The results are as follows: 1. Mesorectum: located behind the rectum, covered with smooth pelvic fascia. It is about 8 ~ 10 cm in length and 1.5 ~ 2 cm in thickness. Adipose tissue, blood vessel, nerve, lymphoid tissue can be found in it. Denonvilliers fascia: located at the bottom of the bladder, seminal vesicle, vas deferens, prostate and rectum. From perineum fascia downward to rectum reflexes. The median line height was 3.7 cm in men. (3) Waldeyer's fascia: a dense connective fiber band formed by the fusion of the pelvic fascia and the sacral fascia approximately before S3~S5. 4. Distribution of pelvic fascia: the anterior pelvic fascia reflexed to the lateral wall of the pelvis to cover the pelvic nerve plexus and the internal iliac vessels, which wrapped the rectum to form a fascia on the surface of the mesorectum, and then forward to wrap the bladder and the surface of the prostate. The visceral fascia surrounds the potential space behind the rectum. The visceral fascia is attached to or even fused with the parietal fascia to form the presacral fascia in front of the sacrum. 5, rectal lateral ligament: located in the posterior side of the rectum, lower 1 / 3 segment. The distance from the median position of the rectal lateral ligament to the level of the rectal anal canal was 4.5 卤0.60 cm. (6) Superior inferior plexus: distributed between the end of the abdominal aorta and its bifurcation to about 2cm under the sacral promontory, forming an irregular reticular pattern.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R735.37;R322
本文编号：2412242
[Abstract]:Due to the existence of high local recurrence rate, postoperative sexual dysfunction and urinary dysfunction after curative resection of low rectal cancer, it has always been a thorny problem in the field of surgery. These problems have been improved since Heald et al proposed the new technique of total mesorectal excision (total mesorectal excision,TME) in 1982. At present, TME is more and more widely recognized and applied, and has become the "gold standard" for rectal cancer surgery. In this study, the pelvic specimens of 22 male cadavers were dissected, observed and measured. The anatomical structures related to TME, including mesorectum, Denonvilliers fascia, Waldeyer ligament, pelvic fascia, pelvic autonomic nerve and so on, were described. Some data and photos are provided to provide reference for clinicians. The results are as follows: 1. Mesorectum: located behind the rectum, covered with smooth pelvic fascia. It is about 8 ~ 10 cm in length and 1.5 ~ 2 cm in thickness. Adipose tissue, blood vessel, nerve, lymphoid tissue can be found in it. Denonvilliers fascia: located at the bottom of the bladder, seminal vesicle, vas deferens, prostate and rectum. From perineum fascia downward to rectum reflexes. The median line height was 3.7 cm in men. (3) Waldeyer's fascia: a dense connective fiber band formed by the fusion of the pelvic fascia and the sacral fascia approximately before S3~S5. 4. Distribution of pelvic fascia: the anterior pelvic fascia reflexed to the lateral wall of the pelvis to cover the pelvic nerve plexus and the internal iliac vessels, which wrapped the rectum to form a fascia on the surface of the mesorectum, and then forward to wrap the bladder and the surface of the prostate. The visceral fascia surrounds the potential space behind the rectum. The visceral fascia is attached to or even fused with the parietal fascia to form the presacral fascia in front of the sacrum. 5, rectal lateral ligament: located in the posterior side of the rectum, lower 1 / 3 segment. The distance from the median position of the rectal lateral ligament to the level of the rectal anal canal was 4.5 卤0.60 cm. (6) Superior inferior plexus: distributed between the end of the abdominal aorta and its bifurcation to about 2cm under the sacral promontory, forming an irregular reticular pattern.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R735.37;R322
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