从直肠系膜的解剖学形态来认识直肠系膜全切除术

Understand total mesorectal excision from the anatomic morphology of the mesorectum

目的通过研究直肠系膜的形态学特点和范围来认识直肠系膜全切除(TME)的理论依据。方法上海交通大学医学院附属瑞金医院对24具尸体的盆腔进行解剖。结果在直肠及周围脂肪周围存在两个相互独立的结构,一个是直肠侧后方的脏筋膜,另一个是直肠前方的Denonvilliers筋膜,它们共同组成了直肠周围的环状筋膜,Denonvilliers筋膜并不能构成直肠系膜的前界。结论TME改善预后的原因并不在于其切除平面为肿瘤难以逾越的"Holy plane",而是在于其完全切除了"直肠腔室"。

Objective To clarify the basis of total mesorectal excision by studying the morphology of the mesorectum. Methods Twenty-four pelvises （12 male, 12 female） harvested from embalmed cadavers were studied by dissectiodn. Results There were two different fascial envelopes around the perirectal fat：a postero-lateral envelope made up of the visceral pelvic fascia and an anterior membrane made up of the Denonovilliers fascia. DenonviUiers＇ fascia couldn＇ t be regarded as anterior part of mesorectum. Conclusion The improved prognosis achieved by total mesorectal excision lies in the excision of rectal compartment en bloc.