首次发现:Denonvilliers筋膜手术标识线的术中辨识

First discovered: How to identify the surgical indication line of Denovilliers' fascial

由于传统的全直肠系膜切除(TME)术后泌尿生殖功能障碍发生率居高不下,以致引起国内外学者对TME理念的争议及质疑,直肠癌手术保留Denonvilliers筋膜的必要性已受到越来越多国内外学者的赞同。然而,术中如何精准定位Denonvilliers筋膜,一直没有定论。通过反复临床实践,结合尸体标本解剖,首次发现Denonvilliers筋膜的顶部位于膀胱直肠陷凹(或直肠子宫陷凹)腹膜返折最低处,呈白色增厚线,这条线是辨认Denonvilliers筋膜最好的手术标记线。在该线前方游离则进入Denonvilliers筋膜的前方,而在线后方游离,则进入Denonvilliers筋膜的后方,从而完整地保留Denonvilliers筋膜,并更好地保护术后泌尿生殖功能。该手术标识线的发现,可为改良的保留Denonvilliers筋膜的TME术式提供标准化手术流程及入路,并为从事盆底手术操作的外科医生提供借鉴。

The high incidence of postoperative urogenital dysfunction after traditional total mesorectal excision （TME） surgery has led to worldwide controversy and query on TME surgery. More and more scholars agree with the view on necessity of preserving Denonvilliers＇ fascia during rectal cancer resection. However, how to figure out the exact location of Denonvilliers＇ fascia is still elusive. Through repeated clinical practice and studies on the anatomy of cadaver specimens, we first discovered that the roof of Denonvilliers＇ fascia is located in the lowest level of peritoneal reflex （rectovesical ponch or Douglas＂ Pouch）, and presented as a white thick line. This white thick line （as we call Wei＇s line） is the best surgical marker to identify Denonvilliers＇ fascia. Dissection in front of Wei＇ s line can enter into the front plane of Denonvilliers＇ fascia, while dissection behind the line helps to enter into the back plane of Denonvilliers＇ fascia and thus preserve Denonvilliers＇ fascia entirely, as well as protect postoperative urogenital function. Wei＇ s line helps to provide standardized surgical procedure and surgical plan for preservation of Denonvilliers＇ fascia in improved TME surgery and is also useful for surgeons majored in pelvic surgery.