腹腔镜直肠癌低位前切除术

Laparoscopic anterior resection for low rectal cance

腹腔镜直肠癌低位前切除术已在临床上受到广泛认可。术中手术层面的识别与游离、盆腔自主神经的保护对于手术成功与否以及患者术后生活质量尤为重要。腹腔镜直肠癌低位前切除术中需注意:(1)直肠系膜与神经前筋膜之间游离;(2)紧贴直肠系膜游离间隙;(3)保证直肠系膜后方、两侧方和前方的完整;(4) TME手术直肠系膜终止线位于肛门直肠环,游离应到位,不能残留直肠系膜。实践证实,基于膜解剖的直肠癌全系膜切除有助于盆腔自主神经保护以及实现肿瘤的根治性切除。

Laparoscopic anterior resection has been widely verified in clinical practice for low rectal cancer.Recognition and separation of the surgical fascia are crucial for the protection of pelvic autonomic nerves with better postoperative quality of life for patients.Notes of laparoscopic anterior resection for low rectal cancer are as following:(1)Proper separation of rectal fascia and prehypogastric nerve fasia;(2)Sharp separation along with rectal posterior fascia;(3)Keep the completeness of rectal circumferential fascia;(4)Sufficient separation of rectal fascia to anorectal ring plane without residual mesorectum.It is proved that total mesorectal excision of rectal cancer based on the anatomy of the fascia is beneficial for protection of pelvic autonomic nerves and radical resection of tumor.