从胚胎学与膜解剖理解完整结肠系膜切除手术

Understanding complete mesocolonic excision from the perspectives of embryology and membrane anatomy

Hohenberger提出的完整结肠系膜切除术(CME)已成为结肠癌根治手术的标准术式。近年来,随着腹腔镜手术的广泛开展以及高清腹腔镜设备的普及,以往开腹手术中无法辨识的膜结构及精细解剖层面逐渐被认识。人体解剖结构随胚胎发育过程而发生变化,理解胚胎发育的过程,有助于加强对结肠膜解剖和CME游离层面的正确认识,对CME的标准化、规范化亦具有重要的意义。本文通过对胚胎发育和膜解剖理论的文献学习,结合笔者团队的临床实践经验,对CME手术的清扫边界、血管结扎部位、游离层面以及手术流程展开讨论。

Complete mesocolic excision(CME),proposed by Hohenberger,has become the standard operation for colon cancer.In recent years,with extensive application of laparoscopic surgery and high definition laparoscopic equipments,the membrane structure and the fine anatomy of tissue layers that could not be identified in open surgery have been gradually recognized.The anatomical structure of human body changes with the development of embryo,understanding the process of embryogenesis can help recognize the colonic membrane anatomy and the tissue layers of CME,which is of great significance to the standardization of CME.In this paper,the boundary and layers of dissection,the blood vessel ligation site,and CME’s operation procedure are discussed based on our experiences,the understanding of embryogenesis,and membrane anatomy theory.