层面优先入路直肠癌侧方淋巴结清扫术的解剖学研究

Anatomical study of lateral lymph node dissection for rectal cancer with fascia space priority approach

目的对盆腔侧方腔室的层面解剖进行研究,以期为层面优先入路直肠癌侧方淋巴结清扫术(LLND)提供解剖学指导,建立常规手术流程。方法对10具新鲜冰冻尸体完成全直肠系膜切除术后,按照层面优先入路LLND步骤分离盆腔侧方腔室疏松无血间隙,观察、标记重要的解剖标志。结果输尿管腹下神经筋膜和膀胱腹下筋膜是盆腔侧方两个重要的脏筋膜层面。在所有尸体标本中,这两个脏筋膜层面及盆壁筋膜均易于分离。输尿管、骶前筋膜、闭锁脐动脉及盆筋膜腱弓是重要的解剖标志,在所有尸体标本中解剖结构恒定。结论层面优先入路直肠癌LLND层面清晰,重要的解剖标志恒定,可作为LLND的常规入路。

Objectives To provide anatomical guidance and establish a surgical procedure of lateral lymph node dissection through the anatomical study of the lateral pelvic compartment.Methods Autopsy of 10 fresh frozen cadavers was performed with total mesorectal excision followed by lateral lymph node dissection with fascia space priority approach.The loose and avascular spaces of the lateral pelvic compartment were dissected,and the important anatomical landmarks were analyzed and marked.Results The ureterohypogastric nerve fascia and the vesicohypogastric fascia are two important pelvic visceral fasciae lateral to the pelvic cavity,which can be easily dissected from all cadaver specimens as well as parietal pelvic fascia.The ureter,presacral fascia,umbilical artery,and tendinousarch of pelvic fascia are important anatomical landmarks,and the anatomical structure is consistent in all cadaver specimens.Conclusion Fascia space priority approach can be used as a standard approach for lateral lymph node dissection of rectal cancer due to its clear surgical level and consistent anatomical landmarks.