采用直肠腔内超声观察Denonvilliers筋膜解剖结构初探

Preliminary study of endorectal ultrasonography for anatomic structure of Denonvilliers’ fascia

目的探讨直肠腔内超声(ERUS)显示Denonvilliers筋膜解剖结构特点的可行性。方法回顾性分析15例男性直肠癌患者术前ERUS图像,观察辨别Denonvilliers筋膜解剖结构特点,并与术中腹腔镜所见进行对照。其中1例实施术中ERUS与腹腔镜下所见进行对照以验证术前ERUS识别的结构是否为Denonvilliers筋膜。结果在ERUS图像上,走行于直肠固有筋膜与前列腺、精囊腺之间的线状高回声部位为Denonvilliers筋膜,显示率达100%。15例术前ERUS图像与术中腹腔镜所见均相符。Denonvilliers筋膜与前列腺后方包膜贴合紧密,在精囊后方有疏松较宽间隙。在精囊腺后方及侧方存在结构个体差异,依据线状高回声数量的不同可分为单层结构(3例)及多层结构(12例)。结论 ERUS可以准确显示Denonvilliers筋膜解剖结构特点。

Objective To evaluate the feasibility of endorectal ultrasonography(ERUS) for displaying the anatomic characteristics of Denonvilliers’ fascia. Methods Preoperative ERUS images of 15 male patients with rectal cancer were retrospectively analyzed. The anatomic characteristics of Denonvilliers’ fascia were observed and identified, and compared with recorded videos of laparoscopic surgery. For one patient, intraoperative ERUS images were compared with laparoscopic total mesorectal excision to verify whether the structure identified by preoperative ERUS was Denonvilliers’ fascia. Results It was confirmed that the linear hyperecho between the rectum fascia and the seminal vesicle and the prostate on ERUS images was Denonvilliers’ fascia, and the display rate was 100%. Preoperative ERUS images of 15 patients were consistent with intraoperative observation. Denonvilliers’ fascia was closely adherent to the posterior capsule, manifested with loose and wide space behind the seminal vesicle. Individual differences existed on the posterior and lateral sides of the seminal vesicle, which could be divided into monolayer structures(n =3) and multilayer structures(n = 12) according to the quantity of linear hyperecho. Conclusion ERUS can accurately reveal the anatomic characteristics of Denonvilliers’ fascia.