腹腔镜保留Denonvilliers筋膜全直肠系膜切除术

Laparoscopic Denonvilliers9 fascia preserving total mesorectal excision

Heald教授提出的全直肠系膜切除术(TME)成为中低位直肠癌手术的金标准,然而因TME手术导致术中盆腔自主神经损伤,术后患者泌尿生殖功能障碍发生率居高不下,严重影响患者术后生活质量。笔者团队从解剖、生理、组织、手术实践等多方面,对直肠癌保留盆腔自主神经开展了一系列系统研究,在国际首创保留Denonvilliers筋膜全直肠系膜切除术(iTME),并形成中国专家共识并向国际推广;同时提出邓氏筋膜术中标记线——“卫氏线”,确保iTME术式的可操作性和推广性。本例手术视频为男性患者Denonvilliers筋膜保留的iTME术式。

Total mesorectal excision(TME)as proposed by R.J.Healdhas become the gold standard for middle and low rectal cancer surgery.Due to intraoperative pelvic autonomic nerve injury,the incidence of postoperative urogenitaldys function after total mesorectal excision(TME)surgery is high,seriously afiecting postoperative quality of life.We conducted a series of studies on protection of pelvic autonomic nerve,including anatomy,physiology,histochemistry and surgical practice.We propose to retain Denonvilliers5 fascia total mesorectal excision(iTME),which has been recognized by more and more surgical experts,and form Chinese expert consensus and promote it to the world.We also first discovered that the best surgical marker for Denonvilliers5 fascia(as we call Wei's line),Wei's line ensures the operability and promotion of the iTMEtechnique.This surgical video shows the iTME procedure in a male patient.