taTME术野下的盆腔解剖结构辨识要点和手术操作技巧

Key points in identification of pelvic anatomy and surgical technique skills during transanal total mesorectal resection

经肛全直肠系膜切除术(taTME)是近年来治疗中低位直肠癌较新的手术方式。与传统经腹手术相比,其逆向的手术入路,需要外科医师更加熟练和准确掌握盆腔解剖结构知识。笔者经过多年的taTME临床实践,积累了一定的经验,由繁入简,将taTME术中所涉及盆腔解剖结构要点、难点概括为“四间隙,四标志,四陷阱”。“四间隙”即括约肌间隙、Denonvilliers筋膜间隙、盆膈上间隙、直肠后间隙,“四标志”即直肠尿道肌(男性)、Hiatal韧带、直肠骶骨筋膜、盆内脏神经,以及由此产生的四个解剖陷阱即“四陷阱”。熟练掌握“四间隙,四标志,四陷阱”的辨识要点及taTME术中操作技巧,将有利于减少taTME术中的并发症,缩短taTME的学习曲线。

Transanal total mesorectal excision(taTME)has been a new emerging surgery for mid-and low rectal cancer in re⁃cent years.Compared with traditional transabdominal surgery,the reverse surgical approach of taTME requires more substantial knowledge of pelvic anatomy from the surgeons.Through years of practicing taTME,the authors have accumulated specific experi⁃ences in this field.We summarized the key points of mastering the pelvic anatomy into“four spaces”,“four landmarks”,and“four traps”.The“four spaces”refers to internal and external sphincter space,Denonvilliers fascia space,upper pelvic diaphragm space,and posterior rectum space.The“four landmarks”are rectourethralis muscle,Hiatal ligament,rectosacral fascia,and pelvic splanchnic nerves.From the“four spaces”and“four landmarks”arises the“four traps”.Mastering key points in identification of the“four spaces”“,four landmarks”,and“four traps”and surgical technique skills will help reduce the complications of taTME and shorten the learning curve of taTME.