三角分离模型在腹腔镜下直肠癌根治手术解剖层面显露中的应用

Application of Triangle Separation Model in Anatomical Exposure of Laparoscopic Radical Resection of Rectal Cancer

直肠癌全系膜切除术(total mesorectal excision,TME)手术的关键是识别并进入Toldt间隙,手术全程需维持在该间隙中。文章提出的“三角分离模型”是将受到牵拉的Toldt间隙视为立体结构,正确识别手术过程中Toldt间隙的不断变化的分离点,由点到线,由线到面,沿着正确的手术平面进行分离操作。文章以行腹腔镜下直肠癌根治术(Dixon)的49岁女性直肠癌患者为例,术中根据该模型选择手术入路进入Toldt间隙,完成直肠周围各层筋膜分离,顺利完成手术。该模型不仅能简化手术操作,便于青年医师学习和掌握,还能最大程度地降低系膜残留,减少直肠周围血管、神经、输尿管等损伤的机会,最终提高TME的手术质量。

The key of total mesorectal resection(TME)for rectal cancer is to identify and enter the Toldt space,in which the operation should be maintained throughout the surgical process.The“triangle separation model”proposed in this paper is to regard the pulled Toldt space as a three-dimensional structure,which can correctly distinguish the dynamic changes of the space and separate it from a point to a line and from a line to a plane during the operation.The article took a 49-year-old female rectal cancer patient who underwent laparoscopic radical resection of rectal cancer(Dixon)as an example.According to the model,the operation was successfully completed by selecting the right surgical approach to enter the correct Toldt space and separating all layers of fascia around the rectum.The model can simplify surgical operation,easily to be learned and mastered by young surgeons,minimize the mesenteric residues,reduce the chance of injury of blood vessels,nerves and ureters around the rectum,and improve the quality of TME surgery.