路标血管在结直肠外科膜解剖中的应用

Landmark vessel in membrane anatomy-based colorectal surgery

膜解剖理论已广泛运用于结直肠外科领域,要高质量施行全直肠系膜切除术(TME)和完整结肠系膜切除(CME),关键点在于进入到正确的解剖层面,而术中如何识别各种筋膜和膜间隙,则成为进入正确手术层面乃至手术成功的要点。路标血管是指在胚胎发育过程中,来源于腹腔脏器表面原始腹膜、随着筋膜间隙发生融合而产生的细小血管。从胚胎发育的过程来看,腹盆腔筋膜结构是一个延续的整体,而其表面的路标血管不会随着筋膜的融合而发生形态学变化,并具有特定的规律。笔者团队通过结合既往文献和临床手术观察,发现这些细小血管具有辅助辨识各种融合筋膜及解剖层次的作用,是膜解剖外科的具体体现。

The theory of membrane anatomy has been widely used in the field of colorectal surgery.The key point to perform high quality total mesorectal excision(TME)and complete mesocolic excision(CME)is to identify the correct anatomical plane.Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success.The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space.From the point of view of embryonic development,the abdominopelvic fascial structure is a continuous unit,and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern.Drawing on previous literature and clinical surgical observations,we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes.This is a specific example of membrane anatomical surgery.