直肠侧系膜的再认识及临床价值

Reappraisal of the lateral mesorectum and its clinical importance

肠系膜是指由两层腹膜包裹血管、淋巴及神经,将肠管固定于腹后壁的结构。从肠系膜上动脉根部开始,肠系膜沿肠管呈扇形展开,跟随直肠止于盆底,直肠系膜是腹腔内肠系膜在盆腔内的延续。直肠侧方结构复杂,传统观点中这一区域被称为直肠侧韧带,但从胚胎发育和膜解剖角度去理解,可以把直肠侧方的结构视作直肠侧系膜。直肠侧系膜是直肠与盆腔侧壁血管、神经、淋巴管沟通的桥梁,同时具有固定直肠的作用,也是低位直肠癌发生侧方淋巴结转移的解剖基础。全直肠系膜切除术中明确辨认直肠侧系膜及其周围结构并保证其完整性,是确保肿瘤根治和保护盆腔自主神经的重要环节。

The mesentery has been defined as a double fold of the peritoneum connecting some regions of the intestine to the posterior abdominal wall.It emerges from the superior mesenteric root region and fans out to span the intestine from the duodenum to the rectum.The mesorectal is a continuation of the intraperitoneal mesentery in the pelvic cavity.The lateral structure of the rectum is complex and the traditional view calls it the lateral ligament of the rectal.However,this structure could be called the lateral mesorectum from the perspective of embryonic development and membrane anatomy.The lateral mesorectum is the bridge of the vessels,lymphatic,and nerves between the rectum and the pelvic wall.It anchors the rectum to the lateral pelvic wall and is the anatomical basis of lateral lymph node metastasis in low rectal cancer.Meanwhile,it is important to identify the lateral mesorectum and its surrounding structure to radically resect the tumor and protect the pelvic autonomic nerve during the total mesorectal excision procedure.