腹腔镜全直肠系膜切除术中直肠侧系膜处理方式

The surgical strategy of the lateral mesorectum in laparoscopic total mesorectal excision

直肠侧方结构致密,空间狭小,是全直肠系膜切除(TME)术中分离的难点区域。直肠侧方结构解剖复杂,争议较多,传统观点将直肠侧方结构称为直肠侧韧带,但从肠系膜发育和膜解剖角度理解,可以将直肠侧方结构称为直肠侧系膜,其是直肠与盆腔侧壁血管、神经、淋巴管沟通的桥梁。在TME术中,可采用先游离直肠后方,再分离直肠前间隙的方式完整显露直肠侧系膜,最后紧贴盆壁将其离断,即可将直肠完整游离至盆底。按此方法,可在保证直肠系膜完整的基础上,最大限度避免损伤盆腔植物神经,保护病人术后泌尿生殖系统功能。

The lateral rectum is dense with narrow space,which is difficult to dissect in TME.The lateral structure of the rectum is complex and controversial.It is called the lateral ligament of the rectum traditionally.But from the perspective of embryonic development and membrane anatomy,It can be called the lateral mesorectum,the bridge of the vessels,lymphatic,and nerves between the rectum and pelvic wall.The lateral mesorectum can be exposed entirely after the posterior and anterior space of the rectum has been dissected during the TME procedure.After that,the lateral mesorectum should be cut off close to the pelvic wall so the rectum can be fully mobilized to the pelvic floor.This method allows rectal cancer to be resected radically,and the pelvic autonomic nerve can be protected during the TME procedure.