直肠周围筋膜的解剖特点及其临床意义

The anatomic characteristics of the fascias arounding rectum and its clinical significance

目的 :为全直肠系膜切除术治疗直肠癌提供解剖学基础。方法 :在 5 0侧成人防腐固定的盆腔标本上解剖观测直肠系膜、Denonvilliers筋膜及直肠周围腔隙的结构特点。结果 :1、直肠系膜中上段较厚 ,与直肠连结疏松 ,有纤维束伸入直肠壁 ;下段逐渐变薄至 ( 2 .1± 1.2 )mm ,并有 ( 1.5 9± 0 .47)cm长的系膜与直肠肌层连结紧密 ,末端借致密结缔组织与肛提肌相连。 2、Denonvilliers筋膜薄而致密 ,最薄处为 ( 1.4± 0 .5 )mm。 64 %的筋膜有细小纤维束伸入前列腺、精囊腺 (或阴道 )之间。 3、未见明显呈束状结构直肠侧韧带。结论 :直肠系膜及Denonvilliers筋膜是包裹直肠的独立结构 ,沿骶前间隙及直肠两侧壁锐性分离可完整游离直肠系膜 ,但直肠下端的系膜与直肠壁、Denonvilliers筋膜与前列腺 (或阴道 )之间结合紧密 。

Objective: To provide anatomical foundation for TME(total mesorectal excision) used for treating rectal cancer. Methods: To dissect and measure structures of mesorectal, Denonvilliers fascia and the lacuna around rectum. Results: 1. The upper middle segment of Mesorectum which mostly contained a mass of fat tissue and presented loose linkage with rectum , while stretched out Fibrous bands and entered rectal floor was thicker than lower part. The lower part gradually thinned to 2.1±1.2 mm and there were mesenter with length of 1.59±0.47 cm tightly connecting with rectal muscle, as well its end was joined with levator ani by tight connective tissue. 2. Denonvilliers fascia was thin and tight, and the thinnest site was just 1.4±0.5 mm. 64% of the fascia stretched out Fibrous bands and entered the space between prostate and spermatophore (or vagina ) 3. There was no obvious Fascicles of side ligament of rectum. Conclusions: Mesorectal and Denonvilliers fascia were separate structures enwrapping rectum. It is possible to separate the integrated mesorectal sharply along the retrorectal space and the lateral of rectum completely. However, the separating process need to be cautious and careful for Denonvilliers fascia and prostate(vagina) as well as the nether mesenter of rectum and rectal floor are tightly joined.