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直肠全系膜切除术能完全切除直肠系膜吗？ 被引量：3

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摘要 经过20余年的发展，直肠全系膜切除术（TME）已成为直肠癌手术的“金标准”，但是这一概念依然备受争议，有学者称之为“错误的称谓，正确的手术”。TME手术不同的称谓尚有：环形系膜切除、锐性系膜切除、筋膜外切除、全解剖切除，名称的不同其实体现了解剖学上理解的差异。这也反映了TME的现实情况：一方面TME在临床实践上明显改善了直肠癌的预后，但另一方面解剖基础并不明确，外科医生对其解剖学的描述不尽相符，有时甚至相互矛盾，如Havenga等认为腹下神经走脏筋膜的前方，而Bisset则认为腹下神经位于脏筋膜的后方。
作者 林谋斌 金志明 尹路 陈伟国 倪俊声
机构地区 上海交通大学医学院附属瑞金医院普外科
出处 《中华外科杂志》 CAS CSCD 北大核心 2008年第8期627-629,共3页 Chinese Journal of Surgery
基金 上海市科委基金资助项目（074119602）
关键词 直肠全系膜切除术 直肠系膜 完全切除 直肠癌手术 TME手术 腹下神经 “金标准” 临床实践
分类号 R686 [医药卫生—骨科学]
  • 相关文献

参考文献15

  • 1Havenga K, Deruiter MC, Enker WE, et al. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg,1996, 83:384-388.
  • 2Bisset IP, Chau KY, Hill GL. Extrafascial excision of the rectum: surgical anatomy of the fascia propria. Dis Colon Rectum, 2000, 43:903-910.
  • 3Heald KJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence. Br J Surg, 1982,69: 613-616.
  • 4Diop M,Parratte B, Tatu L, et al. " Mesorectun" : the surgical value of an anatomical approach. Surg Radiol Anat, 2003,25: 290-304.
  • 5Kneist W, Junginger T. Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Colorectal,2007 ,22 :675-682.
  • 6Yabuki Y, Sasaki H, Hatakeyama N, et al. Discrepancies between classic anatomy and modem gynecologic surgery on pelvic connective tissue structure: harmonization of those concepts by collaborative cadaver dissection. Am J Obstet Gynecol,2005,193 : 7-15.
  • 7高桥孝.Waldeyer筋膜和膀胱腹下筋膜//高桥孝.大肠癌根治术.北京:人民卫生出版社,2003:123-133.
  • 8Heald R J, Chir MA, Karanjia ND, et al. Results of radical surgery for rectal cancer. World J Surg, 1992,16:848-857.
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  • 10Uchimoto K, Takenaka A, Yajima T, et al. Operating behind Denonvilliers' fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum,2006,49:1024-1032.

二级参考文献9

  • 1Bisset IP, Chau KY, Hill GL. Extrafascial excision of the rectum: surgical anatomy of the fascia propria. Dis Colon Rectum, 2000, 45:905-910.
  • 2Havenga K, DeRuiter MC, Enker WE, et al. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg, 1996,83:384-388.
  • 3Diop M, Parratte B, Tatu L, et al. "Mesorectun" : the surgical value of an anatomical approach. Surg Radiol Anat, 2003,25: 290 -304.
  • 4Lindsey I, Guy RJ, Warren BF,et al. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg,2000 ,87 : 1288-1299.
  • 5Heald RJ, Chir MA, Karanjia ND, et al. Results of radical surgery for rectal cancer. World J Surg, 1992,16:848-857.
  • 6Bissett IP, Chau KY, Hill GL. Extrafascial Excision of the Rectum for Cancer: a Technique for the Avoidance of the Complications of Rectal Mobilization. Semin Surg Oncol,2000,18:207-215.
  • 7Baader B, Herrmann M. Topography of the pelvic autonmic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat,2003,16 : 119 -130.
  • 8Heald RJ. Sphincter and nerve preserving total mesorectal excision. Acta Chir Iugosl,2002,49:7-8.
  • 9Heald RJ. The ‘Holy plane' of rectal surgery. J R Soc Med, 1988, 81:503-508.

共引文献8

同被引文献13

  • 1Clausen N, Wolloscheck T, Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg, 2008,32 : 1768-1775.
  • 2Abel E3, Masterson TA, Warner iN, et al. Nerve-sparing prostatectomy and urinary function: a prospective analysis using validated quality-of-life measures. Urology, 2009,73:1336-1340.
  • 3Dursun P, Ayhan A, Kuscu E. Nerve-sparing radical hysterectomy for cervical carcinoma. Crit Rev Oncol Hematol, 2009,70 : 195-205.
  • 4Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer. World J Surg, 1992,16: 848-857.
  • 5Lin M, Chen W, Huang L, et al. The anatomy o1" lateral ligament of the rectum and its role in toral mesorec.tal excision. World J Surg, 2010,34: 594-598.
  • 6Lin M, Chen W, Huang L, et al. The anatomic basis of total mesorectaI excision. Am ： Surg, 2011,2OI :537-543.
  • 7Bisset IP, Chau KY, Hill GL. Extrafascial excision of the rectum: surgical anatomy of the fascia propria. Dis Colon Rectum, 2000,43 : 903-910.
  • 8Sugihara K, Moriya Y, Akasu T, et al. Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer, 1996,78 : 187 l- 1880.
  • 9Taguchi K, Tsukamoto T, Murakami G. Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses. J Urol, 1999,161:320-325.
  • 10Kihara K, de Groat WC. Sympathetie efferent pathways projecting bilaterally to the vas deferens in the rat. Anat Rec, 1997,248 : 291-299.

引证文献3

二级引证文献20

中华外科杂志
2008年 第8期

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