腹腔镜低位直肠癌手术全程膜解剖理论基础与操作难点
The oretical basis and operative difficulties of whole-course membrane anatomy in laparo-scopic low rectal cancer surgery
施赟杰 1王颢1
作者信息
- 1. 海军军医大学第一附属医院肛肠外科 上海 200433
- 折叠
摘要
直肠全系膜切除(total mesorectal excision,TME)是腹腔镜低位直肠癌手术中必须遵循的"金标准".遵循"膜解剖"的手术理念是实现低位直肠癌TME的基础.笔者团队提倡低位直肠癌"全程膜解剖分离",手术游离始终保持在器官脏、壁筋膜之间的"神圣平面"中进行,确保手术的规范与根治性.遵循"全程膜解剖分离"原则,可以减少术中和术后并发症的发生,并且保证肿瘤根治效果.本文就腹腔镜低位直肠癌手术中253组淋巴结的清扫、结肠脾曲游离、直肠周围间隙的膜解剖与神经保护、超低位直肠癌极限保肛术式及其他手术相关问题进行探讨.
Abstract
Total mesorectal excision(TME)is the"golden standard"that must be followed in laparoscopic surgery for low rectal cancer.Adhering to the surgical concept of"membrane anatomy"is the foundation for achieving TME in low rectal cancer.Our team advocates the surgical separation of"whole-course membrane anatomy"for low rectal can-cer,with the surgical dissection always maintained in the"holy plane"between the visceral and parietal fasciae of the organs,which ensures the standardization and radicality of the surgery.Following the principle of"whole-course mem-brane anatomy"surgical separation can reduce intraoperative and postoperative complications and ensure the effect of tumor radical resection.This article discusses hotspots and difficulties such as the dissection of 253 lymph node groups,freedom of the splenic flexure of the colon,membrane anatomy and nerve protection in the perirectal space,extreme sphincter-preserving surgery for very low rectal cancer,and other surgical related issues that require special attention during surgery in laparoscopic low rectal cancer surgery.
关键词
直肠癌/直肠全系膜切除/膜解剖Key words
rectal cancer/total mesorectal excision/membrane anatomy引用本文复制引用
基金项目
上海申康医院发展中心《促进市级医院临床技能与临床创新三年行动计划》研究型医师创新转化能力培训项目(第二轮)(SHDC2023CRD023)
出版年
2024
国家科技期刊平台
NSTL
万方数据