【摘要】：由于低位直腸癌行治愈性切除后存在著較高的局部復(fù)發(fā)率及術(shù)后性功能障礙和泌尿功能的障礙,一直是困繞外科界的一大棘手問題。隨著Heald等在1982年提出全直腸系膜切除術(shù)(total mesorectal excision,TME)這一新技術(shù)以來(lái),上述問題才得以改觀。目前,TME正得到越來(lái)越廣泛的認(rèn)可和應(yīng)用,并已成為直腸癌手術(shù)的“金標(biāo)準(zhǔn)”。本課題通過對(duì)22具男性尸體的盆腔標(biāo)本進(jìn)行解剖、觀察及測(cè)量,對(duì)與TME有關(guān)的解剖結(jié)構(gòu)包括直腸系膜、Denonvilliers筋膜、Waldeyer韌帶、盆腔筋膜、盆腔自主神經(jīng)等進(jìn)行了描述,并提供一些數(shù)據(jù)和照片,為臨床醫(yī)師提供參考。其結(jié)果如下: 1、直腸系膜:位于直腸后方,外覆光滑的盆臟層筋膜。長(zhǎng)約8~10cm,厚約1.5~2.0cm。其內(nèi)可見脂肪組織、血管、神經(jīng)、淋巴組織等。 2、Denonvilliers筋膜:位于膀胱底部、精囊腺、輸精管、前列腺與直腸之間。向下起自會(huì)陰筋膜,向上至直腸膀胱陷凹腹膜返折處。中位線高度男性平均值3.7cm。 3、Waldeyer筋膜:約在S3~S5前,由盆臟層筋膜與骶前筋膜融合成的一致密結(jié)締纖維束帶。 4、盆腔筋膜的配布:骶前的盆臟筋膜于盆側(cè)壁向前返折覆蓋盆腔神經(jīng)叢與髂內(nèi)血管,包裹直腸形成直腸系膜表面的筋膜,并再向前包裹膀胱、前列腺的表面。臟層筋膜在直腸后面圍成潛在間隙。臟層筋膜與壁層筋膜相貼甚至融合,在骶骨前形成骶前筋膜。 5、直腸側(cè)韌帶:位于直腸的后外方,下1/3段。直腸側(cè)韌帶中位至直腸肛管平面距離:4.5±0.60cm。 6、上腹下叢:分布于腹主動(dòng)脈末端及其分叉處至骶岬下約2cm處之間,成不規(guī)則的網(wǎng)狀。
[Abstract]:Due to the existence of high local recurrence rate, postoperative sexual dysfunction and urinary dysfunction after curative resection of low rectal cancer, it has always been a thorny problem in the field of surgery. These problems have been improved since Heald et al proposed the new technique of total mesorectal excision (total mesorectal excision,TME) in 1982. At present, TME is more and more widely recognized and applied, and has become the "gold standard" for rectal cancer surgery. In this study, the pelvic specimens of 22 male cadavers were dissected, observed and measured. The anatomical structures related to TME, including mesorectum, Denonvilliers fascia, Waldeyer ligament, pelvic fascia, pelvic autonomic nerve and so on, were described. Some data and photos are provided to provide reference for clinicians. The results are as follows: 1. Mesorectum: located behind the rectum, covered with smooth pelvic fascia. It is about 8 ~ 10 cm in length and 1.5 ~ 2 cm in thickness. Adipose tissue, blood vessel, nerve, lymphoid tissue can be found in it. Denonvilliers fascia: located at the bottom of the bladder, seminal vesicle, vas deferens, prostate and rectum. From perineum fascia downward to rectum reflexes. The median line height was 3.7 cm in men. (3) Waldeyer's fascia: a dense connective fiber band formed by the fusion of the pelvic fascia and the sacral fascia approximately before S3~S5. 4. Distribution of pelvic fascia: the anterior pelvic fascia reflexed to the lateral wall of the pelvis to cover the pelvic nerve plexus and the internal iliac vessels, which wrapped the rectum to form a fascia on the surface of the mesorectum, and then forward to wrap the bladder and the surface of the prostate. The visceral fascia surrounds the potential space behind the rectum. The visceral fascia is attached to or even fused with the parietal fascia to form the presacral fascia in front of the sacrum. 5, rectal lateral ligament: located in the posterior side of the rectum, lower 1 / 3 segment. The distance from the median position of the rectal lateral ligament to the level of the rectal anal canal was 4.5 鹵0.60 cm. (6) Superior inferior plexus: distributed between the end of the abdominal aorta and its bifurcation to about 2cm under the sacral promontory, forming an irregular reticular pattern.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R735.37;R322

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