摘要
Abstract
Total mesorectal excision is the standard surgical modality for mid-and low-rectal cancer,yet it is still associ-ated with a high incidence of postoperative autonomic nerve dysfunction.Based on the anatomical studies conducted at our center and a review of relevant literature,this study elucidates the fascial-bound architecture of the pelvic autonomic nervous system and proposes an anatomy-driven nerve-preservation protocol.At the level of the peritoneal reflection,non-anterior wall tumors are managed by initially extending the dissection plane from the retrorectal space bilaterally into the anterolateral space,thereby establishing a"tent-like"configuration prior to incising the peritoneal reflection(i.e.mem-brane bridge).For anterior wall tumors,the incision is made 1 cm anterosuperior to the peritoneal reflection.Denonvil-liers'fascia,rich in nerve fibers,is transected 0.5 cm cephalad to the base of the seminal vesicles or at an even higher level,balancing oncological radicality with the protection of communicating branches of the neurovascular bundle.Below the peritoneal reflection,rectal circumferential dissection follows the sequence of"posterior → anterior → lateral".The"fascial barrier"is divided last,preserving the fusion area of the pelvic plexus and the pre-hypogastric fascia.At the cau-dal aspect of the mesorectum,the neurovascular bundle fat pad is treated as a single unit,and sharp dissection is per-formed along its course enveloping the rectum.At the level of the levator ani muscle,complete mesorectal excision is achieved by using both the horizontal levator ani muscle plane and the vertical neurovascular bundle plane as dual refer-ence points.During perineal approach dissection,at the level of the levator hiatus,the rectourethralis muscle should be divided close to the rectal side to avoid injury to the underlying neurovascular bundle.关键词
全直肠系膜切除术/盆自主神经系统/膜解剖/直肠癌Key words
total mesorectal excision/pelvic autonomic nervous system/fascial anatomy/rectal cancer分类
医药卫生
