中国实用外科杂志2026，Vol.46Issue(2)：189-196,8.DOI:10.19538/j.cjps.issn1005-2208.2026.02.06
基于外科精细解剖的直肠癌手术策略
Precision anatomy-guided rectal cancer surgery——Fasciae,mesenteries,and spaces
池畔 1王枭杰1
作者信息
- 1. 福建医科大学附属协和医院结直肠外科,福建 福州 350001
- 折叠
摘要
Abstract
Based on a series of research findings on the meticulous anatomy related to fascia,mesentery and interstitial spaces in recent years,combined with clinical practice experience,an anatomical framework for"function-sparing total mesorectal excision(TME)"is proposed:(1)The left primitive retroperitoneum is the anatomical substrate of the"wrong-plane"phenomenon during left mesocolic mobilization;an initial lateral approach that exposes the left ureter followed by a central dissection minimizes the convergence distance.(2)Metastasis to No.253 lymph nodes is relatively rare,but the prognosis is extremely poor in patients with such metastasis;selective intrasheath dissection of the inferior mesenteric artery in patients with locally advanced disease can achieve both adequate lymph node dissection and preservation of the inferior mesenteric plexus.(3)Revisiting the classical"two-concentric-rings"model,the rectosacral fascia was found to split laterally and fuse densely with the pelvic plexus.The optimal circumferential dissection sequence is therefore posterior-anterior-lateral:posteriorly,the rectosacral fascia is arcuately incised;anteriorly,a"partial Denonvilliers fascia preservation"technique safeguards the neurovascular bundle while ensuring complete anterior mesorectal excision;finally,residual lateral tethering bands are divided to reach the"terminal line"while preserving the pelvic plexus.This stepwise anatomy-driven strategy secures oncologic radicality while maximizing genito-urinary function,providing a reproducible and standardized plane for laparoscopic/robotic rectal cancer surgery.关键词
全直肠系膜切除/筋膜/系膜/间隙/直肠癌Key words
total mesorectal excision/fascia/mesentery/anatomical spaces/rectal cancer分类
医药卫生引用本文复制引用
池畔,王枭杰..基于外科精细解剖的直肠癌手术策略[J].中国实用外科杂志,2026,46(2):189-196,8.
