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中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 8 -11. doi: 10.3877/cma.j.issn.2095-3224.2018.01.002

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直肠癌全直肠系膜切除术中盆腔植物神经的易损区域及保护
申占龙1, 叶颖江1,(), 王杉1   
  1. 1. 100044 北京大学人民医院胃肠外科、外科肿瘤研究室、北京市结直肠癌诊疗研究重点实验室
  • 收稿日期:2017-09-27 出版日期:2018-02-25
  • 通信作者: 叶颖江
  • 基金资助:
    国家自然科学基金面上项目(No.81672375)

The vulnerable sites and protection of pelvic autonomic nerve in total mesorectal excision of rectal cancer

Zhanlong Shen1, Yingjiang Ye1,(), Shan Wang1   

  1. 1. Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People′s Hospital, Peking 100044, China
  • Received:2017-09-27 Published:2018-02-25
  • Corresponding author: Yingjiang Ye
  • About author:
    Corresponding author: Ye Yinjiang, Email:
引用本文:

申占龙, 叶颖江, 王杉. 直肠癌全直肠系膜切除术中盆腔植物神经的易损区域及保护[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(01): 8-11.

Zhanlong Shen, Yingjiang Ye, Shan Wang. The vulnerable sites and protection of pelvic autonomic nerve in total mesorectal excision of rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(01): 8-11.

全直肠系膜切除术(TME)是目前国际公认的直肠癌标准术式,随着TME手术的推广和认识,盆腔植物神经保护(PANP)的理念逐渐受到重视。笔者认为,在开展直肠癌TME手术时,有六个区域容易发生盆腔植物神经损伤,需要识别和保护:肠系膜下动脉根部的肠系膜下丛、上腹下神经丛及腹下神经的近端、盆丛前丛的近端、盆丛后丛的主干、盆丛后丛的终末支及盆腔内脏神经。熟悉盆腔筋膜、植物神经解剖,开展以TME手术层面为主导,盆腔植物神经为引导的精准直肠癌手术,对于提高手术质量,保护器官功能至关重要。

Total mesorecal excision (TME) is considered as the standard procedure for rectal cancer worldwide. With the popularization and cognition of TME procedure, the pelvic autonomic nerves preservation (PANP) in the operation is valued gradually. We considered there are six areas which are easily injured in the TME procedure: inferior mesorectal plexus (IMP) at the root of inferior mesorectal artery (IMA), superior hypogastric plexus (SHP) and the proximal part of hypogastric plexus (HP), proximal part of anterior branches of pelvic plexus, main trunk of posterior branches of pelvic plexus, terminal part of posterior branches of pelvic plexus, pelvic splanchnic nerves. Familiarity with the anatomy of pelvic fascia and autonomic nerves, development of TME plane dominated and pelvic autonomic nerves guided precise rectal cancer surgery play an important role in promoting the quality of surgery and protecting the function of organ.

图6 盆壁筋膜覆盖的盆腔内脏神经(箭头所示)
[1]
Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997 [J]. Arch Surg, 1998, 133(8): 894-899.
[2]
Chew MH, Yeh YT, Lim E, et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades [J]. Gastroenterol Rep (Oxf), 2016, 4(3): 173-185.
[3]
Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy [J]. Dis Colon Rectum, 1989, 32(2): 128-133.
[4]
Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum [J]. J Am Coll Surg, 1995, 181(4): 335-346.
[5]
Yang XF, Li GX, Luo GH, et al. New insights into autonomic nerve preservation in high ligation of the inferior mesenteric artery in laparoscopic surgery for colorectal cancer [J]. Asian Pac J Cancer Prev, 2014, 15(6): 2533-2539.
[6]
Havenga K, Enker WE. Autonomic nerve preserving total mesorectal excision [J]. Surg Clin North Am, 2002, 82(5): 1009-1018.
[7]
Lee JF, Maurer VM, Block GE. Anatomic relations of pelvic autonomic nerves to pelvic operations [J]. Arch Surg, 1973, 107(2): 324-328.
[8]
Havenga K, DeRuiter MC, Enker WE, et al. Anatomical basis of autonomic nerve preserving total mesorectal excision for rectal cancer [J]. Br J Surg, 1996, 83(3): 384-388.
[9]
Bisset IP, Chau KY, Hill GL. Extrafascial excision of the rectum: surgical anatomy of the fascia propria [J]. Dis Colon Rectum, 2000, 43(7): 903-910.
[10]
Bertrand MM, Colombo PE, Alsaid B, et al. Transanal endoscopic proctectomy and nerve injury risk: bottom to top surgical anatomy, key points [J]. Dis Colon Rectum, 2014, 57(9): 1145-1148.
[11]
Rink AD, Kneist W, Radinski I, et al. Differences in ano-neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomy [J]. Color Dis, 2010, 12(4): 342-350.
[12]
Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance [J]. Surg Endosc, 2010, 24(5): 1205-1210.
[13]
Heald RJ. A new solution to some old problems: transanal TME [J]. Tech Coloproctol, 2013, 17(3): 257-258.
[14]
申占龙,叶颖江,Sam Atallah, 等. 经肛门直肠癌系膜切除解剖层面及盆腔神经保护 [J]. 中国实用外科杂志, 2015, 35(8):45-46.
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