腹腔镜直肠癌根治术中保留盆自主神经的关键技术与意义

doi:10.3877/cma.j.issn.1674-3946.2019.01.003

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 8 -12. doi: 10.3877/cma.j.issn.1674-3946.2019.01.003

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腹腔镜直肠癌根治术中保留盆自主神经的关键技术与意义

冯波¹^,^†(

), 苏浩¹

^1. 上海交通大学医学院附属瑞金医院胃肠外科　上海市微创外科临床医学中心

收稿日期:2018-01-23 出版日期:2019-02-26
通信作者: 冯波

Techniques and significance of pelvic autonomic nerve preservation in laparoscopic total mesorectal excison for rectal cancer

Bo Feng¹^,^†(), Hao Su¹

^1. Department of gastrointestinal surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai minimally invasive center

Received:2018-01-23 Published:2019-02-26
Corresponding author: Bo Feng
About author:
Corresponding author: Feng Bo, Email: fengbo2022@163.com
Supported by:
Key project of Shanghai Municipal Commission of Health and Family Planning(No.201640030); Key project of Shanghai MunicipalScience and Technology Commission(No.11411950703); Shanghai Jiao Tong University Medicine-Engineering Interdisciplinary Crossing project(No.YG2013MS26)

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直肠癌术中盆自主神经(PAN)的损伤是患者术后排尿功能和性功能障碍的主要原因之一。术中盆自主神经的精准辨认和保护始终是直肠癌根治术的要点与难点。术者应熟悉PAN的走行，把握直肠周围筋膜的解剖层次，才能维持正确的外科平面(surgical plane)，最大程度降低盆神经损伤概率。高清腹腔镜设备及应用解剖技术的进展使外科医生更精准地辨认PAN、血管、筋膜等重要解剖结构。本文对腹腔镜下直肠癌根治术中保留PAN的关键技术和意义作一综述。

关键词: 直肠肿瘤, 肠系膜, 腹腔镜, 自主神经系统

Intraoperative pelvic autonomic nerve (PAN) damage is major reason of postoperative urogenital dysfunction in treating patients with rectal cancer. The accurate identification and preservation of PAN, which should be tricky during the operation, is the key points of proctectomy. In order to maintain the dissection in the right surgical plane, the surgeon should be familiar with both anatomy of PAN and perirectal fascia, thus could minimize the damage to PAN.Nowadays, by using advanced laparoscopic equipment and evolvement of pelvic anatomical theory, the surgeons could discriminate the configurations of nerves, vessels and fascia in pelvis in a more precise and efficient way. In this review, we stressed the significance of pelvic autonomic nerve preservation in proctectomy for rectal cancer, and discussed a few surgical techniques to do that.

Key words: Rectal neoplasms, Mesentery, Laparoscopes, Autonomic nervous system

图1 盆内脏神经术中示意图

图2 直肠周围结构示意图

图3 直肠前间隙手术示意图

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Techniques and significance of pelvic autonomic nerve preservation in laparoscopic total mesorectal excison for rectal cancer

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Techniques and significance of pelvic autonomic nerve preservation in laparoscopic total mesorectal excison for rectal cancer