Evaluation of anatomical landmarks for transanal total mesorectal excision based on MRI
Evaluation of anatomical landmarks for transanal total mesorectal excision based on MRI
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基于MRI的经肛门全直肠系膜切除术解剖标志评价
DOI：
10.1016/j.asjsur.2018.10.003
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发表时间：
2019
影响因子：
3.5
通讯作者：
Wang Shan
中科院分区：
文献类型：
--
作者：
Shen Zhanlong;Cheng Jin;Yin Mujun;Jiang Kewei;Xie Qiwei;Gao Zhidong;Bao Yudi;Wang Yi;Ye Yingjiang;Wang Shan
背景经肛门全直肠系膜切除术（taTME）是一种新颖的低位直肠癌保留括约肌手术。这种“自下而上”的方法对于结直肠外科医生来说并不熟悉，关键的解剖标志也不清楚。方法回顾性分析2015年至2016年的205例盆腔磁共振成像（MRI）病例。测量并分析直肠系膜后筋膜曲率、远端直肠系膜角、直肠系膜后筋膜长度、直肠系膜周围主要结构。 MRI上识别的标志在5例直肠癌患者的taTME手术中得到了验证。结果直肠后系膜筋膜锐角大部分位于尾骨韧带-尾骨的关节处。远端直肠系膜角度与性别和尾骨韧带-尾骨角度独立相关。通过 MRI 评估并在 taTME 手术期间进行验证的候选标志包括：前部：男性的精囊，而女性的子宫颈。腹膜反光是术中难以确认宫颈时的替代标志；后部：尾骨韧带-尾骨的关节。尾骨韧带-尾骨与S3单键S4的连接处是一个“过渡区”，S3单键S4的水平可以作为taTME过程中经肛门后解剖的终点标志。结论术前直肠系膜MRI几何测量可能对术前评估taTME手术的难度以及标准化taTME过程中的标志起到重要作用。
BackgroundTransanal total mesorectal excision (taTME) is a novel sphincter-preserving procedure for low rectal cancer. This “bottom to up” approach is unfamiliar to colorectal surgeons and the crucial anatomical landmarks also remain unclear.MethodsTwo hundred and five cases of pelvic magnetic resonance imaging (MRI) from 2015 to 2016 were reviewed. Curvature of posterior mesorectal fascia, distal mesorectal angle, length of posterior mesorectal fascia, main structures around the mesorectum were measured and analyzed. The landmarks identified on MRI were verified in taTME procedures of five rectal cancer patients.ResultsThe most of acute angles of posterior mesorectal fascia located at the joint of anococcygeal ligament-coccyx. Degree of distal mesorectal angle was independently correlated with gender and degree of angle of anococcygeal ligament-coccyx. Candidate landmarks evaluated by MRI with verification during taTME procedures included: anterior: seminal vesicle for male while cervix for female. And peritoneal reflection was a substitute landmark when cervix was hardly confirmed in operation; posterior: the joint of anococcygeal ligament-coccyx. The area between the joint of anococcygeal ligament-coccyx and S3single bondS4 was a “transitional zone”, the level of S3single bondS4 could be the as the terminal landmark of transanal posterior dissection during taTME.ConclusionsPreoperative MRI geometrical measurement of mesorectum might play an important role in evaluating the difficulty of taTME procedure before operation, as well as standardizing landmarks during taTME procedure.