Identification of the surgical indication line for the Denonvilliers' fascia and its anatomy in patients with rectal cancer
Identification of the surgical indication line for the Denonvilliers' fascia and its anatomy in patients with rectal cancer
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DOI：
10.1002/cac2.12003
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发表时间：
2020-02-18
影响因子：
16.2
通讯作者：
Wei, Hongbo
中科院分区：
文献类型：
--
作者：
Huang, Jianglong;Liu, Jing;Wei, Hongbo
背景 传统全直肠系膜切除术（TME）后泌尿生殖功能障碍的高发生率引起了学者们对解剖标准方式的质疑。我们提出了直肠癌患者保留 Denonvilliers 筋膜的必要性。然而，如何准确定位 Denonvilliers 筋膜尚不清楚。本研究旨在通过比较尸检结果和手术视频观察结果，探讨Denonvilliers筋膜的解剖特征，提出直肠癌手术中保留盆腔自主神经的解剖方法。方法解剖5具成年男性尸体标本，回顾2009年1月至2019年2月期间接受TME治疗的135例中低位直肠癌患者的手术视频，识别和比较Denonvilliers筋膜的结构。结果5例男性尸体标本中观察到Denonvilliers筋膜单层结构，位于直肠、膀胱底部、精囊、输精管和前列腺之间。 Denonvilliers筋膜起源于直肠膀胱囊（或直肠子宫囊），向下与前列腺顶端的直肠尿道肌尾部融合，并与两侧的外侧韧带融合。中线筋膜较薄，厚度为 1.06 +/- 0.10 毫米。 Denonvilliers 筋膜的冠部形状略呈三角形，中线高度约为 5.42 +/- 0.16 cm。神经分布在 Denonvilliers 筋膜前面比后面更密集，尤其是在筋膜两侧。腹腔镜下，Denonvilliers筋膜起源于直肠膀胱囊（或直肠-子宫囊）的最低点，有一条粗白线，是识别Denonvilliers筋膜的良好标志。结论 Denonvilliers筋膜手术指征线的识别可以帮助我们识别Denonvilliers筋膜，提高保护盆腔自主功能的能力。接受 TME 治疗直肠癌的患者。
Background The high rate of urogenital dysfunction after traditional total mesorectal excision (TME) has caused doubts among scholars on the standard fashion of dissection. We have proposed the necessity to preserve the Denonvilliers' fascia in patients with rectal cancer. However, how to accurately locate the Denonvilliers' fascia is unclear. This study aimed to explore anatomical features of the Denonvilliers' fascia by comparing autopsy findings and observations of surgical videos so as to propose a dissection method for the preservation of pelvic autonomic nerves during rectal cancer surgery.Methods Five adult male cadaver specimens were dissected, and surgical videos of 135 patients who underwent TME for mid-low rectal cancer between January 2009 and February 2019 were reviewed to identify and compare the structure of the Denonvilliers' fascia.Results The monolayer structure of the Denonvilliers' fascia was observed in 5 male cadaver specimens, and it was located between the rectum, the bottom of the bladder, the seminal vesicles, the vas deferens, and the prostate. The Denonvilliers' fascia was originated from the rectovesical pouch (or rectum-uterus pouch), down to fuse caudally with the rectourethral muscle at the apex of the prostate, and fused to the lateral ligaments on both sides. The fascia was thinner on the midline with a thickness of 1.06 +/- 0.10 mm. The crown shape of the Denonvilliers' fascia was slightly triangular, with a height of approximately 5.42 +/- 0.16 cm at midline. Nerves were more densely distributed in front of the Denonvilliers' fascia than behind, especially on both sides of it. Under laparoscopic view, the Denonvilliers' fascia was originated at the lowest point of the rectovesical pouch (or rectum-uterus pouch), with a thickened white line which was a good mark for identifying the Denonvilliers' fascia.Conclusion Identification of the surgical indication line for the Denonvilliers' fascia could help us identify the Denonvilliers' fascia, and it would improve our ability to protect the pelvic autonomic function of patients undergoing TME for rectal cancer.