\u80cc\u666f\uff1a\u4f20\u7edf\u5168\u76f4\u80a0\u7cfb\u819c\u5207\u9664\u540e\u4f34\u968f\u9ad8\u7684\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u969c\u788d\uff0c\u5b66\u8005\u4eec\u56e0\u6b64\u5bf9\u6807\u51c6\u624b\u672f\u5206\u89e3\u65b9\u5f0f\u4ea7\u751f\u8d28\u7591\u3002\u6211\u4eec\u63d0\u51fa\u5728\u76f4\u80a0\u764c\u624b\u672f\u4e2d\u4fdd\u7559\u9093\u6c0f\u7b4b\u819c\u7684\u5fc5\u8981\u6027\u3002\u4f46\u662f\uff0c\u5982\u4f55\u51c6\u786e\u627e\u5230\u9093\u6c0f\u7b4b\u819c\uff1f\u672c\u7814\u7a76\u65e8\u5728\u901a\u8fc7\u6bd4\u8f83\u5c38\u4f53\u89e3\u5256\u7ed3\u679c\u548c\u624b\u672f\u5f55\u50cf\u89c2\u5bdf\u6765\u63a2\u8ba8\u9093\u6c0f\u7b4b\u819c\u7684\u89e3\u5256\u7279\u5f81\uff0c\u4ece\u800c\u63d0\u51fa\u4e00\u79cd\u5728\u76f4\u80a0\u764c\u624b\u672f\u4e2d\u4fdd\u7559\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u7684\u5206\u79bb\u65b9\u6cd5\u3002<\/p>\n
\u65b9\u6cd5\uff1a2009\u5e741\u6708\u81f32019\u5e741\u6708\u4e4b\u95f4\uff0c\u8fdb\u884c\u4e865\u4e2a\u6210\u5e74\u7537\u6027\u5c38\u4f53\u89e3\u5256\uff0c\u5e76\u56de\u987e\u4e86135\u4f8b\u56e0\u4e2d\u4f4e\u4f4d\u76f4\u80a0\u764c\u63a5\u53d7\u76f4\u80a0\u5168\u7cfb\u819c\u5207\u9664\u624b\u672f\u7684\u60a3\u8005\u624b\u672f\u5f55\u50cf\uff0c\u4ece\u800c\u5bfb\u627e\u548c\u6bd4\u8f83\u9093\u6c0f\u7b4b\u819c\u7684\u7ed3\u6784\u3002<\/p>\n
\u7ed3\u679c\uff1a\u57285\u5177\u7537\u6027\u5c38\u4f53\u6807\u672c\u4e2d\u89c2\u5bdf\u5230\u9093\u6c0f\u7b4b\u819c\u7684\u5355\u5c42\u7ed3\u6784\uff0c\u5176\u4f4d\u4e8e\u76f4\u80a0\u3001\u8180\u80f1\u5e95\u3001\u7cbe\u56ca\u3001\u8f93\u7cbe\u7ba1\u548c\u524d\u5217\u817a\u4e4b\u95f4\u3002\u9093\u6c0f\u7b4b\u819c\u8d77\u6e90\u4e8e\u76f4\u80a0\u8180\u80f1\u53cd\u6298\uff0c\u5411\u5c3e\u4fa7\u4e0e\u524d\u5217\u817a\u9876\u7aef\u7684\u76f4\u80a0\u5c3f\u9053\u808c\u878d\u5408\uff0c\u5e76\u5728\u4e24\u4fa7\u4e0e\u4fa7\u65b9\u97e7\u5e26\u878d\u5408\u3002\u5728\u4e2d\u90e8\u8be5\u7b4b\u819c\u53d8\u8584\uff0c\u539a\u5ea6\u4e3a1.06+-0.1mm\u3002\u9093\u6c0f\u7b4b\u819c\u7684\u7687\u51a0\u5f62\u72b6\u6709\u4e00\u70b9\u5448\u4e09\u89d2\u5f62\uff0c\u4e2d\u95f4\u7684\u9ad8\u5ea6\u5927\u7ea6\u57285.42+-0.16cm\u3002\u795e\u7ecf\u5728\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u5206\u5e03\u6bd4\u540e\u65b9\u5bc6\u96c6\uff0c\u7279\u522b\u5728\u4e24\u4fa7\u3002\u5728\u8179\u8154\u955c\u4e0b\uff0c\u9093\u6c0f\u7b4b\u819c\u8d77\u6e90\u4e8e\u76f4\u80a0\u8180\u80f1\u9677\u51f9\u7684\u6700\u4f4e\u70b9\uff0c\u5f62\u6210\u4e00\u4e2a\u589e\u539a\u7684\u767d\u7ebf\uff0c\u53ef\u4ee5\u505a\u4e3a\u5bfb\u627e\u9093\u6c0f\u7b4b\u819c\u7684\u826f\u597d\u6807\u5fd7\u3002<\/p>\n
\u7ed3\u8bba\uff1a\u627e\u5230\u9093\u6c0f\u7b4b\u819c\u7684\u624b\u672f\u6307\u793a\u7ebf\u53ef\u4ee5\u5e2e\u52a9\u6211\u4eec\u627e\u5230\u9093\u6c0f\u7b4b\u819c\uff0c\u63d0\u9ad8\u6211\u4eec\u5728\u76f4\u80a0\u764c\u884c\u5168\u7cfb\u819c\u5207\u9664\u672f\u4e2d\u4fdd\u7559\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u529f\u80fd\u7684\u80fd\u529b\u3002<\/p>\n
In 1982,Heald et al. proposed the theory of total mesorectal excision as the gold standard surgery for rectal cancer. However, after traditional TME, the occurrence rate of urogenital dysfunction was still high. The reason is that the surgery directly damages the pelvic autonomic nerves.<\/p>\n
\u57281982\u5e74\uff0cHeald\u7b49\u63d0\u51fa\u4e86\u76f4\u80a0\u5168\u7cfb\u819c\u5207\u9664\uff0c\u4f5c\u4e3a\u76f4\u80a0\u764c\u624b\u672f\u7684\u6807\u51c6\u672f\u5f0f\u3002\u4f46\u662f\uff0c\u5728\u4f20\u7edf\u76f4\u80a0\u5168\u7cfb\u819c\u5207\u9664\u672f\u540e\uff0c\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u969c\u788d\u7684\u53d1\u751f\u7387\u4ecd\u5f88\u9ad8\u3002\u539f\u56e0\u662f\u624b\u672f\u533b\u751f\u76f4\u63a5\u635f\u4f24\u4e86\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u3002<\/p>\n
Because the pelvic autonomic nerve is thick in the retrorectal and lateral space, it is easy to be identified at this site in a TME surgery, especially under laparoscopy. However, the distribution of the pelvic autonomic nerves in front of the rectum is clump-like and difficult to identify, challenging the dissection of the anterior wall of the rectum.<\/p>\n
\u56e0\u4e3a\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u5728\u76f4\u80a0\u540e\u548c\u4fa7\u65b9\u95f4\u9699\u539a\uff0c\u56e0\u6b64\u53ef\u4ee5\u5728\u76f4\u80a0\u5168\u7cfb\u819c\u5207\u9664\u672f\u4e2d\u8f7b\u677e\u627e\u5230\u8be5\u795e\u7ecf\uff0c\u7279\u522b\u662f\u5728\u8179\u8154\u955c\u4e0b\uff0c\u4f46\u662f\uff0c\u5728\u76f4\u80a0\u524d\u65b9\uff0c\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u7684\u5206\u5e03\u5448\u675f\u72b6\uff0c\u96be\u4ee5\u5b9a\u4f4d\uff0c\u56e0\u6b64\u5728\u76f4\u80a0\u524d\u58c1\u5206\u79bb\u65f6\u975e\u5e38\u56f0\u96be\u3002<\/p>\n
Autopsy identification of the Denonvilliers’fascia<\/p>\n
TME was performed by incisively dissociating the rectum using the intermediate approach, pulling the rectum forward, dissecting the mesorectum along the retroperitoneum, continuing the dissection along the rectum intrinsic fascia, posteriorly entering the retrorectal space until reaching the pelvic floor. The left side of thin layered retroperitoneum was dissected and opened, reaching the back side, followed by dissecting through the anterior peritoneum,dissociating the bladder and the rectal preperitoneum until reaching the Douglas fossa and joining the top of Denonvilliers’ fascia. The Denonvilliers’ fascia was dissociated between the seminal vesicle and the rectum to maintain its integrity.<\/p>\n
Dissection was performed between the fascia propria of the rectum and the presacral fascia posteriorly in the retrorectal space that contains loose areolar tissue and is devoid of vessels and nerves, leaving the dense and tough tissue strips laterally which are the lateral ligaments. The medial pelvis was divided into the left and right parts along the median sagittal plane, pulling the lateral rectum laterally, and the posterior lateral plexus was further dissociated to expose the hypogastric nerve to find the anatomical relationship between the Denonvilliers’ fascia and the lower abdomen. The start and end points of the Denonvilliers’ fascia were confirmed, the fascia was extracted, and the length of the fascia was measured and recorded.<\/p>\n
\u5c38\u4f53\u89e3\u5256\u4e2d\u5bfb\u627e\u9093\u6c0f\u7b4b\u819c<\/p>\n
\u4e2d\u95f4\u5165\u8def\u5207\u5f00\u5206\u79bb\u76f4\u80a0\u8fdb\u884c\u76f4\u80a0\u5168\u7cfb\u819c\u5207\u9664\u624b\u672f\uff0c\u5c06\u76f4\u80a0\u5411\u524d\u7275\u5f15\uff0c\u5c06\u76f4\u80a0\u7cfb\u819c\u6cbf\u7740\u540e\u8179\u819c\u5206\u79bb\uff0c\u6301\u7eed\u6cbf\u7740\u76f4\u80a0\u5185\u7b4b\u819c\u5206\u79bb\uff0c\u540e\u65b9\u8fdb\u5165\u76f4\u80a0\u540e\u95f4\u9699\uff0c\u76f4\u81f3\u5230\u8fbe\u76c6\u5e95\u3002\u5206\u79bb\u6253\u5f00\u8584\u7684\u5de6\u4fa7\u540e\u8179\u819c\uff0c\u5230\u8fbe\u540e\u65b9\uff0c\u7136\u540e\u5206\u79bb\u524d\u65b9\u8179\u819c\uff0c\u5206\u79bb\u8180\u80f1\u548c\u76f4\u80a0\u524d\u8179\u819c\uff0c\u76f4\u81f3\u5230\u8fbe\u5b50\u5bab\u76f4\u80a0\u9677\u51f9\uff0c\u63a5\u5165\u9093\u6c0f\u7b4b\u819c\u7684\u9876\u7aef\u3002\u5c06\u8be5\u7b4b\u819c\u5728\u7cbe\u56ca\u548c\u76f4\u80a0\u4e4b\u95f4\u5206\u79bb\uff0c\u4ece\u800c\u7ef4\u6301\u5176\u5b8c\u6574\u6027\u3002<\/p>\n
\u5728\u76f4\u80a0\u7b4b\u819c\u548c\u9ab6\u524d\u7b4b\u819c\u4e4b\u95f4\u7684\u76f4\u80a0\u540e\u95f4\u9699\u5185\uff0c\u5206\u79bb\u758f\u677e\u65e0\u8840\u7ba1\u795e\u7ecf\u7ec4\u7ec7\uff0c\u4fdd\u7559\u4e24\u4fa7\u81f4\u5bc6\u575a\u786c\u7684\u7ec4\u7ec7\uff0c\u5373\u4fa7\u65b9\u97e7\u5e26\uff0c\u4e2d\u76c6\u8154\u6cbf\u7740\u6b63\u4e2d\u5e73\u9762\u5206\u4e3a\u5de6\u53f3\u4fa7\uff0c\u5c06\u76f4\u80a0\u5411\u4fa7\u65b9\u7275\u62c9\uff0c\u8fdb\u4e00\u6b65\u5206\u79bb\u540e\u4fa7\u4e1b\uff0c\u66b4\u9732\u8179\u4e0b\u795e\u7ecf\uff0c\u4ece\u800c\u53d1\u73b0\u9093\u6c0f\u7b4b\u819c\u548c\u4e0b\u8179\u7684\u89e3\u5256\u5173\u7cfb\u3002\u786e\u5b9a\u9093\u6c0f\u7b4b\u819c\u7684\u8d77\u59cb\u70b9\uff0c\u7136\u540e\u53bb\u9664\u8be5\u7b4b\u819c\uff0c\u6d4b\u91cf\u5e76\u8bb0\u5f55\u8be5\u7b4b\u819c\u7684\u957f\u5ea6\u3002<\/p>\n
There weren’t controversies regarding the separation of the posterior and lateral rectal walls. The correct plane for separation of the posterior and lateral rectal walls was avscular in most cases except where it was crossed by the lateral ligaments. By pursuing the lipoma-like outer surface of the mesorectum, the autonomic nerve pelxuses could be preserved. The lateral ligaments could simply be cut by Harmonic Ultrasonic Knives. Hoever, the distribution of the pelvic autonomic nerves in the anterior rectal wall is complicated and difficult to recognize.<\/p>\n
\u5bf9\u4e8e\u76f4\u80a0\u540e\u58c1\u548c\u4fa7\u58c1\u7684\u5206\u79bb\u6ca1\u6709\u4e89\u8bae\u3002\u5728\u5927\u591a\u6570\u75c5\u4f8b\u4e2d\uff0c\u4fa7\u65b9\u548c\u540e\u65b9\u7684\u5206\u79bb\u5e73\u9762\u662f\u65e0\u8840\u7684\uff0c\u9664\u4e86\u5728\u4fa7\u65b9\u97e7\u5e26\u8de8\u8fc7\u5904\u3002\u901a\u8fc7\u9075\u5faa\u76f4\u80a0\u7cfb\u819c\u7684\u8102\u80aa\u6837\u5916\u8868\u9762\uff0c\u53ef\u4ee5\u4fdd\u7559\u81ea\u4e3b\u795e\u7ecf\u4e1b\u3002\u4fa7\u65b9\u97e7\u5e26\u53ef\u4ee5\u7528\u8d85\u58f0\u5e26\u79bb\u65ad\u3002\u4f46\u662f\uff0c\u5728\u76f4\u80a0\u524d\u65b9\u7684\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u5c31\u5f88\u590d\u6742\uff0c\u96be\u4ee5\u8bc6\u522b\u3002<\/p>\n
Heald et al. believed that the Denonvilliers’ fascia is the front boundary of the rectal intrinsic fascia and acts as a barrier to rectal cancer. Therefore, TME should be performed in front of the Denonvilliers’ fascia to completely remove the mesorectum so that no residual tumor is left. This operative procedure is widely accepted all over the world.<\/p>\n
Heald\u7b49\u76f8\u4fe1\u9093\u6c0f\u7b4b\u819c\u662f\u76f4\u80a0\u5185\u7b4b\u819c\u7684\u524d\u65b9\u8fb9\u754c\uff0c\u53ef\u4ee5\u4f5c\u4e3a\u76f4\u80a0\u764c\u7684\u5c4f\u969c\u3002\u56e0\u6b64\uff0c\u76f4\u80a0\u7cfb\u819c\u5207\u9664\u672f\u5e94\u8be5\u5728\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u8fdb\u884c\uff0c\u4ece\u800c\u5b8c\u5168\u5207\u9664\u76f4\u80a0\u7cfb\u819c\uff0c\u786e\u4fdd\u6ca1\u6709\u80bf\u7624\u6b8b\u7559\u3002\u8fd9\u4e00\u624b\u672f\u64cd\u4f5c\u88ab\u5168\u4e16\u754c\u6240\u8ba4\u53ef\u3002<\/p>\n
According to our anatomical observations, the Denonvilliers’fascia terminates at the lateral ligaments, which present as constant, dense connective bundles that are located on the lateral sides of the lower part of the rectum and extend between the rectal visceral fascia and pelvic parietal fascia, above the levator ani. The lateral ligaments constitue the inferior hypogastric plexus that gives rise to the rectal plexus, extends toward the rectum and the vessels from the lower part of the rectum toward the iliac lymph nodes. A small branch of the internal pudendal artery lies in front of the fascia, and nerve fibers from the lateral ligaments form a neurovascular bundle in the anterolateral side of the Denonvilliers’fascia. The components of the inferior hypogastric plexus include some parasympathetic nerves and are closely related to urogenital function.<\/p>\n
\u6839\u636e\u6211\u4eec\u7684\u89e3\u5256\u89c2\u5bdf\uff0c\u9093\u6c0f\u7b4b\u819c\u7ec8\u6b62\u4e8e\u4fa7\u65b9\u97e7\u5e26\uff0c\u540e\u8005\u662f\u4e00\u4e2a\u6052\u5b9a\u7684\u81f4\u5bc6\u7ed3\u7f14\u7ec4\u7ec7\u7ea4\u7ef4\u675f\uff0c\u4f4d\u4e8e\u76f4\u80a0\u4e0b\u90e8\u7684\u4e24\u4fa7\uff0c\u5728\u76f4\u80a0\u810f\u5c42\u7b4b\u819c\u548c\u76c6\u8154\u58c1\u5c42\u7b4b\u819c\u4e4b\u95f4\u5ef6\u4f38\uff0c\u5728\u809b\u63d0\u808c\u4e0a\u65b9\u3002\u4fa7\u65b9\u97e7\u5e26\u5305\u542b\u4e0b\u8179\u4e0b\u795e\u7ecf\u4e1b\uff0c\u5176\u53d1\u51fa\u76f4\u80a0\u4e1b\uff0c\u5ef6\u4f38\u5230\u76f4\u80a0\u548c\u76f4\u80a0\u4e0b\u90e8\u7684\u8840\u7ba1\uff0c\u671d\u7740\u9ac2\u5185\u5185\u6dcb\u5df4\u7ed3\u3002\u9634\u90e8\u5185\u52a8\u8109\u7684\u4e00\u4e2a\u5c0f\u5206\u652f\u4f4d\u4e8e\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\uff0c\u4fa7\u65b9\u97e7\u5e26\u7684\u795e\u7ecf\u5f62\u6210\u4e00\u4e2a\u795e\u7ecf\u8840\u7ba1\u675f\uff0c\u4f4d\u4e8e\u9093\u6c0f\u7b4b\u819c\u7684\u524d\u5916\u4fa7\u3002\u4e0b\u8179\u4e0b\u795e\u7ecf\u4e1b\u7684\u7ec4\u6210\u5305\u62ec\u4e00\u4e9b\u526f\u4ea4\u611f\u795e\u7ecf\uff0c\u548c\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u5bc6\u5207\u76f8\u5173\u3002<\/p>\n
If the dissection is performed behind the Denonvilliers’fascia, it would damage the rectal intrinsic fascia, destroy the mesangial tissue, and affect radical tumor resection. If the dissection is performed in front of the Denonvilliers’fascia, well-defined, bead-like plump seminar vesicles and the prostate could be located. However, if a slight inadvertent injury to the neurovascular bundle occurs in the anterolateral side of the Denonvilliers’fascia, the visual field would be stained by blood, and the anatomical structures would be unclear, resulting in damage to the parasympathetic corpus cavernosum. Additonally, it is easy to damage the parasympathetic corpus cavernosum from the pelvic plexus in front of the Denonvilliers’fascia, which plays an important compensatory role in the damage of the pelvic wall and cause urogenital dysfunction. We believe that the preservation of the Denonvilliers’ fascia is of great significance in reducing the rate of postoperative urogenical dysfunction in rectal cancer patients, which is supported by the results from other studies.<\/p>\n
\u5982\u679c\u89e3\u5256\u5728\u9093\u6c0f\u7b4b\u819c\u540e\u65b9\u8fdb\u884c\uff0c\u5c31\u4f1a\u635f\u4f24\u76f4\u80a0\u5185\u5728\u7b4b\u819c\uff0c\u7834\u574f\u819c\u7ec4\u7ec7\uff0c\u5f71\u54cd\u80bf\u7624\u5e7f\u6cdb\u5207\u9664\u3002\u5982\u679c\u89e3\u5256\u5728\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u8fdb\u884c\uff0c\u8fb9\u754c\u6e05\u695a\u7684\uff0c\u67f1\u5b50\u6837\u7684\u7cbe\u56ca\u548c\u524d\u5217\u817a\u5c31\u53ef\u4ee5\u770b\u5230\u3002\u4f46\u662f\uff0c\u8f7b\u5fae\u7684\u610f\u5916\u635f\u4f24\u5230\u9093\u6c0f\u7b4b\u819c\u524d\u5916\u4fa7\u7684\u795e\u7ecf\u8840\u7ba1\u675f\uff0c\u8840\u6db2\u5c31\u4f1a\u7834\u574f\u672f\u91ce\uff0c\u89e3\u5256\u7ed3\u6784\u5c31\u4f1a\u6a21\u7cca\uff0c\u5bfc\u81f4\u635f\u4f24\u5468\u56f4\u7684\u526f\u4ea4\u611f\u6d77\u7ef5\u4f53\u3002\u6b64\u5916\uff0c\u5f88\u5bb9\u6613\u635f\u4f24\u8d77\u6e90\u4e8e\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u76c6\u4e1b\u7684\u526f\u4ea4\u611f\u795e\u7ecf\u6d77\u7ef5\u4f53\uff0c\u5176\u5bf9\u4e8e\u76c6\u58c1\u635f\u4f24\u6709\u91cd\u8981\u7684\u4ee3\u507f\u4f5c\u7528\uff0c\u4ece\u800c\u5bfc\u81f4\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u5931\u8c03\u3002\u6211\u4eec\u76f8\u4fe1\u4fdd\u7559\u9093\u6c0f\u7b4b\u819c\uff0c\u5bf9\u4e8e\u51cf\u5c11\u76f4\u80a0\u764c\u60a3\u8005\u672f\u540e\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u969c\u788d\u975e\u5e38\u91cd\u8981\uff0c\u8fd9\u4e00\u70b9\u5f97\u5230\u5176\u5b83\u7814\u7a76\u7684\u652f\u6301\u3002<\/p>\n
In clinical practice, most surgeons are unable to accurately identify the Denonvilliers’fascia, leading to the destruction of the Denonvilliers’fascia and damage to the pelvic autonomic nerves. At present, a popular practice is to incise the rectovesical pouch at the point of 1cm above the peritoneal reflection. It would enter the surgical plane in front of the Denonvilliers’fascia and then sperarates in the loose space in front of the Denonvilliers’fascia. This process coincides with the modified ‘U’-shaped resection of the Denonvilliers’fascia proposed by Heald et al. Although this method preserves the anterolateral side of the Denonvilliers’fascia to avoid damage to the inferior hypogastric plexus, it still damages the ramus communicans in front of the Denonviiliers’fascia and damages the pelvic autonomic nerves. Our clinical observations showed that this method did not cause significant sexual dysfunction.<\/p>\n
\u5728\u4e34\u5e8a\u5b9e\u8df5\u4e2d\uff0c\u5927\u591a\u6570\u624b\u672f\u533b\u751f\u4e0d\u80fd\u51c6\u786e\u627e\u5230\u9093\u6c0f\u7b4b\u819c\uff0c\u5bfc\u81f4\u635f\u4f24\u9093\u6c0f\u7b4b\u819c\u548c\u76c6\u8154\u81ea\u4e3b\u795e\u7ecf\u3002\u76ee\u524d\uff0c\u4e00\u4e2a\u5e38\u7528\u7684\u65b9\u6cd5\u662f\u5728\u76f4\u80a0\u8180\u80f1\u9677\u51f9\u5904\u8179\u819c\u53cd\u6298\u4e0a\u65b91cm\u5207\u5f00\uff0c\u7136\u540e\u8fdb\u5165\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u7684\u624b\u672f\u5e73\u9762\uff0c\u7136\u540e\u5728\u6b64\u5904\u7684\u758f\u677e\u95f4\u9699\u7b4b\u819c\u5206\u79bb\u3002\u8fd9\u4e00\u8fc7\u7a0b\u4e0eHeald\u7b49\u63d0\u51fa\u7684U\u5f62\u5207\u5f00\u76f8\u4f3c\u3002\u5c3d\u7ba1\u8fd9\u4e00\u65b9\u6cd5\u4fdd\u7559\u4e86\u9093\u6c0f\u7b4b\u819c\u524d\u5916\u4fa7\uff0c\u4ece\u800c\u907f\u514d\u635f\u4f24\u4e0b\u8179\u4e0b\u795e\u7ecf\u4e1b\uff0c\u4f46\u4ecd\u7136\u635f\u4f24\u4e86\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u7684\u5206\u652f\uff0c\u635f\u5bb3\u76c6\u8154\u81ea\u4e3b\u795e\u7a76\u7adf\u3002\u6211\u4eec\u7684\u4e34\u5e8a\u89c2\u5bdf\u53d1\u73b0\u8fd9\u4e00\u65b9\u6cd5\u4e0d\u4f1a\u5bfc\u81f4\u660e\u663e\u7684\u6027\u529f\u80fd\u969c\u788d\u3002<\/p>\n
We combined cadaver dissection with surgical video observations and found that the Denonvilliers’fascia was originated at the rectovesical pouch, presenting as a thickened white strip\/line. The thickened white line is a good mark for identifying the Denonvilliers’fascia. Our results indicate that if a dissection is made in front of the white line, the ramus communicans in front of the Denonvilliers’fascia woudl be damaged. However, if a dissection is performed behind the white line, damages to the inferior hypogastric plexus and the ramus communicans in front of the Denonvilliers’fascia could be avoided.<\/p>\n
\u6211\u4eec\u8054\u5408\u5c38\u4f53\u89e3\u5256\u548c\u624b\u672f\u5f55\u50cf\u89c2\u5bdf\uff0c\u7ed3\u679c\u53d1\u73b0\u9093\u6c0f\u7b4b\u819c\u8d77\u6e90\u4e8e\u76f4\u80a0\u8180\u80f1\u53cd\u6298\uff0c\u8868\u73b0\u4e3a\u4e00\u4e2a\u589e\u539a\u7684\u767d\u8272\u6761\u5e26\u3002\u589e\u539a\u7684\u767d\u7ebf\u662f\u4e00\u4e2a\u786e\u5b9a\u9093\u6c0f\u7b4b\u819c\u7684\u826f\u597d\u6807\u5fd7\u3002\u6211\u4eec\u7684\u7ed3\u679c\u63d0\u793a\uff0c\u5982\u679c\u5728\u767d\u7ebf\u524d\u65b9\u5206\u79bb\uff0c\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u7684\u795e\u7ecf\u5206\u652f\u5c31\u4f1a\u635f\u4f24\uff0c\u4f46\u662f\u5982\u679c\u5728\u767d\u7ebf\u540e\u65b9\u5206\u79bb\uff0c\u5c31\u53ef\u4ee5\u907f\u514d\u635f\u4f24\u4e0b\u8179\u4e0b\u795e\u7ecf\u4e1b\u548c\u9093\u6c0f\u7b4b\u819c\u524d\u65b9\u7684\u795e\u7ecf\u5206\u652f\u3002<\/p>\n<\/p>\n<\/p>\n
\u6765\u6e90\uff1aHuang J, Liu J, Fang J, Zeng Z, Wei B, Chen T, Wei H. Identification of the surgical indication line for the Denonvilliers’ fascia and its anatomy in patients with rectal cancer. Cancer Commun (Lond). 2020 Jan;40(1):25-31. doi: 10.1002\/cac2.12003. Epub 2020 Feb 18. PMID: 32067419; PMCID: PMC7163926.<\/p>\n
\u70b9\u8bc4\uff1a\u903b\u8f91\u975e\u5e38\u6e05\u695a\u7684\u4e00\u7bc7\u6587\u7ae0\uff0c\u975e\u5e38\u9ad8\u5174\u80fd\u591f\u5728\u56fd\u9645\u6742\u5fd7\u4e0a\u770b\u5230\u8d8a\u6765\u8d8a\u591a\u7684\u4e2d\u56fd\u4e34\u5e8a\u533b\u751f\u53d1\u8868\u7684\u624b\u672f\u6587\u732e\u3002\u89e3\u5256\u662f\u624b\u672f\u7684\u7075\u9b42\uff0c\u7b80\u5355\u5355\u7eaf\u7684\u91cd\u590d\u6ca1\u6709\u610f\u4e49\uff0c\u66f4\u4f55\u51b5\uff0c\u9519\u8bef\u91cd\u590d\u4e00\u5343\u6b21\uff0c\u4e5f\u4f9d\u7136\u8fd8\u662f\u9519\u8bef\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"
\u80cc\u666f\uff1a\u4f20\u7edf\u5168\u76f4\u80a0\u7cfb\u819c\u5207\u9664\u540e\u4f34\u968f\u9ad8\u7684\u6ccc\u5c3f\u751f\u6b96\u529f\u80fd\u969c\u788d\uff0c\u5b66\u8005\u4eec\u56e0\u6b64\u5bf9\u6807\u51c6\u624b\u672f\u5206\u89e3\u65b9\u5f0f … \u7ee7\u7eed\u9605\u8bfb