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| 1 | Identification of the surgical indication line for the Denonvilliers’fascia and its anatomy in patients with rectal cancer显示文摘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. | Jianglong Huang Jing Liu Jiafeng Fang Zongheng Zeng Bo Wei Tufeng Chen Hongbo Wei | 2020 | Cancer Communications2020，40，1： | 10 |
| 2 | 直肠癌患者Denonvilliers筋膜的手术标识线及其解剖结构的确定显示文摘背景与目的传统的全直肠系膜切除术(total mesorectal excision,TME)后泌尿生殖功能障碍的发生率很高,这引发了学者们对解剖分离标准方式的质疑。我们提出了保留直肠癌患者Denonvilliers筋膜的必要性。但是,如何准确定位Denonvilliers筋膜尚不清楚。本研究旨在通过比较大体解剖结果和手术录像的观察结果来探究Denonvilliers筋膜的解剖特征,进而提出一种在直肠癌手术中保留盆腔自主神经的解剖方法。方法通过解剖5例成年男性大体标本,并回顾了2009年1月至2019年2月期间135例接受中低位直肠癌TME手术患者的手术录像,以鉴定和比较Denonvilliers筋膜的结构。结果在5例男性大体标本中对Denonvilliers筋膜的单层结构进行了观察,其位于直肠、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陷窝(或直肠子宫陷窝),向下与前列腺顶部的直肠尿道肌的末端融合,并融合至两侧的外侧韧带。筋膜在中线较薄,厚度为1.06±0.10 mm。Denonvilliers筋膜的冠状面形状略呈三角形,中线高度为5.42±0.16 cm。Denonvilliers筋膜的前方比后方神经分布密集,在两侧更为显著。在腹腔镜观察下,Denonvilliers筋膜起源于直肠膀胱陷窝(或直肠–子宫陷窝)的最低点,并带有一条加粗的白线,可作为识别Denonvilliers筋膜的良好标识。结论确定Denonvilliers筋膜的手术标识线可以帮助我们识别Denonvilliers筋膜,更好地保护直肠癌患者接受TME手术后的骨盆自主神经功能。 | Jianglong Huang Jing Liu Jiafeng Fang Zongheng Zeng Bo Wei Tufeng Chen Hongbo Wei | 2020 | 癌症2020，39，5： | 0 |
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