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首页> 外文期刊>Surgical Endoscopy >The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3-lymphadenectomy in right colon cancer
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The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3-lymphadenectomy in right colon cancer

机译：FERDET的融合筋膜：右结肠癌完全切除切除和D3淋巴结切除术的重要胚胎学位

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Background The fusion fascia of Toldt is a well-known landmark used by colorectal surgeons. On the contrary, the fusion fascia of Fredet (the plane between the ascending mesocolon and the visceral duodenal-pancreatic peritoneum) still remains a neglected embryological structure. Aim of this study was to provide an anatomic description of this fascia and its application to minimally invasive D3-lymphadenectomy (D3-L) and complete mesocolic excision (CME) for right colon cancer. Methods First phase: Cadaveric dissection and anatomic description of the fascia of Fredet. Second phase: prospective evaluation of its surgical application in a consecutive series of laparoscopic right hemicolectomies with CME and D3-L at a tertiary hospital. Results The fascia of Fredet was identified and dissected in one fresh and two formalin-fixed cadavers. The trunk of Henle and the medial border of the superior mesenteric vein defined the medial limit of this embryologic plane. Seventeen patients were operated on. Laparoscopic dissection of the fascia of Fredet was possible in every patient. Median operative time was 210 (120-380) min. There were no major postoperative complications. All cases were adenocarcinomas, except one adenomatous polyp. T stage was Tis in three, T2 in two, T3 in seven, and T4 in five patients. Median number of harvested lymph nodes was 24 (9-39). Lymphatic invasion was found in six patients. All resections were classified as satisfactory mesocolic excision and R0. Median postoperative length of stay was 6 (4-20) days. Median follow-up time was 28 (16-41) months. Local and distal recurrence rate was 0. Conclusion The fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons.
机译：背景技术德国的融合筋膜是着色外科医生使用的着名地标。相反，Fredet的融合筋膜（上升的内核和内发蛋白 - 胰腹膜腹膜之间的平面）仍然是忽略胚胎结构。本研究的目的是提供对该筋膜的解剖学描述及其在微创D3淋巴结切除术（D3-L）和右结肠癌的完全中殖民切除（CME）的应用。方法第一阶段：尸体解剖和皱纹筋膜的解剖学描述。第二阶段：在第三级医院的CME和D3-L中连续系列的腹腔镜右半结肠切除术治疗其手术应用的前瞻性评价。结果覆盖弗雷迪特的筋膜，并在一个新鲜和两个福尔马林固定的尸体中解剖。 HENLE的躯干和高级肠系膜静脉的内侧边界定义了这种胚胎植物的内侧限制。 17名患者被操作。每位患者都有可能腹腔镜解剖筋膜筋膜。中位数手术时间为210（120-380）分钟。没有主要的术后并发症。除了一种腺瘤息肉外，所有病例均为腺癌。 T阶段是三，T2的TIS，七个，T3和5名患者的T4。收获淋巴结的中位数为24（9-39）。在六名患者中发现了淋巴侵袭。所有切除术均被归类为令人满意的中思肠切除和R0。中位术后逗留时间为6（4-20）天。中位后续时间为28（16-41）个月。局部和远端复发率为0.结论Fredet的融合筋膜可用于在右上结肠癌中实现CME和D3-L，降低术目不然并发症的风险。这种结构特别适用于微创手术;因此，我们鼓励通过结直肠外科医生了解弗雷迪特的筋膜。

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