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首页> 外文期刊>Surgical Endoscopy >Laparoscopic dissection of Denonvilliers' fascia and implications for total mesorectal excision for treatment of rectal cancer.
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Laparoscopic dissection of Denonvilliers' fascia and implications for total mesorectal excision for treatment of rectal cancer.

机译：Denonvilliers筋膜的腹腔镜解剖及其对直肠系膜全直肠切除的意义。

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AIM: To inspect Denonvilliers' fascia and its relationship with neighboring oncologically and functionally important anatomic structures by laparoscopic approach. METHODS: A total of 112 patients with middle or low rectal cancer were successfully treated by laparoscopic total mesorectal excision (TME). Digital versatile disk (DVD) recordings were retrieved for scrutiny of the whole dissection process of Denonvilliers' fascia and its contiguous anatomic structures. RESULTS: As highlighted in the attached video footage, for nearly all male patients (91%, n = 58), the boundaries of Denonvilliers' fascia could be clearly recognized by laparoscopy. Denonvilliers' fascia, varying in nature from a fragile translucent fibrous layer to a tough leathery membrane, manifests itself as a trapezoidal "apron" covering the glistening fatty tissues of the anterior mesorectum. Anterior dissection in TME can be efficiently continued downwards "in front of" Denonvilliers' fascia. When the prostate is reached, the natural surgical plane halts, and the dissection plane should be shifted to behind this fascia. In contrast, in female patients, Denonvilliers' fascia was much less obvious as a distinct fibrous layer than in male patients. The most appropriate term for the structure in between the rectum and vagina may be rectovaginal septum, in which there is no natural surgical plane, rather than Denonvilliers' fascia. CONCLUSIONS: By laparoscopic approach, the nature of Denonvilliers' fasciae in male and female patients can be better defined and facilitates more precise laparoscopic total mesorectal excision for rectal cancer.
机译：目的：通过腹腔镜检查法检查Denonvilliers的筋膜及其与相邻的在肿瘤学和功能上重要的解剖结构的关系。方法：通过腹腔镜全直肠系膜切除术（TME）成功治疗了112例中低位直肠癌患者。检索数字多功能磁盘（DVD）记录，以仔细检查Denonvilliers筋膜的整个解剖过程及其连续的解剖结构。结果：如所附视频片段中所突出显示，对于几乎所有男性患者（91％，n = 58），腹腔镜检查均可清楚地识别Denonvilliers筋膜的边界。 Denonvilliers筋膜的性质从脆弱的半透明纤维层到坚韧的皮革膜不等，其自身表现为梯形“围裙”，覆盖了前直肠系膜的闪亮脂肪组织。 TME的前部解剖可以在Denonvilliers筋膜“前方”有效地向下继续。到达前列腺后，自然手术平面停止，并且解剖平面应移至该筋膜后面。相反，在女性患者中，Denonvilliers筋膜作为明显的纤维层远不如男性患者明显。直肠和阴道之间的结构最合适的术语可能是直肠阴道隔，其中没有自然的手术平面，而不是Denonvilliers的筋膜。结论：通过腹腔镜方法，可以更好地定义男女患者Denonvilliers筋膜的性质，并有助于更精确地进行直肠癌的腹腔镜全直肠系膜切除术。

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