Chapuis Pierre, Bokey Les, Fahrer Marius, Sinclair Gael, Bogduk Nikolai
Department of Colon and Rectal Surgery, The University of Sydney at Concord Hospital, New South Wales, Australia.
Dis Colon Rectum. 2002 Jan;45(1):1-8; discussion 8-9. doi: 10.1007/s10350-004-6104-5.
Sound surgical technique is based on accurate anatomic knowledge. In surgery for cancer, the anatomy of the perirectal fascia and the retrorectal plane is the basis for correct mobilization of the rectum to ensure clear surgical margins and to minimize the risk of local recurrence.
This review of the literature on the perirectal fascia is based on a translation of the original description by Thoma Jonnesco and a later account by Wilhelm Waldeyer. The Jonnesco description, first published in 1896 in French, is compared with the German account of 1899. These were critically analyzed in the context of our own and other techniques of mobilizing the rectum.
Mobilization of the rectum for cancer can be performed along anatomic planes with minimal blood loss, preservation of the pelvic autonomic nerves and a low prevalence of local recurrence. Different techniques including total mesorectal excision are based on the same anatomic principles, however, popular words have been used to replace accepted, established terminology. In particular, the description of total mesorectal excision has been confusing because of its emphasis on the words "total" and "mesorectum." The use of the word "mesorectum" anatomically is inaccurate and the implication that total excision of all the perirectal fat contained within the perirectal fascia "en bloc" in all patients with rectal cancer will minimize local recurrence remains contentious.
精湛的外科技术基于准确的解剖学知识。在癌症手术中，直肠周围筋膜和直肠后平面的解剖结构是正确游离直肠以确保手术切缘清晰并降低局部复发风险的基础。
本关于直肠周围筋膜的文献综述基于托马·约内斯科的原始描述以及威廉·瓦尔代尔后来的阐述进行翻译。将1896年首次用法语发表的约内斯科描述与1899年的德语描述进行比较。并结合我们自己及其他直肠游离技术对这些描述进行批判性分析。
直肠癌的直肠游离可沿解剖平面进行，术中失血少，能保留盆腔自主神经且局部复发率低。包括全直肠系膜切除术在内的不同技术都基于相同的解剖学原理，然而，一些常用词汇取代了公认的、既定的术语。特别是，全直肠系膜切除术的描述一直令人困惑，因为它强调“全”和“直肠系膜”这两个词。从解剖学角度来看，“直肠系膜”一词不准确，而且认为在所有直肠癌患者中整块切除直肠周围筋膜内包含的所有直肠周围脂肪就能将局部复发风险降至最低这一观点仍存在争议。
