Takada Moriatsu, Ichihara Takao, Kuroda Yoshikazu
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kobe University, Japan.
Hepatogastroenterology. 2005 Nov-Dec;52(66):1722-4.
Total mesorectal excision (TME) based operation is now established as a standard procedure for patients with lower or middle third rectal cancer. Laparoscopic surgery has a great advantage in colorectal surgery, with good operative views, as well as benefit to the patients owing to less invasiveness, early recovery and shorter hospitalization. From April 2001 through March 2002, we assessed the laparoscopic TME for eight consecutive patients with rectal cancer in Kobe University Hospital (median age: 65.3). The procedure included sharp mesorectal dissection with high vascular ligation and preservation of autonomic pelvic nerves. During the laparoscopic TME, the hiatal ligament that is the sequence of anococcygeal raphe body can be identified with the traction of the rectum upward, and this fixes the posterior wall of the rectum to the levator hiatus. Resection of the hiatal ligament enables us to isolate the recto-anal canal up to the level of the internal anal sphincter. We conclude that identification of the hiatus ligament is essential to achieve the appropriate laparoscopic TME.
基于全直肠系膜切除术（TME）的手术目前已成为中低位直肠癌患者的标准手术方式。腹腔镜手术在结直肠手术中具有很大优势，手术视野良好，且由于侵袭性小、恢复快、住院时间短而对患者有益。从2001年4月至2002年3月，我们在神户大学医院对8例连续的直肠癌患者（中位年龄：65.3岁）进行了腹腔镜TME评估。该手术包括锐性直肠系膜分离、高位血管结扎以及保留自主盆腔神经。在腹腔镜TME过程中，通过向上牵拉直肠可识别作为肛门尾骨缝体延续的裂孔韧带，它将直肠后壁固定于提肌裂孔。切除裂孔韧带可使我们将直肠肛管分离至内括约肌水平。我们得出结论，识别裂孔韧带对于实施合适的腹腔镜TME至关重要。
