Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, P. R. China.
Department of Human Anatomy, Histology and Embryology, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, P. R. China.
Cancer Commun (Lond). 2020 Jan;40(1):25-31. doi: 10.1002/cac2.12003. Epub 2020 Feb 18.
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.
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.
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.
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.
传统全直肠系膜切除术（TME）后泌尿生殖功能障碍发生率高，引发学者对直肠系膜解剖标准方式的质疑。我们提出在直肠癌患者中保留盆膈筋膜的必要性，但如何准确定位盆膈筋膜尚不清楚。本研究旨在通过对比尸体解剖发现和手术视频观察，探讨盆膈筋膜的解剖学特征，提出直肠癌手术中保护盆腔自主神经的解剖方法。
对 5 具成年男性尸体标本进行解剖，并对 2009 年 1 月至 2019 年 2 月期间接受中低位直肠癌 TME 的 135 例患者的手术视频进行回顾性分析，以识别和比较盆膈筋膜的结构。
在 5 具男性尸体标本中观察到盆膈筋膜的单层结构，其位于直肠、膀胱底部、精囊、输精管和前列腺之间。盆膈筋膜起源于直肠膀胱囊（或直肠子宫囊），向下与前列腺尖端的直肠尿道肌融合，向两侧融合至侧韧带。筋膜在中线较薄，厚度为 1.06±0.10mm。盆膈筋膜的冠状形状略呈三角形，中线高度约为 5.42±0.16cm。神经在前盆膈筋膜分布比后更密集，特别是在其两侧。腹腔镜下，盆膈筋膜起源于直肠膀胱囊（或直肠子宫囊）的最低点，有一条增厚的白线，是识别盆膈筋膜的良好标志。
识别盆膈筋膜的手术指示线有助于我们识别盆膈筋膜，提高在直肠癌 TME 中保护患者盆腔自主功能的能力。
