Li A J, Wang J Q, Liu H L, Lin M B
Department of General Surgery, Yangpu Hospital of Tongji University, Shanghai 200090, China.
Department of General Surgery, Yangpu Hospital of Tongji University, Shanghai 200090, China Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jul 25;26(7):625-632. doi: 10.3760/cma.j.cn441530-20230322-00088.
Because the classification system of radical surgery for rectal cancer has not been established, it is impossible to select the appropriate surgical method according to the clinical stage of the tumor. In this paper, we explained the theory of " four fasciae and three spaces " of pelvic membrane anatomy and then combined this theory with the membrane anatomical basis of Querleu-Morrow classification for radical cervical cancer resection. Based on this theory and the membrane anatomy of Querleu-Morrow classification of radical cervical cancer resection, we proposed a new classification system of radical rectal cancer surgery based on membrane anatomy according to the lateral lymph node dissection range of the rectum. This system classifies the surgery into four types (ABCD) and defines corresponding subtypes based on whether the autonomic nerve was preserved. Among them, type A surgery is total mesorectal excision (TME) with urogenital fascia preservation, type B surgery is classical TME, type C surgery is extended TME, and type D surgery is lateral extended resection. This classification system unifies the anatomical terminology of the pelvic membrane, validates the feasibility of using the " four fasciae and three fascial spaces " theory to classify rectal cancer surgery, and lays the theoretical foundation for the future development of a unified and standardized classification of radical pelvic tumor surgery.
由于直肠癌根治性手术的分类系统尚未建立，因此无法根据肿瘤的临床分期选择合适的手术方法。在本文中，我们阐述了盆膈膜解剖的“四筋膜三间隙”理论，然后将该理论与宫颈癌根治性切除的Querleu-Morrow分类的膜解剖学基础相结合。基于这一理论以及宫颈癌根治性切除的Querleu-Morrow分类的膜解剖学，我们根据直肠侧方淋巴结清扫范围，提出了一种基于膜解剖学的直肠癌根治性手术新分类系统。该系统将手术分为四种类型（ABCD），并根据自主神经是否保留定义了相应的亚型。其中，A型手术是保留泌尿生殖筋膜的全直肠系膜切除术（TME），B型手术是经典TME，C型手术是扩大TME，D型手术是侧方扩大切除术。该分类系统统一了盆膈膜的解剖学术语，验证了使用“四筋膜三间隙”理论对直肠癌手术进行分类的可行性，并为未来盆腔肿瘤根治性手术统一和标准化分类的发展奠定了理论基础。
