Chen Zhou, Zhang Xiao-Jing, Chang Hao-Dong, Chen Xiao-Qian, Liu Shan-Shan, Wang Wei, Chen Zhi-Heng, Ma Yu-Bin, Wang Liang
Department of Gastrointestinal Oncology Surgery, TheAffiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China.
Department of General Surgery, The Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China.
World J Gastrointest Surg. 2023 Oct 27;15(10):2108-2114. doi: 10.4240/wjgs.v15.i10.2108.
The total mesorectal excision (TME) approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer. This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery. However, standardized TME causes urogenital dysfunction in more than half of patients, thus lowering the quality of life of patients. Of note, pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction. The anatomy of the Denonvilliers' fascia (DVF) and its application in surgery have been investigated both nationally and internationally. Nevertheless, controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery. Currently, it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection. Herein, this study systematically describes the anatomy of DVF and its application in surgery, thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.
全直肠系膜切除术（TME）已被确立为中低位直肠癌手术治疗的金标准。这种方法被广泛认可，可将局部复发风险降至最低，并提高接受手术患者的长期生存率。然而，标准化的TME会导致超过一半的患者出现泌尿生殖功能障碍，从而降低患者的生活质量。值得注意的是，TME过程中盆腔自主神经损伤是术后泌尿生殖功能障碍的最关键原因。国内外均对Denonvilliers筋膜（DVF）的解剖结构及其在手术中的应用进行了研究。然而，关于DVF的基础至临床解剖结构及其在手术中的应用仍存在争议。目前，通过在根治性切除术后保护直肠癌患者的泌尿和生殖功能来提高其术后生活质量是一个备受关注和研究的热点。在此，本研究系统地描述了DVF的解剖结构及其在手术中的应用，从而为中低位直肠癌患者手术治疗方式的选择及术后生活质量的提高提供参考。
