中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (7): 1051-1056.doi: 10.3969/j.issn.2095-4344.2016.07.020

• 组织构建综述 tissue construction review • 上一篇    下一篇

直肠系膜临床解剖学的研究与进展

李文睿1，周乐群2，张卫光3   

  1. 1北京大学第二临床医学院，北京市 100044；2北京大学第三临床医学院，北京市 100191；3北京大学基础医学院人体解剖学与组织胚胎学系，北京市 100191
  • 收稿日期:2015-11-21 出版日期:2016-02-12 发布日期:2016-02-12
  • 通讯作者: 张卫光，博士，教授，北京大学基础医学院人体解剖学与组织胚胎学系，北京市 100191
  • 作者简介:李文睿，男，1993年生，湖南省人，汉族，北京大学在读硕博连读，主要从事直肠系膜的临床解剖学研究。
  • 基金资助:
    北京大学医学交叉学科联合研究种子项目(BMU20140411)；国家基础科学人才培养基金资助项目(J1030831)

Clinical anatomy of the mesorectum

Li Wen-rui1, Zhou Le-qun2, Zhang Wei-guang3   

  1. 1Peking University People’s Hospital, Beijing 100044, China; 2Peking University Third Hospital, Beijing 100191, China; 3Department of Human Anatomy and Tissue Embryology, School of Basic Medicine, Peking University, Beijing 100083, China
  • Received:2015-11-21 Online:2016-02-12 Published:2016-02-12
  • Contact: Zhang Wei-guang, M.D., Professor, Department of Human Anatomy and Tissue Embryology, School of Basic Medicine, Peking University, Beijing 100083, China
  • About author:Li Wen-rui, Studying for doctorate, Peking University People’s Hospital, Beijing 100044, China
  • Supported by:

    Medical Interdisciplinary Joint Research Project of Peking University, No. BMU20140411; National Basic Science Talents Fund of China, No. J1030831

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534

被引次数

8

摘要：

文章快速阅读：

文题释义：

直肠系膜：被直肠固有筋膜包裹的组织称为直肠系膜，内含脂肪纤维结缔组织、直肠上、下动静脉、直肠的淋巴管及淋巴结、支配直肠的神经等组织。

筋膜：遍布全身，分为浅层筋膜、中层筋膜、深层筋膜3种。①浅筋膜：位于皮下，又称皮下筋膜，由疏松结缔组织构成，其内含有脂肪、浅静脉、皮神经以及浅淋巴结和淋巴管等。脂肪的多少因身体部位、性别和营养状况不同。临床常作的皮下注射，即将药液注入浅筋膜内。②中层筋膜：指包裹肌肉的筋膜。③深筋膜：位于浅筋膜深面，又称固有筋膜，由致密结缔组织构成，遍于全身且互相连续。深筋膜包被肌或肌群、腺体、大血管和神经等形成筋膜鞘。四肢的深筋膜。伸入肌群之间与骨相连，分隔肌群，称肌间隔。

 

背景：目前，对于直肠系膜的边界，及其周围的筋膜、盆腔间隙、神经走行和淋巴结分布尚有争论，各种新技术的发展也使得相关的解剖学研究有新的进展。
目的：综述前人的研究，以描述直肠系膜相关的解剖学进展，并讨论其临床意义。

方法：以“rectum；mesentery；fascia；space；nerve；lymph node，total mesorectal excision(TME)，clinical anatomy”为关键词，检索PubMed数据库中关于直肠系膜及其周围的筋膜、盆腔间隙、淋巴结分布及神经走行的研究，以筋膜及淋巴结分布为主。

结果与结论：对于系膜、筋膜、神经和淋巴结的研究常通过新鲜或者冷冻的标本，采用传统盆部与会阴部解剖的方法进行。目前常采用CAAD(Computer-assisted anatomical dissection)技术将免疫染色和电脑成像结合起来。三维模型能很好地体现不同解剖结构间的相互关系，以及神经走行空间位置。直肠系膜前方是Denonvilliers筋膜，后方是直肠骶骨筋膜。直肠系膜盆内脏神经由骶神经前根发出，穿过骶前筋膜，骶前间隙进入神经筋膜层，根据腹膜分为上、下两部分。直肠系膜内的淋巴结后部及近腹膜反折部较多。关于直肠系膜及其周围结构的解剖关系仍有许多争议，明确这些问题可为临床实践工作提供客观指导依据。 

ORCID:0000-0001-5055-4907 (张卫光)

关键词: 组织构建, 组织工程, 直肠系膜, 筋膜, 间隙, 神经, 淋巴结, 解剖学

Abstract:

BACKGROUND: Currently, it is still controversial about the border, surrounding fascia, space of pelvic cavity, distribution of nerves and lymph nodes of the mesorectum, and the development of new technologies makes a progress in related anatomic research.
OBJECTIVE: To summarize the previous studies so as to describe clearly the progress of mesorectal anatomy and to discuss its clinical value.
METHODS: Using “rectum; mesentery; fascia; space; nerve; lymph node; total mesorectal excision (TME); clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the mesorectum and surrounding fasciae, space of pelvic cavity, distribution of nerves and lymph nodes.
RESULTS AND CONCLUSION: Fresh or frozen specimens are often used for studying the mesenterium, fascia, nerves and lymph nodes by using traditional pelvic and perineum anatomical methods. Computer-assisted anatomical dissection can combine immunostaining with computer imaging. A three-dimensional model can well reflect the relationship among the different anatomical structures, as well as nerve traveling and spatial location. Mesorectum is located behind the denonvilliers and in the front of the sacral fascia of the rectum. Pelvic splanchnic nerve of the mesorectum is derived from the anterior sacral nerve root, runs through the presacral fascia, and enters into the neuro-fascial layer via the pesacral space, which is divided into the upper and lower parts according to the peritoneum. There are more folds in the rear of lymph nodes within the mesorectum within and near the peritoneum. There are still a lot of controversies about anatomical relationship between the mesorectum and surrounding structures, and to elaborate these issues can provide an objective basis for guiding clinical work.