检索历史 清除

全直肠系膜切除术(TME)已成为直肠癌手术的金标准.传统观点认为:直肠肿瘤细胞的转移局限于筋膜包裹的系膜内,正确的手术平面是保证完整系膜切除的关键,因而强调TME手术是膜的解剖可以提高肿瘤的根治性和降低术后泌尿生殖功能障碍的风险.实际上,传统的功能解剖学很难解释TME改善患者预后的原因,主要在于难以证实:神圣平面“Holy Plane”能够成为肿瘤细胞难以逾越的平面,以及正确的手术层次可以保证直肠系膜的完整切除.基于发生解剖学的腔室理论认为:肿瘤细胞在相当长的时间内滞留于同一胚胎起源的腔室内,虽然邻近腔室的器官可能仅有几毫米的距离或者中间并没有筋膜的阻挡,但由于腔室边界的抑制效应,肿瘤细胞在相当长的时间内并不会侵犯,TME改善直肠癌预后的原因可能在于完整切除了来源于后肠的直肠“腔室”.腔室理论的提出,将有可能改变目前临床肿瘤根治术的理论基础.

Total mesorectal excision (TME) improves the prognosis of patients with rectal cancer (RC) and now is being established as the gold standard for RC surgery.Local spread of tumor is thought to be contained within a defined intact visceral mesorectal fascial envelope.Therefore,surgical dissection along correct plane with complete mesorectum excision is the essence of TME.Recent literatures stated that TME with the guidance of membrane anatomy could improve tumor radicality and reduce genitourinary dysfunction.But TME remains the object of ongoing controversy.In fact,the conventional function anatomy can't provide theoretical support for TME.Observations of the anatomical studies found that "Holy Plane" was unlikely to become an almost impenetrable barrier to the spread of carcinoma and it didn't ensure complete excision of mesorectum along the correct surgical plane.Compartment theory based on the ontogenetic anatomy suggested that tumors were always locally confined to a compartment derived from a common embryologic origin (primordium) for a relatively long phase.The potential reasons lie in that tumor propagation is primarily suppressed at the compartment borders.The compartment model of tumor spread provides explanations for TME which excise the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries.The compartment theory may set up the new principles of tumor radicality.