直肠癌手术步骤（Operation procedure of rectal cancer）.doc

直肠癌手术步骤（Operation procedure of rectal cancer） 1. related anatomy: measured from the anal margin, rectum general 12cm - 15cm. The rectum is adjacent to the sacrum and is divided into the upper, middle and lower 1/3. General 1 / 31 / 2 peritoneal covering. After complete free lifting, the rectum can be extended about 3cm 5cm, especially in the posterior wall of the rectum. The tumor is prolonged obviously, and the tumor in the anterior wall of the rectum is not obvious. In the male anal margin, the peritoneal fold is 7cm - 8cm, and the female is 6cm 7cm from the peritoneal fold. The above 5cm10cm puborectal muscle for 1/3, puborectalis 10cm15cm 1/3 as above. Mesorectal membrane: non real mesentery, refers to the pelvic visceral fascia, wrapped around the rectum, fat and lymph tissue. In the parietal fascia (anterior sacral fascia) and between the visceral fascia with a loose gap (called holy plane sacred interface) in S3 or S4, the level of visceral fascia and parietal fascia is formed by the fusion of sacrum ligament (or rectum rectum sacral fascia). Nerve: superior hypogastric plexus in the abdominal aortic bifurcation, the sacral promontory at the left and right hypogastric nerve stem, a sympathetic and parasympathetic nerve composed of pelvic plexus in the pelvic side wall. Blood supply: the rectum has the superior rectal artery, middle rectal artery (from the internal iliac artery), and the inferior rectal artery supplied from the inferior mesenteric artery (from the pudendal artery). Left colon vessels (transverse artery from the superior mesenteric artery) of the arterial supply of the left branch and the inferior mesenteric artery, colon Drummond edge of the superior mesenteric artery and inferior mesenteric artery connected, except for a few in the splenic flexure of colon appeared watershed lacking marginal artery . Attention should be paid to ligation of the inferior mesenteric artery at the root. Anterior resection: resection of the proximal rectum (as the