引用文本：呙耀宇, 刁德昌. 直肠癌根治术：基于解剖的手术艺术[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 387-393.

作者：呙耀宇，刁德昌

单位：中山大学附属第六医院 普通外科（结直肠外科），广东省结直肠盆底疾病研究重点实验室，广州市黄埔区中六生物医学创新研究院，广东 广州 510655

Authors：Guo Yaoyu, Diao Dechang

Unit：Department of Colorectal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Biomedical Innovation Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong, China

摘要：

直肠癌根治术已逐步走向规范化与精准化，全直肠系膜切除（total mesorectal excision, TME）成为直肠癌外科治疗的核心术式，但其在临床实践中仍面临多重难点，包括如何平衡肿瘤根治性与盆腔脏器功能保护、精准界定淋巴结清扫范围、术中稳定识别并维持正确解剖层面、避免直肠系膜筋膜破损与神经血管损伤以及合理确定远端系膜与肠壁切缘。当前直肠癌膜解剖领域的焦点问题集中于直肠周围多层筋膜结构的精准辨识、直肠系膜“神圣平面”的统一界定、邓氏筋膜与Waldeyer筋膜的胚胎起源与解剖分层、侧方间隙与盆腔自主神经的保护策略、系膜完整性对肿瘤复发与预后的影响等。本文系统梳理直肠癌根治术从D3淋巴结清扫到TME理念的演进历程，结合临床实践与膜解剖研究进展，剖析关键解剖要点与手术技术难点，总结膜解剖导向下TME的质量控制标准，并对未来精准化、功能保护型手术发展方向进行展望，旨在为临床优化手术策略、提升根治效果与患者生活质量提供理论与实践参考。

关键词：直肠癌；腹腔镜；全直肠系膜切除术；精准淋巴结清扫；膜解剖

Abstract：

Rectal cancer surgery has become increasingly standardized and precise, and total mesorectal excision (TME) has been established as the cornerstone of surgical treatment for rectal cancer. However, numerous challenges remain in clinical practice, including how to balance oncological radicality and functional preservation, accurately define the scope of lymph node dissection, precisely identify and maintain the correct anatomical plane, avoid damage to the mesorectal fascia and neurovascular structures, and rationally determine distal resection margins. Currently, the key issues in membranous anatomy of rectal cancer focus on the precise identification of multilayer fascial structures around the rectum, the unified definition of the "holy plane" of mesorectum, the embryonic origin and anatomical layers of Denonvilliers’ fascia and Waldeyer’s fascia, the protection strategy of lateral space and pelvic autonomic nerves, and the mechanism of mesorectal integrity affecting tumor recurrence and prognosis. This article systematically reviews the evolution of radical resection of rectal cancer from D3 lymphadenectomy to TME, analyzes key anatomical points and technical difficulties combined with clinical practice and research progress of membranous anatomy, summarizes the quality control criteria of TME guided by membranous anatomy, and prospects the future development of precise and function-preserving surgery. The purpose of this paper is to provide theoretical and practical references for optimizing surgical strategies, improving radical outcomes and quality of life of patients.

Key words：Rectal cancer; Laparoscopy; Total mesorectal excision; Precision lymphadenectomy; Membranous anatomy

注：网络优先发布