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熟练掌握直肠的局部解剖(血管系、神经系、淋巴系的正常走行和变异及因病变而引起的改变),熟练掌握解剖层次知识及脏器、组织结构间的毗邻关系,能保证外科医师精确进行癌肿的整块或联合脏器切除,以减少副损伤和并发症,提高手术效果。 1 直肠分区直肠位于盆腔,全长约15～20cm。前方是膀胱、精囊和前列腺尿道(女性为子宫和阴道),后方是骶、尾骨。直肠上界解剖学定在第二骶椎下缘,外科学定在骶骨岬水平。分为三部:(1)直肠乙状部(Rs):骶骨岬至第二骶椎下缘;(2)直肠上部(Ra):第二骶椎下缘至腹膜返折:(3)直肠下部(Rb):腹膜返折至耻骨直肠肌附着部上缘。直肠下方与肛管(P)相连。在解剖学上肛管上界为齿线。为了临床应用方便,常把直肠分为上、中、下三段:上段12～16cm,中段8～12cm,下段8cm以下,肛管2～3cm。这样,通过直肠指诊
Proficient in the local anatomy of the rectum (normal walking and variation of vascular, neurological, and lymphatic systems and changes caused by lesions), proficiency in the knowledge of the anatomical level and the contiguous relationship between organs, tissue structures, and the accuracy of surgeons Monolithic or combined excision of the cancer is performed to reduce side injuries and complications and improve the surgical outcome. 1 The rectum is divided into rectum and located in the pelvic cavity. The total length is about 15-20cm. The bladder, seminal vesicle, and prostatic urethra (women’s uterus and vagina) are on the front, and the ankles and coccyx are on the back. The upper rectum of the rectum is set at the lower edge of the second sacrum, and the surgery is set at the iliac crest level. Divided into three parts: (1) rectal sigmoid (Rs): humerus to the lower edge of the second sacrum; (2) upper rectal (Ra): the second sacral vertebra to the peritoneal fold: (3) rectum Lower (Rb): The peritoneum returns to the upper edge of the puborectal muscle attachment. Under the rectum is connected to the anal canal (P). Anatomically, the upper boundary of the anal canal is a tooth line. In order to facilitate clinical application, the rectum is often divided into upper, middle, and lower segments: 12 to 16 cm in the upper segment, 8 to 12 cm in the middle segment, 8 cm below the lower segment, and 2 to 3 cm in the anal canal. In this way, the digital rectal examination