Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision / 中华胃肠外科杂志

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

[Correlative analysis of degenerative lumbar scoliosis and osteoporosis].

OBJECTIVE: To investigate the correlation between degenerative lumbar scoliosis and osteoporosis in adults. METHODS: From March 2012 to June 2016, the clinical data of 53 patients with degenerative lumbar scoliosis were retrospectively analyzed for a correlation study between degenerative lumbar scoliosis and osteoporosis. Fifty-three patients with degenerative lumbar scoliosis were selected as observation group and another 53 inpatients without lumbar scoliosis as control group. There were 11 males and 42 females with an average age of 69 years (range 63 to 76 years) old in observation group. And in control group, there were 16 males and 37 females with an average age of 68.5 years (range 59 to 74 years) old, including lumbar disc herniation in 33 cases, lumbar spinal stenosis in 13 cases, spondylolisthesis in 7 cases. The 53 patients with degenerative lumbar scoliosis were confirmed by X-ray and MRI, their Cobb angle of lumbar scoliosis was measured. Dual energy X-ray absorptiometry was used to measure the bone mineral density, the T values of L2-L4 segments, femoral neck, Ward triangle and femoral trochanter were recorded. Linear regression analysis was used to analyze the correlation between osteoporosis and degenerative lumbar scoliosis. RESULTS: There were significant differences in the bone mineral density T values between two groups (P<0.05). Bone mineral density T value in patients with lumbar scoliosis were significantly higher than that in the patients with no lumbar scoliosis (P<0.05), (-2.56±0.65 vs -1.39±0.77). The T values of L2-L4 segments, femoral neck, Ward triangle and femoral trochanter had no remarkable correlation with Cobb's angles. CONCLUSIONS: Osteoporosis is a risk factor for degenerative scoliosis, but the severity of osteoporosis and degree of scoliosis has no obvious correlation.