经肛全直肠系膜切除解剖学基础与临床应用研究进展OA

Transanal total mesorectal excision(taTME)is a reverse anatomical approach developed to overcome the limitations of the traditional transabdominal approach,such as difficult surgical exposure and challenges in controlling the distal resection margin in patients with a narrow pelvis,obesity,or low rectal cancer.The core of taTME lies in the accurate identification and maintenance of the"holy plane"between the rectal visceral fascia and the prehypogastric nerve fascia from a transanal perspective.Key anatomical points include the recognition and management of structures such as the rectosacral fascia in the posterior plane,the pelvic plexus neurovascular bundle in the lateral plane,and Denonvilliers' fascia along with the rectourethralis muscle in the anterior plane.TaTME also demonstrates unique anatomical advantages in complex procedures such as lateral lymph node dissection and multivisceral resection,enhancing the precision and safety of deep pelvic surgery.However,the technique is associated with a steep learning curve and requires further standardization and individualized research to optimize surgical outcomes and functional preservation.