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Anatomische Grundlagen der Rektumchirurgie

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Moderne Chirurgie des Rektumkarzinoms

Zusammenfassung

Die moderne – und damit erfolgreiche – Chirurgie des Rektumkarzinoms ist maßgeblich abhängig von der detaillierten Kenntnis der Anatomie des Anorektums, der perirektalen Hüllfaszien und der lymphatischen Drainagewege. Das darauf basierende Konzept der totalen mesorektalen Exzision (TME) erfordert einerseits eine schichtgerechte und vollständige Mobilisation des Mesorektums und ermöglicht andererseits die Schonung der autonomen Innervation der Beckenorgane zur Aufrechterhaltung der Kontinenz- und Sexualfunktionen. In diesem Kapitel werden die anatomischen Grundlagen zur modernen Rektumchirurgie vermittelt und relevante anatomische „Landmarks“ aufgezeigt, die es bei den verschiedenen Verfahren der Rektumkarzinomchirurgie zu beachten gilt.

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Literatur

  • Aigner F, Zbar AP, Ludwikowski B, Kreczy A, Kovacs P, Fritsch H (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47:131–140

    Article  PubMed  Google Scholar 

  • Baader B, Herrmann M (2003) Topography of the pelvic autonomic nervous system and ist potential impact on surgical intervention in the pelvis. Clin Anat 16:119–130

    Article  CAS  PubMed  Google Scholar 

  • Blaivas JG, Barbalias GA (1983) Characteristics of neural injury after abdomino-perineal resection. J Urol 129:84–87

    CAS  PubMed  Google Scholar 

  • Clausen N, Wolloscheck T, Konerding MA (2008) How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg 32:1768–1775

    Article  PubMed  Google Scholar 

  • Fritsch H, Lienemann A, Brenner E, Ludwikowski B (2004) Clinical anatomy of the pelvic floor. Adv Anat Embryol Cell Biol 175:1–64

    Article  Google Scholar 

  • García-Armengol J, García-Botello S, Martinez-Soriano F, Roig JV, Lledó S (2008) Review of the anatomic concepts in relation to the retrorectal space and endopelvic fascia: Waldeyer’s fascia and the rectosacral fascia. Colorectal Dis 10:298–302

    Article  PubMed  Google Scholar 

  • Havenga K, DeRuiter MC, Enker WE, Welvaart K (1996a) Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg 83:384–388

    Article  CAS  PubMed  Google Scholar 

  • Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996b) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502

    CAS  PubMed  Google Scholar 

  • Heald BJ, Moran BJ (1998) Embryology and anatomy of the rectum. Semin Surg Oncol 15:66–71

    Article  CAS  PubMed  Google Scholar 

  • Heald RJ, Smedh RK, Kald A, Sexton R, Moran BJ (1997) Abdominoperineal excision of the rectum. An endangered operation. Dis Colon Rectum 40:747–751

    Article  CAS  PubMed  Google Scholar 

  • Hollabaugh RS Jr, Steiner MS, Sellers KD, Samm BJ, Dmochowski RR (2000) Neuroanatomy of the pelvis: implications for colonic and rectal resection. Dis Colon Rectum 43:1390–1397

    Article  PubMed  Google Scholar 

  • Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238

    Article  CAS  PubMed  Google Scholar 

  • Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49:1024–1032

    Article  PubMed  Google Scholar 

  • Kinugasa Y, Murakami G, Suzuki D, Sugihara K (2007) Histological identification of fascial structures posterolateral to the rectum. Br J Surg 94:620–626

    Article  CAS  PubMed  Google Scholar 

  • Kinugasa Y, Niikura H, Murakami G, Suzuki D, Saito S, Tatsumi H et al (2008) Development of the human hypogastric nerve sheath with special reference to the topohistology between the nerve sheath and other prevertebral fascial structures. Clin Anat 21:558–567

    Article  PubMed  Google Scholar 

  • Kirkham AP, Mundy AR, Heald RJ, Scholefield JH (2001) Cadaveric dissection for the rectal surgeon. Ann R Coll Surg Engl 83:89–95

    PubMed Central  CAS  PubMed  Google Scholar 

  • Kourambas J, Angus DG, Hosking P, Chou ST (1998) A histological study of Denonvilliers’ fascia and its relationship to the neurovascular bundle. Br J Urol 82:408–410

    Article  CAS  PubMed  Google Scholar 

  • Lindsey I, Guy RJ, Warren BF, Mortensen NJ (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87:1288–1299

    Article  CAS  PubMed  Google Scholar 

  • Lindsey I, Warren BF, Mortensen NJ (2005) Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum 48:37–42

    Article  PubMed  Google Scholar 

  • Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82

    Article  PubMed Central  PubMed  Google Scholar 

  • Maurer CA (2005) Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res 165:196–204

    Article  PubMed  Google Scholar 

  • Nagtegaal ID, van de Velde CJ, Marijnen GC, van Krieken JHJM, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264

    Article  PubMed  Google Scholar 

  • Schünke M, Schule E, Schumacher U (2012a) Prometheus. LernAtlas der Anatomie, Band 1: Allgemeine Anatomie und Bewegungssystem, 3. Aufl. Thieme, Stuttgart

    Google Scholar 

  • Schünke M, Schule E, Schumacher U (2012b) Prometheus. LernAtlas der Anatomie, Band 2: Innere Organe, 3. Aufl. Thieme, Stuttgart

    Google Scholar 

  • Standring S (2004) Gray’s Anatomy, the anatomical basis of clinical practice, 39. Aufl. Churchill Livingstone

    Google Scholar 

  • Stelzner F (1998) Chirurgie an den viszeralen Abschlußsytemen. Thieme, Stuttgart

    Google Scholar 

  • Stelzner S, Holm T, Moran BJ, Heald RJ, Witzigmann H, Zorenkov D, Wedel T (2011) Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer. Dis Colon Rectum 54:947–957

    Article  PubMed  Google Scholar 

  • Takenaka A, Hara R, Soga H, Murakami G, Fujisawa M (2005) A novel technique for approaching the endopelvic fascia in retropubic radical prostatedctomy, based on an anatomical study of fixed and fresh cadavers. BJU International 95:766–771

    Article  PubMed  Google Scholar 

  • Uchimoto K, Murakami G, Kinugasa Y, Arakawa T, Matsubara A, Nakajima Y (2007) Rectourethralis muscle and pitfalls of anterior perineal dissection in abdominoperineal resection and intersphincteric resection for rectal cancer. Anat Sci Int 82:8–15

    Article  PubMed  Google Scholar 

  • Uhlenhuth E, Day EC, Smith RD, Middleton EB (1948) The visceral endopelvic fascia and the hypogastric sheath. Surg, Gynecol Obstet 86:9–28

    CAS  Google Scholar 

  • Walsh PC, Lepor H, Eggleston JC (1983) Radical prostatectomy with prevervation of sexual function: anatomical and pathological considerations. Prostate 4:473–485

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Anatomisches Institut, Christian-Albrechts Universität Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Deutschland

    Thilo Wedel Prof. Dr. med.

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  1. Thilo Wedel Prof. Dr. med.
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Correspondence to Thilo Wedel Prof. Dr. med. .

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Editors and Affiliations

  1. Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Martin E. Kreis

  2. Klinik für Allgemein- und Viszeralchirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Joachim Straßburg

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Wedel, T. (2015). Anatomische Grundlagen der Rektumchirurgie. In: Kreis, M., Straßburg, J. (eds) Moderne Chirurgie des Rektumkarzinoms. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40390-3_2

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  • DOI: https://doi.org/10.1007/978-3-642-40390-3_2

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-40389-7

  • Online ISBN: 978-3-642-40390-3

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