临床解剖是外科手术的基础，外科手术技术的进步离不开对解剖知识的深入理解。对临床解剖的精 准认知是微创技术发展和手术器械日益精细化的重要原因。在经历了平面解剖理论、间隙解剖理论的基础上，现在 临床解剖技术逐步形成了以胚胎发育起源为理论基础的膜解剖手术理念。机器人辅助下腹腔镜手术是继腹腔镜技术 之后微创手术的重大突破，特别是其灵活的手腕系统及三维放大的手术视野等优势，在临床应用中迅速发展并得到 广泛应用。宫颈癌手术作为经典的解剖型手术，使机器人辅助腹腔镜手术的优势最大程度地发挥出来。而在膜解剖 理念的指导下，机器人辅助下广泛性子宫切除手术得到进一步升华，不但可以实现器官水平的无瘤，也实现了组织 胚源性无瘤，从而极大地改善患者预后。

Clinical anatomy is the foundation of surgery, and the progress of surgical technology cannot be separated from the deep understanding of anatomical knowledge. The development of minimally invasive surgery and the change of surgical instruments have contributed greatly to the accurate cognition of clinical anatomy. Based on the plane anatomy theory and gap anatomy theory, the concept of membrane anatomical surgery based on the theoretical origin of embryonic development has been gradually established. Robot-assisted laparoscopic surgery is a breakthrough in the development of minimally invasive surgery following laparoscopic technology, especially its flexible wrist system and three-dimensional enlarged surgical field, which are rapidly highlighted and widely used in clinical practice. As a classic anatomical surgery, cervical cancer surgery makes the advantages of robot-assisted laparoscopic surgery to maximize. With the guidance of membrane anatomy concept, robot-assisted laparoscopic radical hysterectomy could realize the tumor-free at organ level and even the embryonic cell level to maximally improve the prognosis of patients.

收稿日期：2022-05-09  录用日期：2022-10-29 

Received Date: 2022-05-09  Accepted Date: 2022-10-29 

基金项目：2022 年度辽宁省教育厅基本科研项目（LJKFZ20220253） 

Foundation Item: Scientific research project of Liaoning Provincial Department of Education in 2022 (LJKFZ20220253) 

通讯作者：王军，Email：wj202fck@163.com 

Corresponding Author: WANG Jun, Email: wj202fck@163.com 

引用格式：韩世超，那晶，李亚，等 . 膜解剖理念在机器人辅助腹腔镜下宫颈癌手术的应用及展望 [J]. 机器人外科学杂志（中英文）， 2023，4（5）：456-463. 

Citation: HAN S C, NA J, LI Y, et al. Application and prospect of membrane anatomy concept in robot-assisted laparoscopic surgery for cervical cancer [J]. Chinese Journal of Robotic Surgery, 2023, 4(5): 456-463.

[1] Höckel M. Morphogenetic fields of embryonic development in locoregional cancer spread[J].Lancet Oncol, 2015, 16(3): e148-151. 

[2] SU X Y, LYU Y, WANG W Y, et al. Fascia origin of adipose cells[J]. Stem Cells, 2016, 34(5): 1407-1419. 

[3] 龚建平 . 膜解剖的兴起与混淆 [J]. 中华胃肠外科杂 志 , 2019, 22(5): 401-405. 

[4] 原林 . 筋膜学 [M]. 北京 : 清华大学出版社 , 2011. 

[5] 张建平 , 金杭美 . 女性生殖系统胚胎发育学研究 [J]. 中国实用妇科与产科杂志 , 2005, 21(8): 463-464. 

[6] Santiago I A, Gomes A P, Heald R J. An ontogenetic approach to gynecologic malignancies[J].Insights Imaging, 2016, 7(3): 329-339. 

[7] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5): E359-386. 

[8] Querleu D, Morrow C P. Classification of radical hysterectomy[J]. Lancet Oncol, 2008, 9(3): 297-303. 

[9] Querleu D, Cibula D, Abu-Rustum N R. 2017 Update on the Querleu-Morrow classification of radical ysterectomy[J]. Ann Surg Oncol, 2017, 24(11): 3406-3412. 

[10] Guimberteau J C, Armstrong C. 认识活体筋膜 - 细胞 与细胞外基质之间的构成性世界 [M]. 北京 : 科学技 术文献出版社 , 2018. 

[11] Ngo C, Cornou C, Rossi L, et al. Evidence for the use of robotically assisted surgery in gynecologic cancers[J]. Curr Opin Oncol, 2016, 28( 5) : 398-403.

[12] Ramirez P T, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J].New England Journal of Medicine, 2018, 379(20): 1895-1904. 

[13] Melamed A, Margul D J, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer[J]. New England Journal of Medicine, 2018, 379(20) : 1905-1914. 

[14] Koh W J, Abu-Rustum N R, Bean S, et al. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw, 2019, 17(1): 64-84. 

[15] 陈春林 , 郎景和 , 向阳 , 等 . 子宫颈癌腹腔镜手术 治疗的中国专家共识 [J]. 中华妇产科杂志 , 2020, 55(9): 579-585. 

[16] 陈春林 , 黎志强 , 孙立新 , 等 . ⅠA1 (LVSI +)~ ⅠB2 期子宫颈癌腹腔镜与开腹手术长期肿瘤学结局真 实世界研究 [J]. 中国实用妇科与产科杂志 , 2020, 36(6) : 536-543. 

[17] Arian S E, Munoz J L, Kim S, et al. Robot-assisted laparoscopic myomectomy: current status[J]. Robotic Surgery: Research and Reviews, 2017. DOI: 10.2147/ RSRR.S102743.