[Rise and mix of membrane anatomy].

Membrane anatomy is in broad sense the anatomy of the mesentery and its bed, both of which are consisted of fascia membrane or/and serous membrane. Although the traditional mesentery has the definition of mesentery, people unconsciously identify them according to their "fan-shaped" and "free" characteristics. The "generalized mesentery" we propose refers to the fascia and/or serosa, envelope-like organs and their blood vessels, suspending to the posterior wall of the body, regardless of its shape, free or not. So the main points of the anatomy are as follows.(1) Organs or tissues with their feeding structures are enveloped by the fascia membrane or/and serous membrane, suspending to posterior wall of the body, to form different shapes of the mesentery in broad sense, and most of them are buried in the mesentery bed. (2) Cancer metastasis type V of in the gut moves in the envelop of the mesentery in broad sense.(3) Intraoperative breach of the envelop membrane not only results in intraoperative bleeding, but also cancer cell leakage from the mesentery. (4) The cancer of gut can be divided into cancer in the mesentery, cancer out of the mesentery and cancer at edge of the mesentery based on this anatomy. Radical tumor resection is effective for cancer in the mesentery, which should not be artificially breached into those of cancer out of the mesentery. The essence of neoadjuvant chemoradiation is to push cancer at edge of the mesentery back inside the mesentery.(5) Based on such anatomy, radical gut tumor operations are divided into D2/D3 procedure, without emphasizing the integrity of the mesentery during lymphatic dissection; CME procedure, which emphasizes the integrity of the mesentery but does not strictly define the extent of lymphatic dissection; D2/D3 + CME procedure, which strictly defines the integrity of the mesentery and the extent of lymphatic dissection.(6)For gastrointestinal tumors of the same T stage, shorter mesentery indicates worse prognosis.(7) For gastrointestinal tumors with the same T stage and the same length of mesentery, the more mesentery buried in the mesentery bed, the worse prognosis. (8) The above seven principles are universal in the organs of the body cavity (and even all internal organs).Membrane anatomy, unlike traditional "plane surgery" , is completely different from the "anatomy of the membrane..." described by Japanese scholars, but mainly bases on generalized mesentery and mesentery bed, meanwhile inherent life events can be accurately defined and confirmed.膜解剖，是人们对这方面研究工作的统称、总称和简称。具体于解剖学，是指广义的系膜与系膜床的解剖，两者由筋膜和（或）浆膜构成。传统的系膜虽然有着系膜的定义，但人们却不知不觉地据其"扇形"和"游离"的特征来认定它们。我们提出的"广义的系膜"，是指那些筋膜和（或）浆膜，信封样包绕着器官及其血管，悬挂于体后壁，无论其形状如何、无论其游离与否。因此，膜解剖主要论点如下：（1）几乎所有的器官或组织，表面都有解剖的第三元素——膜（主要是筋膜，体腔内者其外还有浆膜）覆盖，其包绕着器官或组织及其血供，悬挂于体后壁，形成千姿百态的系膜，它们大多躺卧并融合于系膜床。（2）在胃肠道，肿瘤的"第五转移"潜行其内。（3）系膜的打破，不仅手术出血多，而且导致第五转移从系膜内泄露至手术野。（4）因此，肿瘤可分为系膜内癌、系膜外癌和系膜边癌；肿瘤根治对系膜内癌有效，而不应人为地将系膜内癌破坏成系膜外癌，新辅助放化疗的本质是将系膜边癌推向系膜内。（5）基于这样的解剖，肿瘤根治手术分为：D2/D3手术，即不强调系膜是否完整的淋巴清扫；CME手术，即强调系膜完整，而不严格定义淋巴清扫范围；D2/D3+CME手术，两者均严格界定。（6）在胃肠道，同等T分期的肿瘤，系膜越短，预后越差。（7）同等T分期肿瘤，同等系膜长度，埋于系膜床内的系膜越多，预后越差。（8）以上7条原理，在体腔内器官（乃至所有体内器官）具有普遍性。膜解剖，不同于传统的"层面外科"，也完全不同于日本学者所描述的"膜的解剖……"。主要在于其广义的系膜和系膜床、及其内在的生命事件可以被准确地定义和证实。.