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男性盆腔自主神经丛的定量解剖学研究及其在直肠切除术中的临床应用潜力

Quantitative anatomical study of male pelvic autonomic plexus and its clinical potential in rectal resection.

作者信息

He Jing-Hu, Wang Qiang, Cai Qing-Ping, Dang Rui-Shan, Jiang Er-Peng, Huang Hui-Long, Sun Yan-Ping

机构信息

Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, People's Republic of China.

出版信息

Surg Radiol Anat. 2010 Oct;32(8):783-90. doi: 10.1007/s00276-010-0677-6. Epub 2010 May 16.

Abstract

The pelvic autonomic nerves innervate the pelvic viscera, and carry a high risk of damage during surgery. This high risk has been ascribed to the complex interrelationship of pelvic paravisceral structures and the difficulty in identifying particular structures, despite the fact that the anatomic characteristics of the pelvic autonomic plexus have been well documented. We dissected ten male embalmed adult cadavers with particular attention to the quantitative parameters of the pelvic plexus and its subsidiary plexus. The right inferior hypogastric plexus and its rectal branch were found to be significantly longer and wider than the left one, while the transverse diameter of the vesical and prostatic branches of the left side was significantly larger the right. The inferior mesenteric plexus gave off fibers directly to form the pelvic plexus in four of 20 hemipelves (20%). In the side-by-side comparison, the distance to midpoint of the sacral promontory of the left rectal plexus was significantly longer than that of the right, whereas the maximum length (the length of the longest nerve fiber from origin to corresponding organ) of the left vesical plexus was significantly shorter than that of the right. Additionally, the craniocaudal and dorsoventral diameters of the right pelvic autonomic plexus were significantly shorter those of the left. The quantitative parameters relating to the pelvic autonomic plexuses not only can enhance our understanding of its anatomy and function, but can also be used as references for surgical procedures and robot-assisted surgery.

摘要

盆腔自主神经支配盆腔脏器,在手术过程中具有较高的损伤风险。尽管盆腔自主神经丛的解剖特征已有详细记录,但这种高风险归因于盆腔脏器旁结构的复杂相互关系以及识别特定结构的困难。我们解剖了10具成年男性防腐尸体,特别关注盆腔丛及其分支丛的定量参数。发现右侧下腹下丛及其直肠支明显比左侧更长更宽,而左侧膀胱支和前列腺支的横径明显大于右侧。在20个半侧骨盆中,有4个(20%)肠系膜下丛直接发出纤维形成盆腔丛。在并排比较中,左侧直肠丛到骶岬中点的距离明显长于右侧,而左侧膀胱丛的最大长度(从起点到相应器官的最长神经纤维长度)明显短于右侧。此外,右侧盆腔自主神经丛的头尾径和背腹径明显短于左侧。与盆腔自主神经丛相关的定量参数不仅可以增进我们对其解剖结构和功能的理解,还可以作为手术操作和机器人辅助手术的参考。

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