Laboratory of Experimental Surgery, Faculty of Medicine, University Paris-Sud 11, Le Kremlin-Bicêtre, France.
Colorectal Dis. 2011 Dec;13(12):1326-34. doi: 10.1111/j.1463-1318.2010.02384.x.
Optimal treatment of rectal adenocarcinoma involves total mesorectal excision with nerve-preserving dissection. Urinary and sexual dysfunction is still frequent following these procedures. Improved knowledge of pelvic nerve anatomy may help reduce this and define the key anatomical zones at risk.
The MEDLINE database was searched for available literature on pelvic nerve anatomy and damage after rectal surgery using the key words 'autonomic nerve', 'pelvic nerve', 'colorectal surgery', and 'genitourinary dysfunction'. All relevant French and English publications up to May 2010 were reviewed. Reviewed data were illustrated using 3D reconstruction of the foetal pelvis.
The ligation of the inferior mesenteric artery and dissection of the retrorectal space can cause damage to the superior hypogastric plexus and/or hypogastric nerve. Anterolateral dissection in the 'lateral ligament' area and division of Denonvilliers' fascia can damage the inferior hypogastric plexus and efferent pathways. Perineal dissection can indirectly damage the pudendal nerve.
In most cases, the pelvic nerves can be preserved during rectal surgery. Complete oncological resection may require dissection close to the nerves where the tumour is located anterolaterally where it is fixed and when the pelvis is narrow.
直肠腺癌的最佳治疗方法包括保留神经的全直肠系膜切除术。这些手术后，尿和性功能障碍仍然很常见。对骨盆神经解剖结构的更好了解可能有助于减少这种情况，并确定有风险的关键解剖区域。
使用“自主神经”、“骨盆神经”、“结直肠手术”和“泌尿生殖功能障碍”等关键词，在 MEDLINE 数据库中搜索有关直肠手术后骨盆神经解剖结构和损伤的可用文献。综述了截至 2010 年 5 月的所有相关法国和英文出版物。使用胎儿骨盆的 3D 重建来图示审查的数据。
肠系膜下动脉结扎和直肠后间隙解剖可能导致腹下丛和/或腹下神经损伤。在“侧韧带”区域进行前外侧解剖和 Denonvilliers 筋膜切开术可能会损伤下腹部丛和传出通路。会阴解剖可能会间接损伤阴部神经。
在大多数情况下，直肠手术期间可以保留骨盆神经。为了达到完全的肿瘤学切除，可能需要在靠近肿瘤的位置进行接近神经的解剖，这些位置在前外侧，当骨盆较窄时，肿瘤被固定。
