Institute of Digestive Surgery and Department of General Surgery, 150 Hospital of PLA, Gaoxin District, Luoyang 471031, Henan Province, China.
World J Gastroenterol. 2010 Nov 21;16(43):5411-5. doi: 10.3748/wjg.v16.i43.5411.
The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
直肠侧韧带（LLR）的存在和组成至今仍是解剖学上的混淆和手术上的误解。自从 Miles 提出经腹会阴切除术作为直肠癌的根治性手术以来，许多外科医生毫不犹豫地接受了通过“用手指钩住它们”来识别的方法；在许多外科教科书中，夹闭、分离和结扎被认为是直肠游离的必要步骤。但在尸体研究中，许多解剖学家无法找到教科书中描述的 LLR，越来越多的外科医生也未能按照全直肠系膜切除术的原则在直肠切除术中找到 LLR。LLR 的解剖结构在文献中有多种描述。根据我们的临床观察，传统的 LLR 解剖结构确实存在；LLR 是恒定的致密结缔束，位于直肠内脏筋膜和提肛肌上方的骨盆壁筋膜之间，位于骨盆横膈膜的上筋膜下方。它们是血管和神经纤维向直肠的通路，以及从直肠下部向髂淋巴结的淋巴管。
