Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Paris Sud-11 University, 78, rue du General Leclerc, 94275 Le Kremlin-Bicetre, France.
World J Surg. 2012 Jan;36(1):201-7. doi: 10.1007/s00268-011-1313-2.
Erectile dysfunction, principally related to injury of the autonomic nerve fibers in men, is a major cause of postoperative morbidity after anterolateral dissection during total mesorectal excision (TME) for rectal adenocarcinoma. However, the autonomic innervation of erectile bodies is less known in women, and the anterolateral plane of dissection during TME remains unclear. The existence of the rectovaginal septum(RVS) is controversial. The purpose of the present study was to identify the RVS in the human fetus and adult female by dissection, immunohistochemistry, and three-dimensional reconstruction, and to define its relationship with erectile nerve fibers so as to determine the anterolateral plane of dissection during TME, which could reduce postoperative sexual dysfunction in women.
Macroscopic dissection, histologic studies, and immunohistochemistry examination with 3D reconstruction were performed in six fresh female adult cadavers and six female fetuses.
The RVS was clearly definable in all adult specimens. It was composed of multiple connective tissue, with smooth muscle fibers originating from the uterus and the vagina. It is closely applied to the vagina and has a relationship with the neurovascular bundles (NVBs) that contain erectile fibers intended for the clitoris. The NVBs are situated anteriorly to the posterior extension of rectovaginal septum. This posterior extension protects the NVBs during the anterior and anterolateral dissection for removal of rectal cancer.
To reduce the risk of postoperative sexual dysfunction in women undergoing TME for rectal cancer, we recommend careful dissection to the anterior mesorectum to develop a plane of dissection behind the posterior extension of the RVS if oncologically reasonable.
勃起功能障碍主要与男性自主神经纤维损伤有关，是直肠癌全直肠系膜切除（TME）后前外侧切开术的主要术后发病率原因。然而，女性的勃起体自主神经支配知之甚少，TME 前外侧切开术的平面仍不清楚。直肠阴道隔（RVS）的存在存在争议。本研究的目的是通过解剖、免疫组织化学和三维重建来识别胎儿和成年女性的 RVS，并确定其与勃起神经纤维的关系，以确定 TME 期间的前外侧切开术，从而减少女性术后性功能障碍。
对 6 具成年女性尸体和 6 具女性胎儿进行了大体解剖、组织学研究和免疫组织化学检查及三维重建。
所有成年标本中均能清楚地定义 RVS。它由多个结缔组织组成，平滑肌纤维起源于子宫和阴道。它紧贴阴道，并与包含用于阴蒂的勃起纤维的神经血管束（NVB）有关。NVB 位于直肠阴道隔后延伸的前方。在进行直肠癌前侧和前外侧切除时，该后延伸保护 NVB。
为了降低接受 TME 治疗直肠癌的女性术后性功能障碍的风险，如果从肿瘤学角度合理，我们建议仔细解剖前直肠系膜，以在后 RVS 后延伸后面发展分离平面。
