Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey.
Dis Colon Rectum. 2012 Aug;55(8):907-12. doi: 10.1097/DCR.0b013e318259b44f.
One of the most important aspects for patients undergoing rectal cancer surgery is quality of life, which is closely related to postoperative sexual, urinary, and bowel functions. To preserve these functions, surgeons need to pay special attention to the fascial planes and autonomic nerve plexuses.
The aim of this study is to describe the locations of autonomic nerves in critical areas and to demonstrate the correct surgical planes for protecting these nerves during total mesorectal excision.
Macroscopic and microscopic surgical dissections were performed in the anatomy laboratory. The dissections were recorded as video clips.
Dissections were performed in accordance with the total mesorectal excision technique down to the pelvic floor on 2 female and 7 male cadavers. Autonomic nerves and related fascias were shown.
Autonomic nerves can be damaged during total mesorectal excision in 4 crucial areas: around the origin of the inferior mesenteric artery, in front of the promontory, the side walls of the pelvis, and the posterolateral corners of the prostate close to the anterior rectal wall. Fibers extending in front of the aorta and fibers coming from the sympathetic trunks combine to form the inferior mesenteric plexus around the origin of the inferior mesenteric artery. Most of the fibers that form the superior hypogastric plexus were fibers going downward from the inferior mesenteric plexus. The erigent nerves merge with the pelvic plexuses through the fascia of piriformis, which is part of the pelvic parietal fascia.
The number of cadavers should be increased, especially the number of female cadavers.
The autonomic nerves must be protected during rectal cancer surgery to maintain the patient's quality of life. Therefore, knowledge of autonomic nerve positions and their relationship with surgical planes are very important for rectal surgeons.
接受直肠癌手术的患者最重要的方面之一是生活质量，这与术后的性功能、尿便功能密切相关。为了保留这些功能，外科医生需要特别注意筋膜平面和自主神经丛。
本研究旨在描述关键区域自主神经的位置，并展示在全直肠系膜切除术中保护这些神经的正确手术平面。
在解剖实验室进行了宏观和微观的外科解剖。解剖过程被记录为视频片段。
在 2 名女性和 7 名男性尸体上，按照全直肠系膜切除技术进行了向下至盆底的解剖。显示了自主神经和相关筋膜。
自主神经在全直肠系膜切除的 4 个关键区域可能受损：肠系膜下动脉起点周围、穹窿前方、骨盆侧壁和靠近直肠前壁的前列腺后外侧角。腹主动脉前方延伸的纤维和来自交感神经干的纤维在肠系膜下动脉起点周围形成肠系膜下丛。形成上腹下丛的大部分纤维是来自肠系膜下丛向下走行的纤维。勃起神经通过梨状肌筋膜与骨盆丛合并，梨状肌筋膜是骨盆壁筋膜的一部分。
应该增加尸体的数量，特别是女性尸体的数量。
在直肠癌手术中必须保护自主神经，以维持患者的生活质量。因此，了解自主神经的位置及其与手术平面的关系对直肠外科医生非常重要。
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