Ma Guolong, Wang Yi, Liang Xiaobo
Department of Minimally Invasive Digestive Surgery, Tumor Hospital, Shanxi Medical University, Taiyuan 030001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Jun;17(6):570-3.
To elucidate the course of pelvic autonomic nerves and its relationship with pelvic fascia in order to identify the safe plane to reduce the damage of pelvic autonomic nerves in total mesorectum I excision(TME).
The course and distribution of pelvic autonomic nerves were observed and their relationship with pelvic interfascial space was examined through the anatomy of 12 adult pelvic specimens.
The entire course of hypogastric nerves ran within the anterior sacral fascia and the inferior hypogastric plexus ran within parietal fascia. Inferior hypogastric plexus crossed the fusion line of Denonvilliers fascia and parietal fascia in the 10 o'clock and 2 o'clock directions of the rectum, and joined urogenital vessel bundle finally. Laterigrade traffic nerves could be found in Denonvilliers fascia.
The safe plane should be chosen between rectal proper fascia and anterior sacral fascia near rectal proper fascia in posterior dissection and lateral dissection of rectum. More attention should be paid to protect the neurovascular bundle in the 10 o'clock and 2 o'clock directions of rectum and traffic nerve within Denonvilliers fascia in anterior dissection.
阐明盆腔自主神经的走行及其与盆腔筋膜的关系，以确定在全直肠系膜切除（TME）中减少盆腔自主神经损伤的安全平面。
通过对12例成人盆腔标本进行解剖，观察盆腔自主神经的走行和分布，并检查其与盆腔筋膜间隙的关系。
腹下神经全程走行于骶前筋膜内，下腹下丛走行于盆壁筋膜内。下腹下丛在直肠的10点和2点方向穿过Denonvilliers筋膜与盆壁筋膜的融合线，最终汇入泌尿生殖血管束。在Denonvilliers筋膜内可发现逆行交通神经。
在直肠后方和侧方解剖时，应在直肠固有筋膜与靠近直肠固有筋膜的骶前筋膜之间选择安全平面。在前侧解剖时，应更加注意保护直肠10点和2点方向的神经血管束以及Denonvilliers筋膜内的交通神经。
