Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Discipline of Anatomy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Med Life. 2022 Jun;15(6):784-791. doi: 10.25122/jml-2022-0145.
Elements that comprise the inferior hypogastric plexus are difficult to expose, intricate, and highly variable and can easily be damaged during local surgical procedures. We aimed to highlight, through dissection, the origin, formation, and distribution of the hypogastric nervous structures and follow them in the female pelvis. We performed detailed dissections on 7 female formalin-fixed cadavers, focusing on structures surrounding the pelvic organs. For each hemipelvis, we removed the peritoneum from the pelvic floor, and after we identified the hypogastric nerves, we continued our dissection towards the inferior hypogastric plexuses, following the branches of the latter. Laterorectally, the hypogastric nerves form the inferior hypogastric plexus, a variable structure - nervous lamina, neuronal network (more frequently), or sometimes a combination of them. We identified three components of the inferior hypogastric plexus. The anterior bundle travels towards the base of the urinary bladder, the middle part innervates the uterus and the vagina, and the posterior segment provides the innervation of the rectum. The plexus can be identified after removing the pelvic peritoneum and the subperitoneal adipose tissue. Intraoperatively, the structures can be preserved by using an immediately-subperitoneal dissection plane. The variable branches are relatively well-organized around the pelvic vessels, supplying the urinary bladder, the genital organs, and the rectum. The ureter is surrounded by some branches, especially in its last segment, and it also receives innervation directly from the hypogastric nerve. Close to the viscera, the nerves enter neurovascular plexuses, making the intraoperative separation of the nerves and the vessels virtually impossible.
构成下腹下丛的元素难以暴露，错综复杂且高度可变，并且在局部手术过程中很容易受损。我们旨在通过解剖来突出强调阴部神经结构的起源、形成和分布，并在女性骨盆中追踪它们。我们对 7 具福尔马林固定的女性尸体进行了详细的解剖，重点关注盆腔器官周围的结构。对于每个半骨盆，我们从骨盆底去除腹膜，在识别出阴部神经后，我们继续向下方的下腹下丛进行解剖，沿着后者的分支进行追踪。在直肠后外侧，阴部神经形成可变的结构 - 神经层、神经元网络（更常见），或有时两者的组合。我们确定了下腹下丛的三个组成部分。前束向膀胱底部行进，中间部分支配子宫和阴道，后节为直肠提供神经支配。去除盆腔腹膜和腹膜下脂肪组织后即可识别出丛。在手术中，可以通过立即进行腹膜下解剖平面来保留这些结构。可变的分支在盆腔血管周围相对有序地分布，为膀胱、生殖器官和直肠提供供应。输尿管周围有一些分支，特别是在其最后一段，它也直接接受来自阴部神经的支配。靠近内脏，神经进入神经血管丛，使得神经和血管的术中分离几乎不可能。
