Havenga K, DeRuiter M C, Enker W E, Welvaart K
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA.
Br J Surg. 1996 Mar;83(3):384-8. doi: 10.1002/bjs.1800830329.
Total mesorectal excision with autonomic nerve preservation for rectal cancer is based on the anatomy of the mesorectum and of the pelvic autonomic nerves. Cadaver dissections were performed to describe the relationship between these structures. Between the rectum and the sacrum a retrorectal space can be developed, lined anteriorly by the visceral leaf and posteriorly by the parietal leaf of the pelvic fascia. The hypogastric nerve runs anterior to the visceral fascia, from the sacral promontory in a laterocaudad direction. The splanchnic sacral nerves originate from the sacral foramina, posterior to the parietal fascia, and run caudad, laterally and anteriorly. After piercing the parietal layer of the pelvic fascia, approximately 4 cm from the midline, the sacral nerves run between a double layer of the visceral part of the pelvic fascia. The relationship between the hypogastric nerves, the splanchnic nerves and the pelvic fascia was comparable in all six specimens examined.
直肠癌保留自主神经的全直肠系膜切除术基于直肠系膜和盆腔自主神经的解剖结构。进行尸体解剖以描述这些结构之间的关系。在直肠和骶骨之间可形成一个直肠后间隙，其前方由盆筋膜的脏层覆盖，后方由盆筋膜的壁层覆盖。腹下神经走行于脏筋膜前方，从骶岬呈外侧向尾侧方向走行。骶内脏神经起源于骶孔，在壁层筋膜后方，向尾侧、外侧和前方走行。在距中线约4厘米处穿破盆筋膜壁层后，骶神经走行于盆筋膜脏层的双层之间。在所检查的所有六个标本中，腹下神经、内脏神经和盆筋膜之间的关系相似。
