直肠癌全直肠系膜切除术中盆腔植物神经的易损区域及保护

全直肠系膜切除术（TME）是目前国际公认的直肠癌标准术式，随着TME手术的推广和认识，盆腔植物神经保护（PANP）的理念逐渐受到重视。笔者认为，在开展直肠癌TME手术时，有六个区域容易发生盆腔植物神经损伤，需要识别和保护：肠系膜下动脉根部的肠系膜下丛、上腹下神经丛及腹下神经的近端、盆丛前丛的近端、盆丛后丛的主干、盆丛后丛的终末支及盆腔内脏神经。熟悉盆腔筋膜、植物神经解剖，开展以TME手术层面为主导，盆腔植物神经为引导的精准直肠癌手术，对于提高手术质量，保护器官功能至关重要。

The vulnerable sites and protection of pelvic autonomic nerve in total mesorectal excision of rectal cancer

Total mesorecal excision (TME) is considered as the standard procedure for rectal cancer worldwide. With the popularization and cognition of TME procedure, the pelvic autonomic nerves preservation (PANP) in the operation is valued gradually. We considered there are six areas which are easily injured in the TME procedure: inferior mesorectal plexus (IMP) at the root of inferior mesorectal artery (IMA), superior hypogastric plexus (SHP) and the proximal part of hypogastric plexus (HP), proximal part of anterior branches of pelvic plexus, main trunk of posterior branches of pelvic plexus, terminal part of posterior branches of pelvic plexus, pelvic splanchnic nerves. Familiarity with the anatomy of pelvic fascia and autonomic nerves, development of TME plane dominated and pelvic autonomic nerves guided precise rectal cancer surgery play an important role in promoting the quality of surgery and protecting the function of organ.