盆腔自主神经的解剖及其在直肠癌手术中的临床价值

目的：了解盆腔自主神经的解剖,减少直肠癌手术中对自主神经的损伤.方法：通过解剖7例尸体了解盆腔自主神经的分布.结果：上腹下丛紧贴肠系膜下血管的后方;直肠正后方的脏层筋膜与壁层筋膜之间的疏松间隙内无明显自主神经分支;直肠与精囊和前列腺（或子宫,阴道）之间无明显的神经支;盆丛呈不规则四边形结构,其四个角不在同一平面;直肠侧韧带主要由盆丛发至直肠的分支及结缔组织构成.结论：当直肠癌根治术保留自主神经时,肠系膜下血管可作为寻找上腹下丛的标志;游离直肠时应先游离其后壁及前壁,后游离其侧方,使直肠侧韧带呈桥状架于直肠与盆丛之间;侧方的游离应于盆丛的内侧,按与其弧面相适应的方向用电刀切断直肠侧韧带.

Clinical value about anatomy of pelvic autonomic nerves during rectal cancer surgery

Objective:To study the anatomy of pelvic autonomic nerves,to avoid autonomic nerves damage during rectal cancer surgery.Methods:Anatomical dissections were carried out on 7 adult cadavers.Rusults:The superior hypogastric plexus lies just posterior to the inferior mesenteric vessels.There were no obvious autonomic nerve trunks in the loose areolar tissue plane between the parietal fascia and the visceral fascia rihgt posterior to the rectum.There were no obvious autonomic nerve trunks between the rectum and the seminal Vesicles or the prostate.The inferior hypogastric plexus was a rhomboid shaped plaque of nervous tissue.The main components of the lateral ligament were autonomic nerves passing from the pelvic plexus to the rectum within a condensation of connective tissue.Conclusion:The inferior mesenteric vessels can be used a landmark intraoperatively to identify the superior hypogastric plexus.In order to preserve the inferior hypogastric plexus,the lateral of rectum should be dissected along the medial surface of the inferior hypogastric plexus,and along its curvature.