直肠癌手术相关腹膜后自主神经的筋膜解剖学观察

目的　从临床解剖学和组织学角度进一步阐明盆自主神经的筋膜层次。 方法　选取7具尸体标本和52例接受腹腔镜直肠癌切除手术的病人，观察其自主神经与肾前筋膜-骶前筋膜的关系。切取尸体降乙结肠系膜与主髂动脉之间、直肠系膜与骶骨骨膜之间的腹膜后组织做组织学检查。 结果　解剖学观察显示，腹主动脉丛、上腹下丛、腹下神经、下腹下丛位于肾前筋膜-骶前筋膜后外侧。组织学检查显示：神经纤维位于筋膜后，部分较细的纤维位于筋膜内。 结论　自主神经位于肾前筋膜-骶前筋膜后外侧。保持这一筋膜的完整性，是直肠癌手术中保护自主神经的解剖学基础和基本方法。

Anatomical observation of fascial layer of retroperitoneal autonomic nerve associated with rectal cancer surgery

Objective To further elucidate the fascial layer of the pelvic autonomic nerve from the view of anatomy and histology. Methods The relationship between autonomic nerve and prerenal fascia-presacral fascia was observed in 7 cadavers and 52 patients undergoing laparoscopic rectal cancer surgery. Histological examination was performed on the retroperitoneal tissue between mesentery of descending sigmoid colon and aortic iliac artery, and between the mesorectal and sacral periosteum. Results Anatomical observation showed that abdominal aortic plexus, superior hypogastric plexus, hypogastric nerve and inferior hypogastric plexus were located at the posterolateral side of the prerenal fascia-presacral fascia. Histological examination showed that the nerve fibers were located behind the fascia and some of the finer nerve fibers were located in the fascia. Conclusion The autonomic nerve is located in the posterolateral part of the prerenal fascia-presacral fascia. Maintaining the integrity of this fascia is the anatomical basis and basic method of preserving autonomic nerve in rectal cancer surgery.