直肠癌外科与自主神经保留:肠系膜下动脉结扎的神经解剖因素

目的研究腹主动脉丛（AAP）等自主神经与肠系膜下动脉（IMA）之间的局部解剖学关系，寻找安全结扎IMA而不损伤自主神经的解剖学位点和比传统方法更合理的操作方法。方法对16具福尔马林固定男性躯干标本进行解剖观察。结果AAP包含于主动脉及其分支的表面一层菲薄的筋膜层中。IMA根部无自主神经纤维分布；AAP左干与IMA交叉点位置不恒定；AAP左干更加贴近IMA而非主动脉。结论从保护自主神经的角度来说，IMA最安全的结扎位点在其根部，除此之外的IMA主干及分支均无安全的结扎点。结扎IMA时正确的外科平面恰好位于IMA与其后方含有自主神经的筋膜层之间，结扎前必须“骨骼化”IMA并保持其后方筋膜层的完整性。

Preservation of the autonomic nerve in rectal cancer surgery: anatomical factors in ligation of the inferior mesenteric artery

Objective To evaluate the regional anatomy between the abdominal autonomic nerves including the abdominal aortic plexus (AAP) and the inferior mesenteric artery (IMA), and explore the safe ligation point on the IMA and the optimal dissection method to avoid autonomic nerve injuries. Methods and Results Dissections and observation were carried out on 16 fixed male cadavers. The AAP located in the thin fascia layer covering the surface of the aorta and its branches. No autonomic nerves were found in the area around the root of the IMA, and the point where the IMA and the left trunk of the AAP intersected was highly variable. The left trunk of the AAP adhered more closely to the IMA than to the aorta. Conclusions In view of autonomic nerve preservation, the only safe site for ligation of the IMA is at its origin, and no other such sites are available a-long the IMA trunk and its branches. The IMA and the posterior fascia layer containing the autonomic nerves constitute the optimal surgical plane for IMA ligation, which should be performed following skeletonization of the IMA with careful preservation of the integrity of the posterior fascia layer.