肠系膜下动脉根部自主神经保护的解剖学基础

目的　观察肠系膜下动脉（IMA）根部与其周围自主神经的解剖学关系，为肠系膜下动脉根部自主神经保护提供解剖学证据。 方法　7例10%福尔马林固定标本进行大体解剖及显微解剖；2例新鲜标本模拟腹腔镜下直肠癌D3根治术中肠系膜下动脉根部自主神经的显露和保护。 结果　上腹下丛(SHP)的左、右侧束及束间交通支与肠系膜下动脉根部关系密切。右侧束距离肠系膜下动脉根部较远，位于肾前筋膜下。以左侧束降支为界，其近端，上腹下丛左侧束、肠系膜下丛、腹主动脉丛紧贴肠系膜下动脉根部左侧壁并相互延续，其远端左侧束走行于肾前筋膜下。左侧束降支距离IMA起点的距离不恒定。 结论　在肾前筋膜前平面分离可有效保护上腹下丛右侧束及侧束间交通支；以SHP左侧束降支作为肠系膜下动脉根部离断的解剖学标志可以有效保护左侧束。

Anatomical basis of the autonomic nerves preservation at the root of the inferior mesenteric artery

Objective　To explore the relationship between the root of inferior mesenteric artery and the autonomic nerves plexus around it for the autonomic nerves preservation in the colorectal surgeries.　Methods Gross and microscopic anatomy were performed on 7 formalin-fixed cadavers and the autonomic nerves preservation around the root of IMA in laparoscopic D3 radical excision for rectal cancer was imitated on 2 fresh cadavers.　Results　The bilateral trunk of the superior hypogastric plexus and communicating branches have intimate relationship with the root of inferior mesenteric artery. The right trunk runs relatively far away from the root of the inferior mesenteric artery under the anterior renal fascia. Above the level of the descending branches of the left trunk, the left trunk, the inferior mesenteric plexus and the abdominal aortic plexus run intimately on the left of the root of inferior mesenteric artery and continue with each other. Below it, the left trunk runs beneath the anterior renal fascia. The distance between the origin of inferior mesenteric artery and the descending branch of the left trunk is variable.　Conclusions　The right trunk of the superior hypogastric plexus and most bilateral communicating branches can be protected if the dissection is performed in the surgical plane anterior to the anterior renal fascia. The left trunk may be protected effectively if the descending branches of the left trunk are chosen as a new anatomical landmark for ligation of the inferior mesenteric artery.