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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 ,并于 10例直肠癌手术中进一步验证。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 ;盆丛呈网状不规则四边形结构 ,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。结论当实施保留自主神经的直肠癌根治术时 ,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
Objective To understand the anatomy of pelvic autonomic nerve and reduce the damage of autonomic nerve in rectal cancer surgery. Methods The autopsy of pelvic autonomic nerve was performed by dissecting seven cadaveric bodies and further verified in 10 cases of rectal cancer. Results The upper abdomen plexus was close to the posterior part of the inferior mesenteric vessels. There was no obvious autonomic nerve branch in the loose space between the visceral fascia and the parietal fascia. The rectum and seminal vesicles and the prostate (or uterus and vagina) There is no obvious nerve branch between them. The plexus is a network of irregular tetragonal structure, whose four corners are not in the same plane. The rectal ligaments are mainly composed of pelvic plexus branches to the rectum and connective tissue. Conclusions When performing radical resection of rectal autonomic nerve, the inferior mesenteric artery can be used as a marker to search for the epigastric plexus. The free rectum should be free from the posterior wall and the anterior wall and then be free from the lateral side. Bridge between the rectum and basin plexus; side of the free plexus should be inside, according to its arc adapted to the direction with the electric knife to cut off the rectal ligament