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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。
Objective To observe the anatomic relationship between the root of the inferior mesenteric artery (IMA) and the surrounding autonomic nerve and provide anatomic evidence for the protection of autonomic nerve in the inferior mesenteric artery. Methods Seven cases of 10% formalin fixed specimens were dissected and microdissected. Two fresh specimens were used to simulate the exposure and protection of the autonomic nerve root of the inferior mesenteric artery in laparoscopic radical resection of D3. Results The left and right bundles and the intercostal branches in the upper abdomen plexus (SHP) were closely related to the root of the inferior mesenteric artery. Right bundle far from the root of the inferior mesenteric artery, located in the anterior fascia. To the left descending branch as the boundary, the proximal, the left inferior bundle, the inferior mesenteric plexus, abdominal aortic plexus close to the left inferior wall of the root and the continuation of the inferior mesenteric artery, the distal left bundle walking in the Prerenal subfascial. The left bundle branch distance is not constant from the IMA start point. Conclusion The anterior segmentectomy can effectively protect the traffic branch between the right and left lateral fascicles. Using the left bundle branch of SHP as the anatomic landmark of inferior mesenteric artery can effectively protect the left bundle .