切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 463 -468. doi: 10.3877/cma.j.issn.2095-3224.2017.06.005

所属专题: 文献

专家论坛

盆腔植物神经解剖学研究在腹腔镜直肠癌根治手术的标识与应用
王海江1,(), 葛磊1   
  1. 1. 830011 新疆医科大学附属肿瘤医院胃肠外科
  • 收稿日期:2017-02-27 出版日期:2017-12-25
  • 通信作者: 王海江
  • 基金资助:
    国家自然科学基金资助项目(No.81560385)

Identificantion and application of surgical pelvic nerve anatomy in rectal cancer with regards to laparoscopic radical resection

haijiang Wang1,(), lei Ge1   

  1. 1. Department of Gastrointestinal Surgery, Xinjiang Medical University Affiliated Tumor Hospital, Xinjiang 830011, China
  • Received:2017-02-27 Published:2017-12-25
  • Corresponding author: haijiang Wang
  • About author:
    Corresponding author: Wang haijiang, Email:
引用本文:

王海江, 葛磊. 盆腔植物神经解剖学研究在腹腔镜直肠癌根治手术的标识与应用[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(06): 463-468.

haijiang Wang, lei Ge. Identificantion and application of surgical pelvic nerve anatomy in rectal cancer with regards to laparoscopic radical resection[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(06): 463-468.

直肠癌外科手术在进入全直肠系膜切除术(TME)及微创手术时代后,病人的局部复发率明显降低及远期生存率得到提高,但术后排尿功能和性功能障碍发生率仍较高,从而影响患者的生活质量。尽管患者术后性功能受多因素影响,例如年龄、术前性功能状况、心理因素及放化疗对性功能的影响等,但是术中损伤自主神经则是无法逆转影响性功能的重要因素,其主要原因是对神经认识缺乏及显露不佳。因此,掌握自主神经的解剖部位及走形是行腹腔镜直肠癌手术保护神经功能的基础。本文对以下区域标识包括肠系膜下动脉根部周围神经丛,骶神经上腹下神经丛,侧盆壁下腹下丛,盆内脏神经及泌尿生殖神经血管束等解剖进行阐述,为盆腔植物神经功能保护提供理论依据和参考。

The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic mid-low rectal cancer surgery has improved in term of OS and decreased the local recurrence rate. However, the incidence of urinary and sexual dysfunction remains high, which affects the patient′s quality of life. Although the above function is influenced by several factors including age, preoperative sexual function, psychological factors, and concurrent chemoradiation, intraoperative nerve damage is the primary reason for sexual and urinary dysfunction and occurs mainly because of the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerves. Therefore, understanding the anatomical landmarks is the basis for protecting nerve function of laparoscopic surgery for rectal cancer. In this review, we illustrate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle, superior hypogastric plexus, inferior hypogastric plexus, pelvic splanchnic nerves, neurovascular bundles and provide a theoretical basis and reference for the protection of pelvic autonomic nerve function.

图1 盆腔自主神经分布走行及上腹下神经丛
图2 肠系膜下动脉根部周围神经丛
图4 盆腔神经丛
图5 泌尿生殖神经血管束
1
Dulskas A,Samalavicius NE. A prospective study of sexual and urinary function before and after total mesorectal excision [J]. Int J Colorectal Dis, 2016, 31(6): 1125-1130.
2
Kim NK,Aahn TW,Park JK, et al. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer [J]. Dis Colon Rectum, 2002, 45(9): 1178-1185.
3
Quah HM,Jayne DG,Eu KW, et al. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer [J]. Br J Surg, 2002, 89(12): 1551-1556.
4
Rutegård J,Sandzén B,Stenling R, et al. Lateral rectal ligaments contain important nerves [J]. Br J Surg, 1997, 84(11): 1544-1545.
5
Moszkowicz D,Alsaid B,Bessede T, et al. Where does pelvic nerve injury occur during rectal surgery for cancer [J]? Colorectal Dis, 2011, 13(12): 1326-1334.
6
Eveno C,Lamblin A,Mariette C, et al. Sexual and urinary dysfunction after proctectomy for rectal cancer [J]. J Visc Surg, 2010, 47(1): e21-30.
7
Bissett IP,Zarkovic,Hamilton P. Localisation of hypogastric nerves and pelvic plexus in relation to rectal cancer surgery [J]. Eur J Anat, 2007, 11(2): 111-118.
8
Lu S,Xu Y,Chang S, et al. Clinical anatomy study of autonomic nerve with respective to the anterior approach lumbar surgery [J]. SurgRadiolAnat SRA, 2009, 31(6): 425-430.
9
Daniels IR,Woodward S,Taylor FGM, et al. Female urogenital dysfunction following total mesorectal excision for rectal cancer [J]. World J SurgOncol, 2006, 31(4): 6.
10
Bissett IP,Hill GL. Extrafascial excision of the rectum for cancer: a technique for the avoidance of the complications of rectal mobilization [J]. SeminSurgOncol, 2000, 8(3): 207-215.
11
Mauroy B,Demondion X,Bizet B, et al. The female inferior hypogastric (pelvic) plexus: anatomical and radiological description of the plexus and its afferences--applications to pelvic surgery [J]. Surg Radiol Anat SRA, 2007, 29(1): 55-66.
12
Garavoglia M,Borghi F,Levi AC. Arrangement of the anal striated musculature [J]. Dis Colon Rectum, 1993, 36(1): 10-15.
13
Havenga K,Maas CP,DeRuiter MC, et al. Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer [J]. Semin Surg Oncol, 2000, 18(3): 235-243.
14
Akasu T,Sugihara K,Moriya Y. Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer [J]. Ann Surg Oncol, 2009, 16(10): 2779-2786.
15
Pearson AA,Sauter RW. Nerve contributions to the pelvic plexus and the umbilical cord [J]. Am J Anat, 1970, 128(4): 485-498.
16
Havenga K,DeRuiter MC,Enker WE, et al. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer [J]. Br J Surg, 1996, 83(3): 384-388.
17
Baader B,Herrmann M. Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis [J]. Clin Anat N Y N, 2003, 16(2): 119-130.
18
Trimbos JB,Maas CP,Deruiter MC, et al. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients [J]. Int J Gynecol Cancer, 2001, 11(3): 180-186.
19
Yucel S,Erdogru T,Baykara M, et al. Recent neuroanatomical studies on the neurovascular bundle of the prostate and cavernosal nerves: clinical reflections on radical prostatectomy [J]. Asian J Androl, 2005, 7(4): 339-349.
20
Spackman R,Wrigley B,Roberts A, et al. The inferior hypogastric plexus: a different view [J]. J Obstet Gynaecol, 2007, 27(2): 130-133.
21
Sato K,Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia [J]. Surg Radiol Anat SRA, 1991, 13(1): 17-22.
22
Zaitouna M,Alsaid B,Diallo D, et al. Identification of the origin of adrenergic and cholinergic nerve fibers within the superior hypogastric plexus of the human fetus [J]. J Anat, 2013, 223(1): 14-21.
23
张策,丁自海,李国新. 全直肠系膜切除相关盆植物神经解剖学观察. 中国临床解剖学杂志 [J]. 2006, 24(1): 60-64.
24
王毅,马国龙,梁小波. Denonvilliers筋膜解剖学研究及其在直肠癌手术中的应用 [J]. 中华解剖与临床杂志, 2015, 20(6): 534-539.
25
Nagpal K,Bennett N. Colorectal surgery and its impact on male sexual function [J]. Curr Urol Rep, 2013, 14(4): 279-284.
26
Jones OM,Smeulders N,Wiseman O, et al. Lateral ligaments of the rectum: an anatomical study [J]. Br J Surg, 1999, 86(4): 487-489.
27
Hollabaugh RS,Steiner MS,Sellers KD, et al. Neuroanatomy of the pelvis: implications for colonic and rectal resection [J]. Dis Colon Rectum, 2000, 43(10): 1390-1397.
28
Mauroy B,Bizet B,Bonnal JL, et al. Systematization of the vesical and uterovaginalefferences of the female inferior hypogastric plexus (pelvic): applications to pelvic surgery on women patients [J]. Surg Radiol Anat SRA, 2007, 29(3): 209-217.
29
Walsh PC,Donker PJ. Impotence Following Radical Prostatectomy: Insight into Etiology and Prevention [J]. J Urol, 2017, 197(2S): S165-170.
30
Clausen N,Wolloscheck T,Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae [J]. World J Surg, 2008, 32(8): 1768-1775.
31
Fetti A,Zaharie F,Geza M, et al. Laparoscopic surgery for the treatment of rectal cancer: short-term results [J]. Chirugia(Buchar), 2012, 107(6): 730-736.
[1] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[3] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[6] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[8] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[9] 李明, 屠松, 闫鹏, 钱军, 高鹏程, 许文山, 杨发英, 胡振涛, 单永玮. 应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 603-606.
[10] 李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[11] 赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[12] 吴胜伟, 王志伟, 陈贵进, 刘序, 吴晓翔. 系膜肥厚低位直肠癌患者改良NOSES Ⅰ式手术的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 615-618.
[13] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[14] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[15] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?