CAJ | 학술논문

目的探讨直肠系膜与盆腔筋膜和神经的关系,以明确直肠全系膜切除术合理的切除平面.方法对24具尸体的盆腔进行解剖.结果直肠周围的层次是连续的,可以分为2段3层,2段指耻骨联合至坐骨棘和坐骨棘至骶岬;3层分别为脏筋膜、膀胱腹下筋膜和壁筋膜.在膀胱腹下筋膜与脏筋膜之间存在盆丛及其膀胱、子宫神经分支,而在脏、壁筋膜之间存在腹下神经和盆内脏神经.结论直肠全系膜切除术的层次在直肠后方为脏、壁筋膜之间,而在直肠侧方实际上位于脏筋膜和膀胱腹下筋膜之间.侧后方的腹下神经、侧前方的盆丛及其分支是正确层次的标记.
목적 탐토직장계막여분강근막화신경적관계,이명학직장전계막절제술합리적절제평면.방법 대24구시체적분강진행해부.결과 직장주위적층차시련속적,가이분위2단3층,2단지치골연합지좌골극화좌골극지저갑;3층분별위장근막、방광복하근막화벽근막.재방광복하근막여장근막지간존재분총급기방광、자궁신경분지,이재장、벽근막지간존재복하신경화분내장신경.결론 직장전계막절제술적층차재직장후방위장、벽근막지간,이재직장측방실제상위우장근막화방광복하근막지간.측후방적복하신경、측전방적분총급기분지시정학층차적표기.
Objective To study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision. Methods Twenty- four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection. Results There were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia. Conclusions The posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.