CAJ | 학술논문

目的明确直肠固有筋膜与周围结构的关系,寻找无血管、神经的间隙,为直肠全系膜切除术中"安全平面"的选择提供解剖学依据.方法选择26例10%甲醛固定的成年男性盆腔标本进行研究,20例沿正中切开行局部解剖观察,6例行断层解剖观察.结果直肠固有筋膜腹侧与Denonvilliers筋膜相邻,共同构成直肠膀胱隔,两者之间为无血管、神经的潜在间隙.直肠固有筋膜背侧与骶前筋膜水平走行,构成无血管、神经的骶前间隙,此间隙解剖变异较大,16例(80%)标本筋膜间隙明显,内有板层状直肠骶骨韧带走行(分层型);4例(20%)无筋膜间隙,由肌肉样组织填充或骶前筋膜融合、增厚(融合型).直肠固有筋膜外侧与盆腔壁层筋膜构成直肠外侧间隙,间隙内可见直肠侧韧带和盆腔神经丛,依据神经丛与直肠固有筋膜的关系分为紧密融合型(17例,85%)和疏松连接型(3例,15%).结论直肠腹侧的"安全平面"介于直肠固有筋膜与Denonvilliers筋膜之间,后外侧位于直肠固有筋膜与壁层筋膜之间.
목적 명학직장고유근막여주위결구적관계,심조무혈관、신경적간극,위직장전계막절제술중"안전평면"적선택제공해부학의거.방법 선택26례10%갑철고정적성년남성분강표본진행연구,20례연정중절개행국부해부관찰,6례행단층해부관찰.결과 직장고유근막복측여Denonvilliers근막상린,공동구성직장방광격,량자지간위무혈관、신경적잠재간극.직장고유근막배측여저전근막수평주행,구성무혈관、신경적저전간극,차간극해부변이교대,16례(80%)표본근막간극명현,내유판층상직장저골인대주행(분층형);4례(20%)무근막간극,유기육양조직전충혹저전근막융합、증후(융합형).직장고유근막외측여분강벽층근막구성직장외측간극,간극내가견직장측인대화분강신경총,의거신경총여직장고유근막적관계분위긴밀융합형(17례,85%)화소송련접형(3례,15%).결론 직장복측적"안전평면"개우직장고유근막여Denonvilliers근막지간,후외측위우직장고유근막여벽층근막지간.
Objective To provide anatomic evidence for identification of "holy plane" between fascia propria and its adjacent fascias in total mesorectal excision. Methods A total of 26 pelvic specimens of adult male preserved in 10% formalin solution were used in this study. Twenty pelvises were employed for topographic anatomy, six for sectional anatomy. Results Rectovesical septum was formed by the ventral part of the fascia propria and Denonvilliers' fascia, with no blood vessel and nerve coursed between two layers. Dorsal part of the fascia propria parallelled with the presacral fascia,with no blood vessel and nerve coursed between two layers in 80% of the pelvises. However, anatomic variations was encountered occasionally--with muscle-like tissue or fusion of presacral fascia interposed between them for 20%. The lateral space of rectum was between lateral part of the fascia propria and parietal fascia which witnessed pelvic nerve plexus and lateral ligament of the rectum traveling. Pelvic nerve plexus was categorized as two types according the relation between fascia propria and nerve plexus:fusion type accounting for 85% and rarefaction type for 15%. Conclusion 'Holy plane' is sandwiched between the fascia propria and its adjacent fascia-ventrally Denonvilliers fascia,dorsally presacral fascia and laterally parietal fascia.