CAJ | 학술논문

目的：了解盆腔内脏神经的走行及与盆腔筋膜的关系，寻找安全的操作平面，减少直肠癌手术中对内脏神经的损伤。方法通过解剖12例人骨盆标本，观察盆腔内脏神经的走向分布及与筋膜间隙的关系。结果腹下神经全程走行于骶前筋膜内，下腹下丛走行于盆壁层筋膜内，并于直肠2点及10点处（截石位）在多个平面交叉穿入 Denonvilliers 筋膜汇入泌尿生殖血管束， Denonvilliers筋膜内存在横行的神经交通支。结论直肠后方及侧方的手术操作平面在直肠固有筋膜与骶前筋膜之间靠近直肠固有筋膜一侧，在直肠前方的手术操作应注意保护直肠2点及10点位置的泌尿生殖神经血管束及Denonvillers筋膜内的神经交通支。
목적：료해분강내장신경적주행급여분강근막적관계，심조안전적조작평면，감소직장암수술중대내장신경적손상。방법통과해부12례인골분표본，관찰분강내장신경적주향분포급여근막간극적관계。결과복하신경전정주행우저전근막내，하복하총주행우분벽층근막내，병우직장2점급10점처（절석위）재다개평면교차천입 Denonvilliers 근막회입비뇨생식혈관속， Denonvilliers근막내존재횡행적신경교통지。결론직장후방급측방적수술조작평면재직장고유근막여저전근막지간고근직장고유근막일측，재직장전방적수술조작응주의보호직장2점급10점위치적비뇨생식신경혈관속급Denonvillers근막내적신경교통지。
Objective To elucidate the course of pelvic autonomic nerves and its relationship with pelvic fascia in order to identify the safe plane to reduce the damage of pelvic autonomic nerves in total mesorectaI excision(TME). Methods The course and distribution of pelvic autonomic nerves were observed and their relationship with pelvic interfascial space was examined through the anatomy of 12 adult pelvic specimens. Results The entire course of hypogastric nerves ran within the anterior sacral fascia and the inferior hypogastric plexus ran within parietal fascia. Inferior hypogastric plexus crossed the fusion line of Denonvilliers fascia and parietal fascia in the 10 o′clock and 2 o′clock directions of the rectum, and joined urogenital vessel bundle finally. Laterigrade traffic nerves could be found in Denonvilliers fascia. Conclusion The safe plane should be chosen between rectal proper fascia and anterior sacral fascia near rectal proper fascia in posterior dissection and lateral dissection of rectum. More attention should be paid to protect the nervovascular bundle in the 10 o′clock and 2 o′clock directions of rectum and traffic nerve within Denonvilliers fascia in anterior dissection.