中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2015年
33期
5389-5394
,共6页
组织构建%组织工程%内脏神经%上腹下丛%盆丛%盆内脏神经%全直肠系膜切除术%临床解剖
組織構建%組織工程%內髒神經%上腹下叢%盆叢%盆內髒神經%全直腸繫膜切除術%臨床解剖
조직구건%조직공정%내장신경%상복하총%분총%분내장신경%전직장계막절제술%림상해부
Splanchnic Nerves%Abdomen%Pelvis
背景：盆腔内走行着大量支配泌尿生殖等系统脏器的神经，包括内脏神经和脊神经两种，每一种均由运动神经和感觉神经两种成分组成。其中内脏神经的核心为盆丛。1982年，Heald提出的全直肠系膜切除已经成为直肠癌诊疗的“金标准”。但术中极易损伤神经，导致术后出现尿潴留、性功能障碍等并发症。目的：综述前人的研究，以明确盆腔内筋膜的解剖结构和神经走形。方法：以“splanchnic nerves，superior hypogastric plexus，pelvic plexus，pelvic splanchnic nerve，total mesorectal excision(TME)，clinical anatomy”为关键词，检索2000年1月至2015年1月PubMed数据库中关于盆腔内神经及相关脊神经的走形和成分、盆腔内神经节及相关脏器反射等研究，以盆腔内的神经为主。结果与结论：盆腔内的主要内脏神经丛为：①上腹下丛：主体位于由左、右髂总动脉和骶岬围成的髂间三角内，左髂总静脉和第5腰椎前面。②盆丛：腹下神经、盆内脏神经、骶内脏神经在直肠侧面的后下方1/3处汇合形成神经丛，也称下腹下丛，位于输尿管后下方、膀胱及精囊腺的背侧。由内脏神经丛发出的神经包含交感神经、副交感神经及感觉神经3种成分，走行分布在盆腔各脏器表面，支配其运动与感觉功能。明确的盆腔内筋膜的解剖结构和神经走形是全直肠系膜切除成功的关键，可在手术中最大程度避免神经损伤，提高患者预后及生活质量。
揹景：盆腔內走行著大量支配泌尿生殖等繫統髒器的神經，包括內髒神經和脊神經兩種，每一種均由運動神經和感覺神經兩種成分組成。其中內髒神經的覈心為盆叢。1982年，Heald提齣的全直腸繫膜切除已經成為直腸癌診療的“金標準”。但術中極易損傷神經，導緻術後齣現尿潴留、性功能障礙等併髮癥。目的：綜述前人的研究，以明確盆腔內觔膜的解剖結構和神經走形。方法：以“splanchnic nerves，superior hypogastric plexus，pelvic plexus，pelvic splanchnic nerve，total mesorectal excision(TME)，clinical anatomy”為關鍵詞，檢索2000年1月至2015年1月PubMed數據庫中關于盆腔內神經及相關脊神經的走形和成分、盆腔內神經節及相關髒器反射等研究，以盆腔內的神經為主。結果與結論：盆腔內的主要內髒神經叢為：①上腹下叢：主體位于由左、右髂總動脈和骶岬圍成的髂間三角內，左髂總靜脈和第5腰椎前麵。②盆叢：腹下神經、盆內髒神經、骶內髒神經在直腸側麵的後下方1/3處彙閤形成神經叢，也稱下腹下叢，位于輸尿管後下方、膀胱及精囊腺的揹側。由內髒神經叢髮齣的神經包含交感神經、副交感神經及感覺神經3種成分，走行分佈在盆腔各髒器錶麵，支配其運動與感覺功能。明確的盆腔內觔膜的解剖結構和神經走形是全直腸繫膜切除成功的關鍵，可在手術中最大程度避免神經損傷，提高患者預後及生活質量。
배경：분강내주행착대량지배비뇨생식등계통장기적신경，포괄내장신경화척신경량충，매일충균유운동신경화감각신경량충성분조성。기중내장신경적핵심위분총。1982년，Heald제출적전직장계막절제이경성위직장암진료적“금표준”。단술중겁역손상신경，도치술후출현뇨저류、성공능장애등병발증。목적：종술전인적연구，이명학분강내근막적해부결구화신경주형。방법：이“splanchnic nerves，superior hypogastric plexus，pelvic plexus，pelvic splanchnic nerve，total mesorectal excision(TME)，clinical anatomy”위관건사，검색2000년1월지2015년1월PubMed수거고중관우분강내신경급상관척신경적주형화성분、분강내신경절급상관장기반사등연구，이분강내적신경위주。결과여결론：분강내적주요내장신경총위：①상복하총：주체위우유좌、우가총동맥화저갑위성적가간삼각내，좌가총정맥화제5요추전면。②분총：복하신경、분내장신경、저내장신경재직장측면적후하방1/3처회합형성신경총，야칭하복하총，위우수뇨관후하방、방광급정낭선적배측。유내장신경총발출적신경포함교감신경、부교감신경급감각신경3충성분，주행분포재분강각장기표면，지배기운동여감각공능。명학적분강내근막적해부결구화신경주형시전직장계막절제성공적관건，가재수술중최대정도피면신경손상，제고환자예후급생활질량。
BACKGROUND:The pelvic nerves innervate the pelvic viscera as wel as bring sensory information to the central nerve system, including splanchnic nerves and spinal nerves. Each of them comprises both motor fibers and sensitive fibers. Mostly, the key part of splanchnic plexus is pelvic plexus. Total mesorectal excision proposed by Heald in 1982 has been the “gold standard” for diagnosis and treatment of colorectal cancer. However, it carries a high risk of nerve damage during surgery, which results in urinary retention, sexual dysfunction and other complications. OBJECTIVE:To summarize the former researches so as to get a precise understanding of the pelvic fascia and nerve structure. METHODS:Using “splanchnic nerves, superior hypogastric plexus, pelvic plexus, pelvic splanchnic nerve, total mesorectal excision (TME), clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the pelvic nerves, including its pathway, consistent, ganglia, and reflection in pelvic viscera, published from 2000 to 2015. RESULTS AND CONCLUSION:The main splanchnic plexus in the pelvic cavity includes superior hypogastric plexus (it is located in the triangle formed by left and right common iliac artery and the sacral promontory), and pelvic plexus (hypogastric nerve, pelvic splanchnic nerve and sacral splanchnic nerve converge at the bottom of rectum, formed pelvic plexus, also known as the inferior hypogastric plexus). It is flattened against the lateral aspect of the rectum, the dorso-lateral bladder wal and the seminal vesicles. Nerves come from the plexus contain the sympathetic nerve, parasympathetic nerve and sensory nerve. They are in charge of the motions and sensations of the pelvic organs. The definite knowledge on the anatomy of pelvic fascia and nerve structures can avoid nerve damage during operation, which can help to improve the life quality of patients.
