直肠侧韧带解剖和腹腔镜下观察的对比研究  

Comparative study of anatomy of lateral ligament of rectum and laparoscopic appearance

作　　者：黄江龙[1] 郑宗珩[1] 刘健培[1] 魏波[1] 陈图锋[1] 黄勇[1] 方佳峰[1] 卫洪波[1] 

机构地区：[1]中山大学附属第三医院胃肠外科,广州510630

出　　处：《中华消化外科杂志》2015年第9期755-758,共4页Chinese Journal of Digestive Surgery

基　　金：基金项目：广东省医学科研基金（B2013127）;广州市产学研协同创新重大专项项目（2060404）

摘　　要：目的通过尸体解剖和手术录像观察研究直肠侧韧带解剖特点，为直肠癌手术提供保留盆腔自主神经的解剖依据和方法。方法解剖并观察广东药学院人体解剖教研室提供的5具成人男性尸体标本。采用全直肠系膜切除方法锐性游离直肠，中间人路解剖分离尸体标本的直肠侧韧带。观察直肠侧韧带与下腹下神经丛的关系，测量直肠侧韧带中点至骶骨岬和尾骨尖的距离。并回顾性分析2013年1-12月中山大学附属第三医院收治的62例中低位直肠癌患者的手术录像资料。观察直肠侧方连接侧盆壁和直肠侧壁的致密组织束，寻找并确认直肠侧韧带和直肠中动脉。比较尸体标本和腹腔镜手术患者直肠侧韧带的解剖学特点和不同点。正态分布的计量资料采用x±s表示。结果5具尸体标本两侧骨盆均可解剖出直肠侧韧带，其位于直肠系膜与侧盆壁问。直肠侧韧带内含神经纤维发自直肠下段外侧的下腹下神经丛。直肠侧韧带的中点距骶骨岬的距离：左侧为（8．2±0．7）cm，右侧为（8．1±0．6）em。直肠侧韧带中点至尾骨尖距离：左侧为（5．4±0．8）cm，右侧为（5．0±0．9）cm。62例行腹腔手术患者中，49例行低位直肠前切除术，13例行腹会阴联合直肠癌根治术。62例患者腹腔镜下直肠侧韧带表现不明显，位于腹膜反折下后方，在S3～5骶椎水平。5具尸体标本中，3具发现单侧直肠中动脉（2具位于左侧、1具位于右侧），直肠中动脉与直肠侧韧带位于同一平面内，其直径为（1．1±0．4）mm。62例行腹腔镜手术患者发现单侧直肠中动脉2例，表现为超声刀切过后少许渗血，直肠中动脉与直肠侧韧带位于同一平面内。尸体标本经直肠侧韧带向骨盆壁解剖，可见位于直肠两侧的下腹下神经丛，由骶交感干的节后纤维和S2～4骶神经的副交感节前纤维组成。该神经丛呈四角形网状Objective To study the anatomic characteristics of lateral ligaments of rectum （LLR） by observing the anatomy and surgical videos, and provide the preserving-pelvic autonomic nerve anatomical basis and method for total mesorectal excision （TME）. Methods Five specimens of adult males from Guangdong Pharmaceutical University were dissected and observed. The sharp dissection of rectum was performed by TME, and LLR of 5 specimens was anatomically separated by medial approach. The relationship between LLR and inferior hypogastric plexus was observed, and the distances from midpoint of LLR to sacral promontory and apex of coccyx were measured. The video data of 62 patients with mid-low rectal cancer who were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from January 2013 to December 2013 were retrospectively analyzed. There were dense connective bundles at the lateral side of rectum to connect lateral pelvic wall and lateral rectal wall, and LLR and median artery of rectum were searched and confirmed. There were comparisons of anatomic key point and difference of LLR between 5 specimens of adult males and 62 patients with laparoscopic surgery. The measurement data with normal distribution were presented as x± s. Results LLR of 5 specimens of adult males was confirmed anatomically and located between the mesorectum and lateral pelvic wall. The nerve fibers originatingfrom inferior hypogastric plexus were found inside LLR. The distance between midpoint of LLR and sacral promontory was （8.2± 0.7 ） cm in the left side and （ 8. 1 ± 0.6 ） cm in the right side. The distance between midpoint of LLR and apex of coccyx was （5.4 ±0.8 ） cm in the left side and （5.0 ± 0.9 ） cm in the right side. Of 62 patients undergoing laparoscopic surgery, 49 underwent low anterior resection of rectum and 13 underwent abdominoperineal radical resection of rectal cancer. LLR in 62 patients appeared at the level of sacral 3-5. Of 5 specimens of adult males, unilateral middle rectal artery was obse

关 键 词：直肠肿瘤 直肠侧韧带 解剖 全直肠系膜切除术 对比研究 

分 类 号：R657.1[医药卫生—外科学] R735.37[医药卫生—临床医学]