盆腔植物神经解剖学研究在腹腔镜直肠癌根治手术的标识与应用  

Identificantion and application of surgical pelvic nerve anatomy in rectal cancer with regards to laparoscopic radical resection

作　　者：王海江[1] 葛磊[1] Wang haijiang;Ge lei(Department of Gastrointestinal Surgery, Xinjiang Medical University Affiliated Tumor Hospital, Xinjiang 830011, China)

机构地区：[1]新疆医科大学附属肿瘤医院胃肠外科,830011

出　　处：《中华结直肠疾病电子杂志》2017年第6期463-468,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金资助项目(No.81560385)

摘　　要：直肠癌外科手术在进入全直肠系膜切除术(TME)及微创手术时代后,病人的局部复发率明显降低及远期生存率得到提高,但术后排尿功能和性功能障碍发生率仍较高,从而影响患者的生活质量。尽管患者术后性功能受多因素影响,例如年龄、术前性功能状况、心理因素及放化疗对性功能的影响等,但是术中损伤自主神经则是无法逆转影响性功能的重要因素,其主要原因是对神经认识缺乏及显露不佳。因此,掌握自主神经的解剖部位及走形是行腹腔镜直肠癌手术保护神经功能的基础。本文对以下区域标识包括肠系膜下动脉根部周围神经丛,骶神经上腹下神经丛,侧盆壁下腹下丛,盆内脏神经及泌尿生殖神经血管束等解剖进行阐述,为盆腔植物神经功能保护提供理论依据和参考。The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic mid-low rectal cancer surgery has improved in term of OS and decreased the local recurrence rate.However,the incidence of urinary and sexual dysfunction remains high,which affects the patient′s quality of life.Although the above function is influenced by several factors including age,preoperative sexual function,psychological factors,and concurrent chemoradiation,intraoperative nerve damage is the primary reason for sexual and urinary dysfunction and occurs mainly because of the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerves.Therefore,understanding the anatomical landmarks is the basis for protecting nerve function of laparoscopic surgery for rectal cancer.In this review,we illustrate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,superior hypogastric plexus,inferior hypogastric plexus,pelvic splanchnic nerves,neurovascular bundles and provide a theoretical basis and reference for the protection of pelvic autonomic nerve function.

关 键 词：直肠肿瘤 全直肠系膜切除 盆腔神经保护 排尿障碍 性功能障碍 

分 类 号：R735.37[医药卫生—肿瘤]