盆腔自主神经的解剖特点及其在直肠癌术中的临床应用  

The Anatomical Characteristics of the Vegetative Nerves and Their Clinical Application in Rectal Carcinectomy

作　　者：池畔[1] 兰宝金 陈玲珑 郑鸣[3] 

机构地区：[1]福建医科大学附属协和医院外科,福州350001 [2]福建省福州卫生学校人体解剖学教研室,福州350007 [3]福建医科大学人体解剖学教研室,福州350004

出　　处：《医学新知》2004年第1期31-32,37,共3页New Medicine

基　　金：福建省福州市科技基金发展项目 (编号 :2 0 0 13 5 0 10 2 0 0 0 2 70 )

摘　　要：目的　根据自主神经的解剖特点探讨保留自主神经的直肠癌根治术 ,对性功能及排尿功能的保护作用。方法　①在 2 5侧成人男性骨盆矢状标本及 17具成人男性躯干标本上解剖观测有关内脏神经丛及分支的形态及位置 ;②对 4 0例直肠癌患者术中采用保留自主神经和不保留自主神经的手术效果进行分析。结果　①盆丛位于直肠膀胱陷凹上外侧 2 .98～ 4 .71cm处的盆壁之间 ;左右腹下神经分别位于骶骨岬中点至左右坐骨大切迹下缘内侧一横指处 ;上腹下丛位于腹主动脉分叉至骶骨岬下约 2cm之间 ;②保留自主神经术后排尿功能障碍率男为 11.1%女为 18.2 % ,性功能障碍率男为 11.1%女为 9.1%。不保留自主神经术后排尿功能障碍率男为 4 5 .4 %女为 88.9% ,性功能障碍率男为 81.8%女为 6 6 .7%。结论　保留自主神经的直肠癌根治术能有效降低术后性功能障碍及排尿功能障碍。Objective to explore a radical cure of rectal cancer through rectal carcinectomy with the vegetative nerves preserved on basis of the anatomical characteristics of vegetative nerves.Methods 1. 25 arrowy adult male pelvis sides cadavers and 17 normal adult male trunk cadavers were anatomized, and the conformation and location of pelvic plexus were observed. 2. The postoperative effects were analyzed according to 40 rectal cancer patients that were operated with or without the vegetative nerves preserved. Results ①Pelvic plexus were located on the pelvic floor between 2.98～4.71cm upper and outboard from excavatio rectovesicalis; the left and right hypogastric nerves were located from the midpoint of the sacrum promontorium to one finger wide to the nether edge of incisua ischiadica major; the midsectional plexus was situated in the about 2cms’scale between the abdominal aorta and the sacrum promontorium. ②Rate of dysuria among patients after operation with the vegetative nerves preserved: male 11.1%, female 18.2%; and rate of sexual dysfunction: male 11.1%, female 9.1%. Rate of dysuria among patients after operation without the vegetative nerves preserved: male 45.5%, female 88.9%; and rate of sexual dysfunction: male 81.8%, female 66.7%. Conclusion The rate of sexual dysfunction and dysuria can be significantly reduced when operation for the radical cure of rectal cancer is carried out with the vegetative nerves preserved.

关 键 词：盆腔 自主神经 解剖特点 直肠癌 肿瘤切除术 排尿功能障碍 性功能障碍 

分 类 号：R735.37[医药卫生—肿瘤]