New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer
New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer
复制标题
腹腔镜结直肠癌手术中肠系膜下动脉高位结扎保留自主神经的新见解
DOI：
10.7314/apjcp.2014.15.6.2533
复制
发表时间：
2014-01-01
影响因子：
--
通讯作者：
Ding, Zi-Hai
中科院分区：
文献类型：
--
作者：
Yang, Xiao-Fei;Li, Guo-Xin;Ding, Zi-Hai
目的：通过尸体解剖深入了解肠系膜下动脉根与周围自主神经丛的关系，探讨腹腔镜结直肠癌肠系膜下动脉高位结扎中自主神经保存的解剖学依据。方法：对11具福尔马林固定尸体和12具新鲜尸体进行解剖解剖。在22例腹腔镜结直肠癌根治性切除术中，采用基于解剖学证据的IMA高位结扎保留自主神经。结果：双侧SHP干作为骶前神经的向上延伸，与IMA根有密切但不同的关系。SHP右主干离IMA根相对较远。当沿肾前筋膜前筋膜间隙在靠近IMA根处清扫根尖淋巴结时，可在肾前筋膜下保持SHP右干。左降支构成了IMA根与左侧自主神经关系的自然和恒定的解剖学标志。在近端，左侧自主神经环绕IMA根部。远端，左主干在肾前筋膜下离开IMA根。在远端高位结扎IMA时，可保留左主干。左降支到SHP和IMA起源的距离在1.3 ~ 2.3 cm之间变化很大。结论：双侧自主神经保存在IMA根周围的分叉可能为今后更精确地评估IMA高位结扎的最佳位置提供解剖学依据。
Aim: To take a deeper insight into the relationship between the root of the inferior mesenteric artery (IMA) and the autonomic nerve plexuses around it by cadaveric anatomy and explore anatomical evidence of autonomic nerve preservation in high ligation of the IMA in laparoscopic surgery for colorectal cancer. Methods: Anatomical dissection was performed on 11 formalin-fixed cadavers and 12 fresh cadavers. Anatomical evidence-based autonomic nerve preservation in high ligation of the IMA was performed in 22 laparoscopic curative resections of colorectal cancer. Results: As the upward continuation of the presacral nerves, the bilateral trunks of SHP had close but different relationships with the root of the IMA. The right trunk of SHP ran relatively far away from the root of IMA. When the apical lymph nodes were dissected close to the root of the IMA along the fascia space in front of the anterior renal fascia, the right trunk of SHP could be kept in suit under the anterior renal fascia. The left descending branches to SHP constituted a natural and constant anatomical landmark of the relationship between the root of IMA and the left autonomic nerves. Proximal to this, the left autonomic nerves surrounded the root of the IMA. Distally, the left trunk of the SHP departed from the root of IMA under the anterior renal fascia. When high ligation of the IMA was performed distal to it, the left trunk of SHP could be preserved. The distance between the left descending branches to SHP and the origin of IMA varied widely from 1.3 cm to 2.3 cm. Conclusions: The divergences of the bilateral autonomic nerve preservation around the root of the IMA may contribute to provide anatomical evidence for more precise evaluation of the optimal position of high ligation of the IMA in the future.