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目的确定直肠侧韧带的解剖位置和构成及与直肠中动脉、盆丛的关系。方法采用全直肠系膜切除(TME)技术,解剖58例沿正中矢状面切开的人半骨盆标本,确认直肠侧韧带,测量侧韧带中点距骶骨岬和尾骨尖的距离,将侧韧带横行切断行病理学检查。解剖盆丛和直肠中动脉,明确二者与侧韧带的关系。结果 58例半骨盆均可解剖出侧韧带。侧韧带自第二、三、四骶骨前缘的外侧部分发出,连于直肠及其系膜中1/3的后外侧。右侧侧韧带的中点距骶骨岬的距离为(8.3±1.6)cm,左侧为(8.4±1.4)cm;右侧侧韧带中点距尾骨尖的距离为(5.2±1.4)cm,左侧为(5.0±1.3)cm。右侧侧韧带的宽度(头肛径)为(3.2±0.4)cm,左侧为(3.1±0.4)cm。组织学检查,侧韧带由疏松结缔组织构成,主要成分为纤维组织、脂肪组织、血管、神经束等。半骨盆中发现直肠中动脉者占83%(48/58),该动脉穿经侧韧带者47%(27/58)。以盆丛为界,可将侧韧带分为内外两部分,外侧包括髂血管的分支,内侧包括盆丛发出的直肠支和直肠中动脉的内侧部分。结论直肠侧韧带是一个明确的解剖结构,主要由桥接于直肠及其系膜后外侧和第二、三、四骶骨体外侧部分的疏松结缔组织构成,侧韧带距尾骨尖的距离小于距骶骨岬的距离。侧韧带中含有盆丛及其直肠支、直肠中动脉或其分支,是血管和神经进入直肠和淋巴自低位直肠流向髂血管周围淋巴结的通道。
Objective To determine the anatomical location and composition of the rectal ligament and the relationship with the middle rectum and pelvic plexus. Methods Total mesorectal excision (TME) technique was used to dissect 58 cases of human pelvis pelvis cut along the median sagittal plane. The lateral ligaments of the rectum were examined. The distance between the lateral ligaments and the tip of the sacral promontory and coccyx was measured. The transverse ligaments Cut off the pathological examination. Anatomical pelvic plexus and rectal artery, a clear relationship between the two and the lateral ligaments. Results 58 cases of pelvis can be anatomized lateral ligaments. Lateral ligaments originate from the lateral portions of the second, third and fourth sacral anterior commissures, and are attached to the posterior lateral aspect of the rectum and its mesangial area. The distance between the midpoint of the right lateral ligament and the sacral promontory was (8.3 ± 1.6) cm and to the left was (8.4 ± 1.4) cm. The distance from the midpoint of the right lateral ligament to the coccyx tip was (5.2 ± 1.4) cm. Side was (5.0 ± 1.3) cm. The width of the right lateral ligament (head and anus diameter) was (3.2 ± 0.4) cm, left (3.1 ± 0.4) cm. Histological examination, the lateral ligament by loose connective tissue, the main components of fibrous tissue, adipose tissue, blood vessels, nerve bundles. In the semi-pelvis, 83% (48/58) of the rectal arteries were found, and 47% (27/58) of the arteries penetrated the lateral ligaments. To the plexus community, the lateral ligaments can be divided into two parts inside and outside, including the iliac vessels on the outside of the branch, the medial plexus containing the rectal branch and medial part of the rectum. Conclusions The rectal ligament is a well-defined anatomical structure composed mainly of loose connective tissue bridging the posterolateral and posterior mesangial segments and the second, third and fourth sacral body. The distance between the lateral ligaments and the coccyx is less than that of the promontory distance. The lateral ligament contains pelvic plexus and its rectum branch, rectum artery or its branches, is the passage of blood vessels and nerves into the rectum and lymph from the lower rectum to the peri-iliac lymph nodes.