Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2000
[Preserving autonomic nerves in rectal surgery. Results of surgical preparation on human cadavers with fixed pelvic sections].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Höer J, Roegels A, Prescher A, Klosterhalfen B, Töns C, Schumpelick V
Аннотация
INTRODUCTION: Preservation of sexual function and voiding capacity after rectal cancer surgery has increased after adopting the technique of nerve-sparing dissection and total mesorectal excision. Still the rate of sexual and urinary dysfunction ranges between 25 and 67%. The precise locations where nerve damage occurs have not been looked at systematically.
MATERIAL AND METHODS: In ten human corpses and two formalin-fixed human pelvises the autonomous pelvic nerves were isolated. Their relation according to surgical mobilization of the rectum were photodocumented.
RESULTS: Pelvic autonomous nerves are clearly defined structures with only minor interindividual variability. The inferior mesenteric plexus forms a dense network around the inferior mesenteric artery (AMI) to a distance of 5 cm from the aorta. The distance between the lateral rectum and the pelvic plexus is only 2-3 mm. The anterior rectum is almost directly adherent to the neurovascular bundle, separated only by Denonvillier's fascia. The parasympathetic branches of the sacral segments S2-S5 cannot be isolated using the standard surgical approach.
CONCLUSION: (1) The nomenclature of fascias and the course of the autonomous pelvic nerves is not clearly defined in the literature; (2) a high tie of the AMI leads to damage of the sympathetic nerves; (3) the narrow space between the anterior and lateral rectum makes sharp dissection under direct vision necessary; (4) fascias and nerves can be used as guiding structures during mobilization; (5) a preservation of selected parasympathetic roots in the small pelvis is not feasible using the standard surgical approach.
MATERIAL AND METHODS: In ten human corpses and two formalin-fixed human pelvises the autonomous pelvic nerves were isolated. Their relation according to surgical mobilization of the rectum were photodocumented.
RESULTS: Pelvic autonomous nerves are clearly defined structures with only minor interindividual variability. The inferior mesenteric plexus forms a dense network around the inferior mesenteric artery (AMI) to a distance of 5 cm from the aorta. The distance between the lateral rectum and the pelvic plexus is only 2-3 mm. The anterior rectum is almost directly adherent to the neurovascular bundle, separated only by Denonvillier's fascia. The parasympathetic branches of the sacral segments S2-S5 cannot be isolated using the standard surgical approach.
CONCLUSION: (1) The nomenclature of fascias and the course of the autonomous pelvic nerves is not clearly defined in the literature; (2) a high tie of the AMI leads to damage of the sympathetic nerves; (3) the narrow space between the anterior and lateral rectum makes sharp dissection under direct vision necessary; (4) fascias and nerves can be used as guiding structures during mobilization; (5) a preservation of selected parasympathetic roots in the small pelvis is not feasible using the standard surgical approach.