直肠骶骨筋膜-泌尿生殖层直肠附着处的临床解剖观察及其临床意义

Clinical anatomical observation of attachment of rectosacral fascia and urogenital stratum on rectum and its clinical significance

目的:观察直肠骶骨筋膜与泌尿生殖层及直肠固有筋膜的解剖学关系,探讨在低位直肠手术中解剖处理该结构在保证直肠系膜完整性及保护自主神经的重要临床意义。方法:回顾性分析2021年1月至12月期间就诊于宁波大学医学院附属医院肛肠外科的直肠癌患者的临床资料和手术录像,观察直肠骶骨筋膜形态和移行情况。结果:观察可见直肠骶骨筋膜自骶前筋膜延续,并附着于直肠固有筋膜,年轻男性尤为明显,并且更加质地坚韧。侧方直肠骶骨筋膜盆壁侧附着于肛提肌腱弓,直肠侧附着于直肠固有筋膜。泌尿生殖层呈环形围绕于直肠周围,直肠骶骨筋膜是泌尿生殖层的尾侧末梢部分,此末梢附着于直肠固有筋膜。盆壁侧末梢附着于肛提肌腱弓处,直肠腹侧的泌尿生殖层脏筋膜继续覆盖精囊向尾侧延续。女性筋膜较为薄弱,尤其是直肠腹侧部分,未能清晰观察其向尾侧和两侧的延续情况。结论:术中应锐性分离泌尿生殖层附着于直肠固有筋膜处,以保护自主神经功能。

Objective:To observe and describe the anatomical relationship between the rectosacral fascia and the urogenictal stratum and the inherent fascia of the rectum for exploring the clinical significance of anatomical treatment of this structure in low rectal surgery to ensure the integrity of the mesentery and protect the autonomic pelvic plexus.Methods:The clinical data and surgical videos of 32 patients with rectal cancer admitted to the Anorectal Surgery Department of the Affiliated Hospital of Ningbo University School of Medicine from January to December 2021 were retrospectively analyzed,and the morphology and migration of rectosacral fascia were observed.Results:The sacral rectum fascia was observed in all 32 cases,extending from the presacral fascia,and attaching to the proper rectum fascia,especially in young men,and was stronger in texture.The lateral rectosacral fascia was attached to the arch of the anal levator tendon on one side and to the inherent fascia of the rectum on the other.The urogenital stratum is annular around the rectum,and the rectosacral fascia is the distal part of the urogenital stratum,which is attached to the inherent fascia of the rectum.The lateral end of the pelvic wall is attached to the arch of the anal levator tendon,and the seminal vesicle gland continues to cover the anterior part.In women,the fascia is weak,especially in the ventral part of the rectum,and the caudal and bilateral continuation is not clearly observed.Conclusion:Attachment of urogenital stratum on fascia propria of rectum should be sharply dissected during operation in order to protect autonomic nerves.