摘要
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 identify the location and contents of the rectal lateral ligaments and its relationship with the middle rectal artery and pelvic plexus. Methods Twenty-nine pelvics of human cadavers were sagittally sectioned into 58 hemipelvic specimens. All of hemipelvics were dissected with sharp technique under direct vision by one surgeon. The lateral ligaments were identified and the distances from the center of its pelvic attachment to sacral promontory and coccyx were measured. Then, the lateral ligaments were transected for histologic examination. Results Lateral ligaments of rectum were found in all 58 hemipelvics. The lateral ligaments connected the posterolateral aspect of the middle 1/3 of the rectum and mesorectum to the lateral aspect of the bodies of the second, third and fourth sacral vertebrae. The distance from the lateral ligament to sacral promontory was （ 8.3 ± 1.6） cm on the right side and （8.4 ± 1.4） cm on left side. The width of lateral ligaments was （3.2 ± 0. 4） cm on the right side and （3. 1 ± 0. 4 ） cm on the left side. The distances from lateral ligament to the coccyx on the right and left sides were （5.2 ± 1.4） cm and （5.0 ± 1.3 ） cm respectively. The content of the lateral ligaments consisted of loose connective tissue with clusters of small nerves and blood vessels. Middle rectal artery was found in 83% （48/58） of hemipelvics and 47% （27/58） of the middle rectal artery went through the lateral ligaments. The inferior hypogastric nerve plexuses were formed inside the lateral ligament, and separated the ligament into two parts. The lateral segment of the lateral ligament contained the tributaries of internal iliac artery, and the medial segment contained nerve fibers or branches to the rectum, together with the middle rectal artery. Condusion The lateral ligaments of rectum are located on the posterolateral side of the rectum, much closer to the coccyx than to the sacral promontory, consisting of connective tissue containing multiple small nerves and middle rectal artery. The lateral ligament is a pathway of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第35期2475-2478,共4页
National Medical Journal of China
关键词
韧带
解剖学
局部
直肠
Ligaments
Anatomy, regional
Rectum
