The Applied Anatomy Study Of The Lower Rectum

Objective:The aim of the study is to study morphological basis of the low rectum and the adjacent tissue by anatomical observation,and provide evidence for the clinical application of radical resection of middle and lower rectal cancer.Methods: The pelvic cavities were dissected on 13 male cadavers in the department of human anatomy of Qingdao University in the fall of 2015.Observation items included the adjacent relationship of the lower rectum,lateral rectal ligament,middle rectal artery,pelvic autonomic nerve plexus(PANP),denonvilliers fascia,etc.According to the anatomic observationes,38 open surgeries,42 laparoscopic surgeries for middle-low rectal cancer and 4 open surgeries with preoperative injection of cannelin for colorectal cancer were conducted by total mesorectal excision.The surgical effect was assessed by spss18.0.Results: Anatomic observation:(1)The lateral rectal ligament,an irregular quadrilateral structure,arised from the intrinsic fascia of the rectum,ended in the fascia of the pelvis in16 cases.The PANP,under the fascia of the pelvis,at lateral to the rectal ligament,sent out numerous small branches which entered the rectal ligament.(2)There were 16 middle rectal arteries in the 13 cadavers.The middle rectal artery,with occurrence rate 61.5%,arised from internal pudendal artery.Only 4 middle rectal arteries entered the rectal ligament,other 12 middle rectal arteries didn't entered the rectal ligament(3)The denonvilliers fascia,a membrane structure,arised from the peritoneal reflection,ended in the perineal body.The connection among the denonvilliers fascia,seminal vesicles,and the rectal fascia,was relatively loose,but the connection between the denonvilliers fascia and prostate was tight junction.The urogenital nerve vessel bundles connected with the outer margin of the denonvilliers fascia.Clinical observation results:(1)The rectal ligament was found in both sides in the84 clinical cases.There were 3 lymph nodes staining black in 2 lateral rectal ligaments of4 clinical cases which were injected the Carbon Nanoparticles into the tumor before the operation.(2)There was no middle rectal artery hemorrhage of the clinical cases with the exception of 1 hemorrhagic case when the rectal ligament was cut off during the operation by ultrasonic dissecto.(3)The denonvilliers fascia was found in both sides in the 84 clinical cases.The surgical margin of denonvilliers fascia was at 0.5 cm above the bottom of the seminal vesicle on account of tight junction between the fascia and the seminal vesicle.(4)The new operation method was safety and effective,it can decreasebleeding volume,avoid the surgical injuries,clean the lymph nodes of metastasis,and improve the quality of life after operation.Conclusion:The rectal ligament is always present and the middle rectum artery is mostly present.The denonvilliers fascia was a safety barrier between the rectum and the urogenital organ.The local anatomy of the lower rectum is important for direct Total mesorectal excision(TME).