Applied Anatomy Of Perirectal Fascia And Rectal Autonomic Nerve

ObjectiveTo investigate the position and level of the perirectal fascia and rectal autonomic nerves by using anatomy to find the correct operation plane for rectal surgery and reduce the damage to the splanchnic nerves.MethodsA total of 5 pelvic specimens(2 males and 3 females)provided by the Department of Anatomy,Xi'an Medical University were cut along the median sagittal plane to form 10 pelvic specimens with bilateral symmetry.Looking for the ureter and the inferior ventral nerve trunk,separating the loose connective tissue between the presacral fascia and the rectum intrinsic fascia along the abdominal nerve trunk,laterally dissecting the rectal ligament,and opening the rectal sacral fascia down the fistula 4 level.Separated to the levator ani muscle plane.Along the intrinsic fascia of the rectum and the anterior tibial fascia,the gap was further separated,and the inferior abdominal plexus was completely exposed.The lower abdominal plexus and branches were observed.Yellow paint stains nerves.Results1.Perirectal fascia: The peritoneum in front of the rectum can be retrorefracted into the anterior rectal space between the front and the back of the Denonvilliers fascia.At the back of the rectum there is at least the rectofascial intrinsic fascia,the presacral fascia,and the sacral surface fascia.The rectum posterior space is divided into posterior rectal space and presacral space;rectal side can be seen in the rectus ligament,and the nerve fibers and connective tissue that dominate the lower rectum can be seen in the ligament.2.Rectal autonomic nerves: the inferior abdominal nerve:The lower abdomen plexus migrated over the metatarsal iliac crest,and was in the form of a “human” shape structure.The lower abdomen nerve plexus was located on the two sides of the rectal wall in the lower abdomen.The orbital veins and veins are located in the anterior tibial fascia.It is an irregular plate-like structure of the mesh and shows the nerve branches that dominate the rectum.The splanchnic nerve fromthe anterior hole of the presacral fascia 2 to 4 can be fan-shaped.Some of the branches can be added to the lower abdominal plexus,and branches can be seen in the urogenital vascular bundle.ConclusionsThere is a gap around the rectum for surgical operation.In front of the rectum,it should be between the rectal intrinsic fascia and the Denonvilliers fascia.Pay attention to protect the bilateral genitourinary neurovascular bundles.The rectum posterior free plane is in the posterior rectal space to avoid entering the wrong level of nerve damage.The side of the operation plane should be close to the rectum intrinsic fascia,pay attention to protect the lower abdominal plexus and urogenital neurovascular bundles.