Clinical Anatomy Study Of Urogenital Fascia And Space Between Viscera And Pelvic Abdomen Wall

Objectives To precisely carry out preperitoneal hernia repair and radical surgery of colorectal cancer with laparoscope,we explored the relationship between viscera and their corresponding fascia.Methods Preperitoneal space of inguinal region and surrounding space of colorectum under the way of laparoscopic surgery were completed in ten cadavers(9 males,1 females),which were from medicine college of Xi’an Jiaotong University.Results The anterior and posterior renal fascia(RF)extend up to the kidney,and the ureter and superior hypogastric plexus(SHP)are located on the medial side of the two layers of fascia.In the lateral direction,the anterior and posterior RF enveloped vas deferens and genital vessels and formed the healing edge,with an extension with lateral fascia outside the genital vessels.Then the anterior and posterior RF downwardly penetrated the internal inguinal ring.The Toldt’s line was located outside of the healing between the anterior and posterior RF in the rear of colon.In the lower extremity of the kidney,the anterior and posterior RF extend to the caudal side,and the genital vessels,ureters,and SHP were located in the two layers of fascia.The SHP extended to the hypogastric nerve(HN)across the sacral promontory.The anterior and posterior RF downwardly continued presacral fascia.The continued RF enveloped seminal vesical and prostate along lateral pelvic walls.The superficial layer of continued RF expanded to posterior bladder wall passing media umbilical fold.However,the deep layer expanded to anterior bladder wall.The two layers of RF which contained the HN was followed by the rectum.The anterior RF and the fascia propria of rectum formed the rectosacral fascia in the 4th sacral vertebral.Transverse fascia crossed the back of inferior epigastric artery and expanded to anterior and posterior abdominal wall.Rectum,bladder,seminal vesical and prostate could be separated from sacral surface by stripping the fascia in front of sacrum expanded from posterior RF.The fascia lying on the surface of sacrum was continued from transverse fascia.Sacral nerves wore out the surface fascia of sacrum and merged to pelvic plexus along lateral pelvic wall.In middle of 1/3 of the rectum,the symmetrical ligament structure had a small arterial branches from the iliac artery and the prostate into the rectum,also had nerves from pelvic plexus enter the rectum.Conclusion:1.There is an independent urogenital fascia(UGF)system which envelope kidney,ureter,vas deferens,genital vessels,superior hypogastric nerve,seminal vesicle,prostate and the bottom of bladder,in the lateral direction enveloping vas deferens and genital vessels to form the healing edge,with an extension with lateral fascia outside the genital vessels,in which part of the independent facia penetrate the internal inguinal ring.And the independent fascia locating at both sides mix together at least below iliac vessel branch.2.The Bogros’ space and Retzius’ space is naturally the same space,which could be termed as viscera-pelvic space.3.The Toldt’s space should be between the Toldt’s fascia and the superior layer of UGF.4.UGF divides the space between retrorectum and transverse fascia on the sacral surface into retrorectal space and presacral space.The superior layer of UGF and the fascia propria of the rectum formed the rectosacral fascia in the 4th sacral vertebrae.5.The superior layer of UGF and the fascia propria of the rectum formed Denonvilliers fascia.Meanwhile,the superior layer of UGF formed a circular fascia structure around the rectum.6.At the end of the pelvic anus,UGF form an open ring at the end of the 4th sacral vertebra and the distal prostate,and the rectum pass through the ring.7.Clarifying the relationship between UGF and the surrounding organs,and unifying related fascia names is beneficial to the discussion and study of the operation on inguinal hernia and colorectal cancer.