Anatomical Observation Of Fascial Layer Of Retroperitoneal Autonomic Nerve Associated With Rectal Cancer Surgery

Backgroup:Current anatomical studies have shown that the autonomic nerves innervating the abdominal and pelvic organs travel behind the peritoneum,but its precise fascial level is still controversial.This ambiguous understanding occasionally causes nerve injury during dissecting descending sigmoid colon and mesorectal in rectal cancer surgery.Objective:To further elucidate the fascial layer of the pelvic autonomic nerve from the view of anatomy and histology.Methods:1、The relationship between autonomic nerve and prerenal fascia-presacral fascia was observed in 7 cadavers2、The relationship between autonomic nerve and prerenal fascia-presacral fascia was observed in52 patients undergoing laparoscopic rectal cancer surgery.3、Histological examination was performed on the retroperitoneal tissue between mesentery of descending sigmoid colon and aortic iliac artery,and between the mesorectal and sacral periosteum.Results:1、Anatomical observation on cadavers showed that abdominal aortic plexus,superior hypogastric plexus,hypogastric nerve and inferior hypogastric plexus were located at the posterolateral side of the prerenal fascia-presacral fascia.2、Vivo observation showed that superior hypogastric plexus and hypogastric nerve were located at the posterolateral side of the prerenal fascia-presacral fascia.3、Histological examination showed that the nerve fibers were located behind the fascia and some of the finer nerve fibers were located in the fascia.Conclusion:The autonomic nerve is located in the posterolateral part of the prerenal fascia-presacral fascia.Maintaining the integrity of this fascia is the anatomical basis and basic method of preserving autonomic nerve in rectal cancer surgery.