| 1. ObjectiveThe different studies of syntopy of rectum limit to the extend and apply of TME. The present article was to study the morpological characteristics and syntopy of the above tissues according to the mesorectum combining with TME, to provide the anatomical basis for TME and to explore the operative approach for apply in clinic.2. Materials and methods1) Anatomical studyThirty-five adult specimens (25 embalmed, 10 fresh), 5 fresh foetuses specimens and two adult unembalmed pelvic viscera were studied with nake eyes, MRI and under light and electron microscopes. The morpologies, structures and syntopies of the mesorectum, the pelvic autonomic nerve, Denonvilliers' fascia, the lateral rectal ligments and the inferior rectal artery were investigated.2) Clinical applyThe present authors summarized 79 cases of rectal cancer after the performation of TME, and contrasted with 58 cases after the operation of non-TME.3. Results1) MesorectumThe mesorectum was the tissues surrounding the rectum including vessels, lymphatics, nerves and adipose tissue. Its anterior part was thin, but the othe parts (the laterals and posterior) were thick. The outside sheet was the smooth visceral fascia which was composed by collagen.The upper of mesorectum follows the sigmoid mesocolon, the inferior extremity attaches the junction of anorectum and becomes thin. Anterior to the rectum, the visceral fascia is covered by peritoneum abovethe peritoneal reflection, but covered by Denonvilliers' fascia below the peritoneal reflection. Posterior to the rectum, the visceral fascia obviously extends distally and attaches to the presacral fascia as "a ligment"-Waldeyer ligment at the level of S4. At the lateral sides of rectum below the peritoneal reflection, the parietal fascia covers the reticular pelvic plexus approximately at the level of viginal fornix or tip of seminal vesicles; there are some connective tissue tracts between the parietal and visceral fascias.All the layers of mesorectum could be showed clearly on MRI image.2) Pelvic autonomic nerveHypogastric nerve originates from the superior hypogasric plexus, lies surficially or beneath the parietal fascia, continues caudal and laterally medial to the internal iliac artery and ureter, joins to the superoposterior part of the pelvic plexus anterolateral to the rectum below peritoneal reflection.Pelvic splanchnic nerves branches from the second to fourth sacral root, mainly from the third and fourth. The pelvic splanchnic branches go laterocaudad and anteriorly between the parietal fascia and the piriformis muscle, after the converging of the sacral splanchnic branches, run into the inferoposterior part of pelvic plexus.The pelvic plexus is a flat quadrilateral nerve plexus with its anteroposterior size of (4.3 ?0.6)cm, superoinferior size of (2.8 ?0.5)cm. It lies beneath the parietal fascia, lateral to the viginal fornix or tip of seminal vesicles, and medial to the forks of the internal iliac vessels. The branches from anterior and superoanterior edges of pelvic plexus distribute to rectum, bladder, prostate or uterus and vagina.3) Denonvilliers' fisciaDenonvilliers' fiscia mainly consists of collagen with some smooth muscle and elastin fibers, locates in the area below the level of peritoneal reflection, above pelvic floor, and between prostate, seminal viscle or the posterior wall of vagina and the anterior wall of rectum. Its upper edge6attaches to the reflected peritoneum, lower edge attaches to the pelvic diaphragm, lateral to the rectum and prostate or the posterior wall of vagina its lateral sides follow the connective tissues containing vessels and nerves. There is a thin sheet of loose connective tissue between Denonvilliers' fiscia and the visceral fascia as well as between Denonvilliers' fiscia and seminal viscle, prostate or the posterior wall of vagina.4) Lateral ligments of the rectum and inferior rectal arteryNo structures in any of the pelvic specimens corresponded to the textbook descriptions of...
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