The Research Of Denonvillier's Fascia And Its Relating Structures

Objective:There is a fascial structure between rectum and seminal vesicle and prostate in the male, called Denonvilliers'fascia. It has been proved by some author that the same fascia existed between vagina and rectum in the female, also named rectovaginal septum. Views about the morphosis and the development of Denonvilliers'fascia were different since the fascia was found 170 years ago. Surgeons focus on and dispute on the proper excising plane in prostatic cancer and rectal cancer. We will explore a new sectional technic of the integrity pelvic viscera, for the purpose of defining Denonvilliers'fascia and the relationship of the fascia between the adjacent organs and nerves and vessels, and providing more detailed data for the operation of prostatic cancer, rectal cancer and vaginocele.Methods:The materials were obtained from 55 formalin-fixed adult male and female cadavers. We severed the tissue attaching to the outlet of pelvis and bluntly separated the tissue between levator ani muscles and the obturator internus till the inlet of the pelvis, then severed the tissue attaching to the inlet of the pelvis. Afeter removed en bloc from the pelvic cavity, the pelvic splanchnic organs including bladder, urethra, uterus, vagina and rectum were trimmed. Some specimens were cut midsagittally, dissected and observed under anatomical microscopy; some were embedded by celloidin, and then made into a series of 250-750μm thick successive slices by immersing-alcohol microtome, and then images were collected for three-dimensional reconstruction.Result:1. The rectovaginal septum was composed of the anterior Denonvilliers' fascia and the posterior fascia propria of rectum. Denonvilliers'fascia and the fascia propria of rectum closely stick together. The bilateral insertions of Denonvilliers' fascia and the anterior vaginal fascia differed at different levels:at the cervix, the two fasciae fused into parametrium; at the upper vagina, they ended laterally at paracolpium and gradually fused together enveloping vagina; at the middle vagina, they anchored to the arcus tendineus fasciae pelvis; at the lower vagina, they ended at the lateral side of the levator ani muscles'outlet.2. Denonvilliers'fascia originated from the inferior side of the reflection of the peritoneum. At the lower part of prostate, Denonvilliers'fascia joined into the fascia of prostate forming the prostatic capsule which ended at the junction of the prostate and sphincter urethrae membranaceae. The rhabdosphincter covered the anterior surface of the prostate; the prostatic fascia covered the lateral and posterior surface of protate. The anteroinferior bundle of pelvic plexus converged into the anterior cavernous nerve reaching to penis.3. The posterior bundle of longitudinal muscle of rectum ran posteroinferiorly between the external and internal anal sphincter. The intermediate fibers of the anterior bundle ended at the perineal body. The lateral fibers attached the posterior end of rhabdosphincter. The deep transverse muscle of perineum's lateral part is anteroinferior to the levator ani muscles, posterior to the hilum of the penis. The medial part is located between rectum and rhabdosphincter. The cavernous nerve passed through the upper border of the deep transverse muscle of perineum, and run downwards, and then goes forwards along the lateral side of rhabdosphincter.Conclusions:1. The technic of celloidin-embedded pelvic viscera is an ideal method for pelvic morphology.2. The rectovaginal septum was composed of Denonvilliers' fascia and the fascia propria of rectum. It can limit the spread of malignancy. Denonvilliers'fascia and the anterior vaginal fascia form the fascia propria of vagina enveloping vagina.3. The NVB is located in a fascial triangle at the lower part of prostate. At the upper of the prostate the NVB or pelvic plexus was intermingled with Denonvilliers'fascia or the lateral fascia of prostate. The prostate has a capsule formed by rhabdosphincter anteriorly, the fascia of propate lateally and posteriorly.4. The intermediate fibers of anterior bundle form the rectoperinealis muscle. The lateral fibers of anterior bundle form the rectourethralis. The anterior bundle and the posterior bundle together make the anterior rectal wall forming the perineal flexure. The deep transverse muscle of perineum is an important supporting structure of the posterior surface of rhabdosphincter.