关键词: 直肠癌, Walsh神经血管束, 性功能, 筋膜解剖, 腹腔镜

Abstract: Preservation of neurovascular bundle of Walsh in laparoscopic total mesorectal excison for rectal cancer：key anatomical and technical points        WANG Zi-qiang. Colorectal cancer center, West China hospital, Sichuan University,Chengdu 610041,China
Abstract    The implementation of total mesorectal excision has brought the art of colorectal surgery for cancer into a new era characterized by fascial dissection. Since then, a dramatic reduction in local recurrence and significant improvement in urogenital and sexual functions’ preservation has been achieved. Distal to the peritoneal reflection, the mesorectum is innervated by the pelvic plexus and the neurovascular bundle of Walsh(NVB) and supplied by small blood vessels from internal iliac vessels, hence attaching closely to the pelvic wall on its anterolateral and posterolateral aspects. The neurovascular bundle is wrapped up and separated into compartments by the multilayered Denonvilliers’ fascia, the posterior lamina of which is continuous with the anterior lamina of the parietal pelvic fascia. The parietal pelvic fascia has been reported to divide into two laminaes to enclose the hypogastric nerve, the pelvic plexus and the neurovascular bundle. Therefore, keeping the integrity of the posterior lamina of Denonvilliers’ fascia and the anterior lamina of parietal pelvic fascia is critical to preserving the neurovascular bundle. Small vessels are also found to accompany autonerve fibres and run in parallel directions on the pelvic wall. Small vessels arising from branches of internal iliac vessels and supplying the mesorectum show distinctive courses from those on the pelvic wall, providing important landmarks for recognizing pelvic fascia. Proper retraction and counter-retraction, certain tricks of separation, optimized surgical steps, a better understanding of pelvic fascial and autonerve anatomy, and especially the value of small vessels in fascial recognition are keys to the prevention of injuries to the neurovascular bundle.

Key words: rectal cancer, neurovascular bundle of Walsh, urogenital function, anatomy of fascia, laparoscopy