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Anatomische Grundlagen der nervenschonenden Rektumchirurgie

Anatomic principles of nerve-sparing rectal surgery

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Die moderne Chirurgie im Bereich des kleinen Beckens fokussiert auf einen Funktionserhalt oder eine Funktionswiederherstellung. In diesem Zusammenhang ist die exakte Beschreibung der anatomisch-topographischen Verhältnisse der Nerven von unmittelbarer klinischer Bedeutung. Dieser Übersichtsbeitrag fasst die wesentlichen aktuellen Erkenntnisse zum Verlauf sowohl der autonomen Nerven und Plexus als auch der somatischen Nervenversorgung im kleinen Becken zusammen. Ein Schwerpunkt liegt dabei auf dem Konzept der zweilamelligen parietalen pelvinen Faszie, in der die Nn. hypogastrici und der Plexus pelvicus sive hypogastricus inferior eingebettet sind. Ein zweiter Schwerpunkt liegt auf der Aufzweigung des N. pudendus in der Fossa ischioanalis. Abschließend werden Perspektiven für die weitere Forschung und deren Relevanz für die alltägliche Praxis benannt.

Abstract

Modern pelvic surgery aims at preservation or restoration of function. In this context the exact description of the pelvic nerve anatomy is of paramount importance for clinical practice. This review summarizes the topography not only of the autonomic nerves of the true pelvis but also of the somatic nerve supply of the pelvic floor. Emphasis is laid on the anatomical architecture of the parietal pelvic fascia that consists of two lamellae with the hypogastric nerves and the pelvic plexus (or inferior hypogastric plexus) in between. Another main topic is the ramification of the pudendal nerve in the ischioanal fossa. Finally, perspectives for further fields of research relevant for daily practice are outlined.

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Danksagung

Die Autoren bedanken sich bei Frau Dr. med. O. Radulova-Mauersberger für die Bearbeitung der Abbildungen. Die anatomischen Präparate wurden im Rahmen des Körperspendeprogrammes der Christian-Albrechts-Universität zu Kiel zur Verfügung gestellt.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland

    S. Stelzner

  2. Zentrum für klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland

    T. Wedel

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  1. S. Stelzner
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Correspondence to S. Stelzner.

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Interessenkonflikt

PD Dr. S. Stelzner erhielt ein Reisestipendium der Deutschen Gesellschaft für Chirurgie. Prof. Dr. T. Wedel gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Stelzner, S., Wedel, T. Anatomische Grundlagen der nervenschonenden Rektumchirurgie. coloproctology 37, 240–247 (2015). https://doi.org/10.1007/s00053-015-0030-y

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