Relationship between the endopelvic fasciae and the inferior hypogastric plexus Activity Log
Relationship between the endopelvic fasciae end the inferior hypogastric plexus
Autor
Mitidieri, Vicente Carlos
Mitidieri, Alejandro
ueirolo Burgos, Brenda Mariana
Paione Oleszuk, Julián Marcos
Cifone, Tomás
Resumen
The Inferior Hypogastric Plexus (PHI) is a difficult plexus to define and dissect, hence the ease with which it can be injured both in anatomical and surgical research. Defining its relationships, with respect to the endopelvic fascia (FEP), including its formation and branches, (Baader B., et al., 2003, p. 129) would facilitate their dissection. This anatomical investigation aims to standardize different portions that require a different approach to preserve their integrity.
Cadaveric material belonging to the Third Chair of Anatomy of the School of Medicine, Buenos Aires University was used. One (n=1) formolized male adult organ block and seventeen (n=17) hemipelvis were dissected: five (n=5) adult male hemipelvis formolized, nine (n=9) fetal hemipelvis formolized (7 male and 2 female), between 18 and 36 weeks of gestational age calculated by femoral length, and three (n=3) adult hemipelvis from fresh cadavers, two (n=2) female and one (n=1) male. Microdissection elements and magnifying glasses were used.
We were able to distinguish three different sectors: the first, preplexual, located posterior and lateral to the FEP, where the sympathetic components (hypogastric nerves) and the parasympathetic (pelvic splanchnic nerves) have not yet converged to form the plexus. A second sector, plexual, with the plexus already fully formed, located in the thickness of the FEP. Finally, its terminal portion, already devoid of the FEP, formed by nerves that go to the perineal membrane accompanied by arterial and venous vessels. Each of these sectors requires a different approach in both anatomical and surgical dissection. El Plexo Hipogástrico Inferior (PHI) es un plexo difícil de definir y disecar, de allí la facilidad con que puede lesionarse tanto en la investigación anatómica como quirúrgica. Definir sus relaciones, con respecto a las fascias endopelvianas (FEP), incluyendo su formación y sus ramos, (Baader B., et al., 2003, p. 129) facilitaría su disección. Esta investigación anatómica pretende estandarizar distintas porciones que requieran distinto abordaje para preservar su integridad.
Se utilizó material cadavérico perteneciente a la Tercera Cátedra de Anatomía de la Facultad de Medicina de la Universidad de Buenos Aires. Se disecaron un bloque de órganos de cadáver adulto formolizado (n=1) y diecisiete (n = 17) hemipelvis: cinco (n = 5) hemipelvis masculinas adultas formolizadas, nueve (n = 9) hemipelvis fetales formalizadas (7 masculinos y 2 femeninas), entre 18 y 36 semanas de edad gestacional calculada por la longitud femoral y tres (n = 3) hemipelvis adultas de cadáveres frescos, dos (n = 2) femeninas y un (n = 1) masculino. Se utilizaron elementos de microdisección y lupas.
Pudimos distinguir tres sectores diferentes: el primero, preplexual, ubicado posterior y lateralmente a la FEP, donde los componentes simpáticos (nervios hipogástricos) y los parasimpáticos (nervios esplácnicos pélvicos) aún no han confluido para su formación. Un segundo sector, plexual, con el plexo ya completamente formado, ubicado en el espesor de la FEP. Por último, su porción terminal, ya desprovisto de la FEP, formado por nervios que se dirigen a la membrana perineal acompañados por vasos arteriales y venosos. Cada uno de estos sectores requiere distinto abordaje tanto en la disección anatómica como quirúrgica.
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