前列腺尖部应用解剖及其对前列腺癌根治术的意义
发布时间：2018-08-21 13:44
【摘要】：【目的】探讨前列腺尖部毗邻结构和神经血管束的分布特点，为保留神经血管束前列腺根治术（NSRP）提供部解剖学依据。 【方法】利用显微解剖和断层解剖技术，对25例（50侧）成人男性盆部标本和5例盆部断层标本，，对前列腺尖部毗邻、神经血管束的分布和阴茎背静脉复合体的构成等进行解剖观测和统计分析。 【结果】 1. Denonvilliers筋膜前方与膀胱底、精囊以及前列腺底部后面之间存在明显的疏松结缔组织间隙；至前列腺底部以下，50侧盆部标本中Denonvilliers筋膜直接与前列腺鞘相融合，两者之间的间隙消失。Denonvilliers筋膜后方与直肠筋膜之间存在明显的筋膜间隙，从直肠膀胱陷凹以下至盆膈，内有脂肪组织和血管神经的分支。 2.阴茎背静脉复合体（DVC）位于耻骨前列腺韧带深面，不仅有阴茎背静脉丛，还含有动脉、前列腺神经丛的分支，其外下方与耻骨尿道肌毗邻关系密切。 3.前列腺尖部神经血管束（NVB）主要集中于前外侧和后外侧部，相当于前列腺1～2、4～5、7～8和10～11点的位置，多呈网状成片分布。两者发出海绵体神经穿盆膈和尿生殖膈分布于阴茎海绵体和尿道海绵体。 4.前列腺尖部后外侧动脉位于前列腺后外侧与Denonvilliers筋膜之间的疏松结缔组织中，发出分支至前列腺，并经耻骨尿道肌和耻骨直肠肌之间穿尿生殖膈向下，分支分布于尿道海绵体后部，其穿入点距尿道膜部的距离为6.2±1.3mm。 【结论】 1. NSRP手术分离前列腺后壁时，在前列腺底及其上方，可以沿精囊和输精管壶腹后面与Denonvilliers筋膜之间的间隙进行，前列腺底部以下应切开Denonvilliers筋膜，沿该筋膜后方的间隙进行。 2.切断阴茎背静脉复合体（DVC）应紧贴筋膜深面进行，同时应仔细分离耻骨尿道肌，以免损伤前外侧海绵体神经和耻骨尿道肌。 3.在前列腺筋膜鞘深面分离前列腺前外侧和后外侧部神经血管束，可避免损伤分布于阴茎海绵体和尿道海绵体的神经。 4.术中损伤穿尿生殖膈分布于尿道海绵体后部的后外侧血管分支，可能造成男性性勃起功能障碍。
[Abstract]:[objective] to study the adjacent structure of the apex of the prostate and the distribution characteristics of the neurovascular bundle, and to provide the anatomical basis for the radical prostatectomy of the nerve vascular bundle of prostate. [methods] the microanatomy and sectional anatomy techniques were used. 25 adult male pelvic specimens (50 sides) and 5 pelvic sectional specimens were adjacent to the apex of the prostate. The distribution of neurovascular bundle and the composition of dorsal penile vein complex were observed and statistically analyzed. [results] 1. There was an obvious loose connective tissue gap between the anterior fascia of Denonvilliers and the bladder floor, seminal vesicle and the posterior part of the prostate, and the Denonvilliers fascia fused directly with the prostatic sheath in 50 pelvic specimens below the bottom of the prostate. The gap between the two disappeared .Denonvilliers posterior fascia and rectum fascia between the obvious fascia space, from rectum bladder depression to the pelvic diaphragm, there is adipose tissue and branches of blood vessels and nerves. 2. The dorsal penile vein complex (DVC) is located on the deep side of the pubic prostatic ligament. It has not only the dorsal penile vein plexus, but also the branches of the artery and the prostatic nerve plexus. The (NVB) of the neurovascular bundle in the apex of the prostate was mainly located in the anterolateral and posterolateral parts, corresponding to the position of the prostatic gland at point 1, 2, 2, 4, 5, 7, 8 and 10, 11, and distributed in a reticular pattern. Both issued cavernous nerve through the pelvic diaphragm and urinary reproductive diaphragm distributed in the corpus cavernosum and urethral cavernous body. 4. The posterolateral artery of the apex of the prostate is located in the loose connective tissue between the posterolateral prostate and the Denonvilliers fascia. The branch was located in the posterior part of the urethral cavernous body, and the distance between the penetration point and the urethral membrane was 6.2 卤1.3 mm. [conclusion] 1. When the posterior wall of prostate is separated by NSRP operation, the space between the seminal vesicle and the posterior ampulla of the vas deferens and the fascia of Denonvilliers can be performed at the prostatic floor and above. The Denonvilliers fascia should be cut down below the bottom of the prostate. Along the space behind the fascia. 2. In order to avoid the injury of anterolateral cavernous nerve and pubic urethral muscle, (DVC) should be cut off from the deep surface of fascia, and the pubo-urethral muscle should be carefully separated. Separation of the anterolateral and posterolateral neurovascular bundles of the prostate on the deep surface of the prostatic fascia can avoid the injury of the nerves distributed in the corpus cavernosum and the urethral cavernous body. 4. Intraoperative injury of the urethral diaphragm distributed in the posterior lateral branches of the urethral cavernous body may lead to male erectile dysfunction.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25
本文编号：2195918
[Abstract]:[objective] to study the adjacent structure of the apex of the prostate and the distribution characteristics of the neurovascular bundle, and to provide the anatomical basis for the radical prostatectomy of the nerve vascular bundle of prostate. [methods] the microanatomy and sectional anatomy techniques were used. 25 adult male pelvic specimens (50 sides) and 5 pelvic sectional specimens were adjacent to the apex of the prostate. The distribution of neurovascular bundle and the composition of dorsal penile vein complex were observed and statistically analyzed. [results] 1. There was an obvious loose connective tissue gap between the anterior fascia of Denonvilliers and the bladder floor, seminal vesicle and the posterior part of the prostate, and the Denonvilliers fascia fused directly with the prostatic sheath in 50 pelvic specimens below the bottom of the prostate. The gap between the two disappeared .Denonvilliers posterior fascia and rectum fascia between the obvious fascia space, from rectum bladder depression to the pelvic diaphragm, there is adipose tissue and branches of blood vessels and nerves. 2. The dorsal penile vein complex (DVC) is located on the deep side of the pubic prostatic ligament. It has not only the dorsal penile vein plexus, but also the branches of the artery and the prostatic nerve plexus. The (NVB) of the neurovascular bundle in the apex of the prostate was mainly located in the anterolateral and posterolateral parts, corresponding to the position of the prostatic gland at point 1, 2, 2, 4, 5, 7, 8 and 10, 11, and distributed in a reticular pattern. Both issued cavernous nerve through the pelvic diaphragm and urinary reproductive diaphragm distributed in the corpus cavernosum and urethral cavernous body. 4. The posterolateral artery of the apex of the prostate is located in the loose connective tissue between the posterolateral prostate and the Denonvilliers fascia. The branch was located in the posterior part of the urethral cavernous body, and the distance between the penetration point and the urethral membrane was 6.2 卤1.3 mm. [conclusion] 1. When the posterior wall of prostate is separated by NSRP operation, the space between the seminal vesicle and the posterior ampulla of the vas deferens and the fascia of Denonvilliers can be performed at the prostatic floor and above. The Denonvilliers fascia should be cut down below the bottom of the prostate. Along the space behind the fascia. 2. In order to avoid the injury of anterolateral cavernous nerve and pubic urethral muscle, (DVC) should be cut off from the deep surface of fascia, and the pubo-urethral muscle should be carefully separated. Separation of the anterolateral and posterolateral neurovascular bundles of the prostate on the deep surface of the prostatic fascia can avoid the injury of the nerves distributed in the corpus cavernosum and the urethral cavernous body. 4. Intraoperative injury of the urethral diaphragm distributed in the posterior lateral branches of the urethral cavernous body may lead to male erectile dysfunction.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25
【参考文献】
相关期刊论文 前6条
1 周荣祥，侯成玉，迟玉友，孟凡学，燕东亮，尹洪山，高文彬，孙兆忠，施利国;前列腺血供的解剖学研究及临床研究[J];滨州医学院学报;1994年01期
2 高新,邱剑光,蔡育彬,周祥福,洪良庆;腹腔镜前列腺癌根治术治疗早期前列腺癌[J];临床泌尿外科杂志;2004年03期
3 袁磊;卢洪凯;臧运江;高远;;男性盆丛的局部解剖特点及其对膀胱前列腺根治性切除的意义[J];临床泌尿外科杂志;2008年03期
4 林礼彰;张奕荣;徐忠华;;男性盆腔神经丛及神经血管束的应用解剖[J];现代泌尿外科杂志;2007年04期
5 洪宝发,王晓雄,肖序仁,叶林阳,张磊,蔡伟,李炎唐;减少术后尿失禁及尿道狭窄的前列腺癌根治术(附42例报告)[J];中华泌尿外科杂志;2001年11期
6 高文彬，孙兆忠，施利国，周荣祥;前列腺动脉的应用解剖[J];中国临床解剖学杂志;1995年01期
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