【摘要】：【目的】探討前列腺尖部毗鄰結(jié)構(gòu)和神經(jīng)血管束的分布特點(diǎn)，為保留神經(jīng)血管束前列腺根治術(shù)（NSRP）提供部解剖學(xué)依據(jù)。 【方法】利用顯微解剖和斷層解剖技術(shù)，對(duì)25例（50側(cè)）成人男性盆部標(biāo)本和5例盆部斷層標(biāo)本，，對(duì)前列腺尖部毗鄰、神經(jīng)血管束的分布和陰莖背靜脈復(fù)合體的構(gòu)成等進(jìn)行解剖觀測(cè)和統(tǒng)計(jì)分析。 【結(jié)果】 1. Denonvilliers筋膜前方與膀胱底、精囊以及前列腺底部后面之間存在明顯的疏松結(jié)締組織間隙；至前列腺底部以下，50側(cè)盆部標(biāo)本中Denonvilliers筋膜直接與前列腺鞘相融合，兩者之間的間隙消失。Denonvilliers筋膜后方與直腸筋膜之間存在明顯的筋膜間隙，從直腸膀胱陷凹以下至盆膈，內(nèi)有脂肪組織和血管神經(jīng)的分支。 2.陰莖背靜脈復(fù)合體（DVC）位于恥骨前列腺韌帶深面，不僅有陰莖背靜脈叢，還含有動(dòng)脈、前列腺神經(jīng)叢的分支，其外下方與恥骨尿道肌毗鄰關(guān)系密切。 3.前列腺尖部神經(jīng)血管束（NVB）主要集中于前外側(cè)和后外側(cè)部，相當(dāng)于前列腺1～2、4～5、7～8和10～11點(diǎn)的位置，多呈網(wǎng)狀成片分布。兩者發(fā)出海綿體神經(jīng)穿盆膈和尿生殖膈分布于陰莖海綿體和尿道海綿體。 4.前列腺尖部后外側(cè)動(dòng)脈位于前列腺后外側(cè)與Denonvilliers筋膜之間的疏松結(jié)締組織中，發(fā)出分支至前列腺，并經(jīng)恥骨尿道肌和恥骨直腸肌之間穿尿生殖膈向下，分支分布于尿道海綿體后部，其穿入點(diǎn)距尿道膜部的距離為6.2±1.3mm。 【結(jié)論】 1. NSRP手術(shù)分離前列腺后壁時(shí)，在前列腺底及其上方，可以沿精囊和輸精管壺腹后面與Denonvilliers筋膜之間的間隙進(jìn)行，前列腺底部以下應(yīng)切開(kāi)Denonvilliers筋膜，沿該筋膜后方的間隙進(jìn)行。 2.切斷陰莖背靜脈復(fù)合體（DVC）應(yīng)緊貼筋膜深面進(jìn)行，同時(shí)應(yīng)仔細(xì)分離恥骨尿道肌，以免損傷前外側(cè)海綿體神經(jīng)和恥骨尿道肌。 3.在前列腺筋膜鞘深面分離前列腺前外側(cè)和后外側(cè)部神經(jīng)血管束，可避免損傷分布于陰莖海綿體和尿道海綿體的神經(jīng)。 4.術(shù)中損傷穿尿生殖膈分布于尿道海綿體后部的后外側(cè)血管分支，可能造成男性性勃起功能障礙。
[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 鹵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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.25

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