前列腺周围盆筋膜内神经网尸体解剖的分布特征

目的 探讨位于前列腺及其周围区域盆筋膜层内的神经网络较确切解剖定位和神经纤维的数目分布。方法 使用6具盆腔结构正常的男性尸体，每具尸体取10处邻近前列腺周围的盆筋膜组织样本，每个样本 1 cm×1 cm大小，按时钟的点位编号并分区。分布如下：前列腺尖部（与膜部尿道交界）区域：1区1点钟，2区11点钟；前列腺中部区域：3区2点钟（右侧骨盆侧面），4区10点钟（左侧骨盆侧面），5区4点钟，6区8点钟；前列腺基底部（与膀胱颈交界）：7区5点钟，8区7点钟；9区（位于前列腺尖部尿道后背侧）6点钟，10区（位于前列腺基底部腹侧）12点钟。比较这10个解剖区域单位面积（1 cm²）内的神经数目和直径大小。结果 共获得60个盆筋膜组织样本。神经数目平均为（13.4 ± 13.3）束。前列腺基底腹侧12点钟10区（平均5.3束）与前列腺中部8点钟侧6区（平均9.8束）神经数目分布较少，两区之间差异无统计学意义（P>0.05）；10区与其他8个区均有统计学差异（P<0.05）；剩余各区之间分布均衡（P>0.05）。神经纤维直径平均为（90.4 ± 61.8）μm。前列腺尖部1点钟1区（平均119.2 μm）和中部2点钟3区（平均101.3 μm）神经纤维较粗， 1区与中部10点钟4区（平均77.7 μm）、尖部背侧6点钟9区（平均81.1 μm）、基底部腹侧12点钟10区（平均79.4 μm）之间差异有统计学意义（P<0.05）；4区（平均77.7 μm）与对侧2点钟3区之间（平均101.3 μm）差异也有统计学意义（P<0.05）；其他各区之间分布均衡（P>0.05）。结论 前列腺周围盆筋膜内神经网分布表现为在前列腺基底部（与膀胱颈交界）腹侧12点钟区域神经纤维数目较少，其他区域均匀分布；神经纤维直径在尖部腹侧区域朝向顶点较粗，左右不对称分布。骨盆筋膜是根治性前列腺切除术中保留神经的关键性解剖标志。

Anatomical localization of the pelvic fascia neural network around the prostate on the cadavers#br#

Objective To investigate the exact localization of neural pathway and the frequency of nerve fibers,which are located in the pelvic facial layers in the prostate and periprostatic regions.Methods Six cadavers with normal pelvic structures were used in this trial. Ten tissue samples, each 1 cm ×1 cm in size, were obtained from each cadaver and zone division separately. The locations of these samples were as follows. Prostate tip (at the junction with the urethra of the membrane): zone 1 from 1 o’clock (apical region), zone 2 from 11 o’clock (apical region). Middle part of the prostate: zone 3 from 2 o’clock(lift far pelvic lateral), zone 4 from 10 o’clock (right far pelvic lateral), zone 5 from 4 o’clock, zone 6 from 8 o’clock, zone 7 from 5 o’clock, zone 8 from 7 o’clock. Base of the prostate (bladder neck junction): zone 9 from 6 o’clock (located on the posterior side of the prostate urethra), 12 o’clock in the 10th zone (located on the ventral side of the prostate).Nerve distribution, frequency and diameters of these 10 zones were compared to each other.Results Sixty specimens were obtained from 6 cadavers. Mean number of nerve fibers was 13.4 ± 13.3. In the 10th zone (prostate basal ventral 12 o’clock), the number of nerves was less distributed (average 5.3 bundles), and there was no statistical significance between the zone 10 and the 6th zone (P>0.05), and the other 8 regions were statistically significant (P<0.05).The average diameter of the nerve fibers was (90.4 ± 61.8)μm, zone 1 of the prostate tip (1 o’clock, average 119.2 μm) and zone 3 of the middle (2 o’clock, average 101.3 μm) nerve fibers are thicker. Zone 1 and 4 at left side of the pelvis (10 o’clock, average 77.7 μm), zone 9 (6 o’clock, average 81.1 μm), and the 10 area at ventral base of the prostate(12 o’clock, average 79.4 μm) (P<0.04, separately) were statistically significant. There was also a statistical difference between the 4 zones (average 77.7 μm) and the contralateral 2 o’clock 3 zones (average 101.3 μm) (P<0.05); Balanced distribution in other regions (P>0.05). Conclusion The distribution of nerve network in the pelvic fascia around the prostate: the number of nerve fibers in the ventral 12 o’clock region of the prostate is small, and the other regions are evenly distributed; The diameter of the nerve fibers is thicker toward the apex in the ventral region of the tip and the left and right are asymmetrically distributed. The pelvic fascia is a key anatomical landmark for the preservation of the nerve during radical prostatectomy.