直肠表面动脉的形态学观测

目的观察直肠表面动脉的分支分布特点。方法随机选取成人尸体20具,婴幼儿尸体15具,行巨微解剖观察。结果上段直肠主要由乙状结肠直肠动脉的横支供血,在器官表面的分支形式多为环绕型;直肠壶腹主要由直肠上动脉的终支供血,其在器官表面的分支形式多呈主根须样;直肠颈主要由直肠下动脉和肛动脉供血,其在器官表面的分支形式可有鸦爪型、单支型、二叉型、三又型及“K”型等;上半直肠多为横行的环状分布,下半直肠多为纵行分布;各支间可存在吻合,方式为网型、直接及不规则型吻合。结论在上半直肠前壁和直肠颈后壁,存在无血管吻合区;直肠动脉在器官表面存在区域性配布的特点。     

The origins of the adrenergic fibres which innervate the internal anal sphincter, the rectum, and other tissues of the pelvic region in the guinea-pig

Summary The adrenergic innervation of the pelvic viscera was examined by the fluorescence histochemical technique, applied to tissue from untreated guinea-pigs and from guinea-pigs in which nerve pathways had been interrupted at operation. It was found that adrenergic neurons in the inferior mesenteric ganglia give rise to axons which run in the colonic nerves and end in the myenteric and submucous plexuses and around the arteries of the distal colon. In the rectum, part of the innervation of the myenteric plexus and all of the innervation of the submucous plexus comes from the inferior mesenteric ganglia. The rest of the adrenergic innervation of the myenteric plexus comes from the posterior pelvic ganglia or the sacral sympathetic chains. The innervation of the blood vessels of the rectum is from the posterior pelvic ganglia. Adrenergic nerves run from the sacral sympathetic chains and pass via nerves accompanying the rectal arteries to the internal anal sphincter. Other adrenergic fibres to the internal anal sphincter either arise in, or pass through, the posterior pelvic plexuses. The anal accessory muscle is innervated by adrenergic axons arising in the posterior pelvic plexuses. Adrenergic nerves which run in the pudendal nerves, probably from the sacral sympathetic chains, innervate the erectile tissue of the penis.This work was supported by grants from the Australian Research Grants Committee and the National Health and Medical Research Council. We thank Professor G. Burnstock for his generous support.     

Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography

This work aimed to study the prevalence and radiologic anatomy of the middle rectal artery (MRA) using computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The retrospective study (October 2010–February 2012) focused in 167 male patients with prostate enlargement (mean age 64.7 years, range 47–81 years) who underwent selective pelvic arterial embolization for the relief of lower urinary tract symptoms. All patients underwent CTA previously to DSA to evaluate the vascular anatomy of the pelvis and to plan the treatment. MRAs were identified and classified according to their origin, trajectory, termination and relationship with surrounding arteries. We found MRAs in 60 (35.9 %) patients (23.9 % of pelvic sides, n = 80) and of those, 20 (12 %) had bilateral MRAs; 24 MRAs (30 %) were independent of neighbouring arteries and 56 MRAs (70 %) had common origins with prostatic arteries (prostato-rectal trunk). The most frequent MRA origin was the internal pudendal artery (60 %, n = 48), followed by the inferior gluteal artery (21.3 %, n = 17) and common gluteal-pudendal trunk (16.2 %, n = 13). In 2 patients the MRA originated from the obturator artery (2.5 %). Anastomoses to the superior rectal and inferior mesenteric arteries were found in 87.5 % of cases (n = 70). We concluded that MRAs are anatomical variants present in less than half of male patients; have variable origins and frequently share common origins with prostatic arteries. Their correct identification is likely to contribute to improve interventional radiology procedures and prostatic or rectal surgeries.     

直肠表面动脉分布与微血管构筑相关性的研究

目的:研究直肠与肛管器官表面动脉分布与器官内小微动脉及毛细血管精确分布间的对应关系.方法:20例成人标本行巨微解剖观察表面动脉分支分布特点;20例胎儿尸体,墨汁灌注,组织切片及揭层透明铺片,光镜观察器官内微血管的构筑情况,测量各部位毛细血管分布密度.结果:器官表面动脉在直肠和肛管呈区域性分布的特点,在上半直肠前壁和直肠颈及肛管后壁中线部位存在"无血管吻合区".微血管测量结果显示上半直肠前壁和直肠颈及肛管后壁中线部位,肌层、粘膜下层及粘膜层毛细血管密度均低于同层其他部位.结论:直肠与肛管表面动脉分布与器官内小微动脉及毛细血管精确分布间存在对应关系,临床可根据肉眼所见表面动脉分布来评估直肠和肛管血供.     

Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用

目的探讨Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用。方法收集我科使用SIEMENS Artis Zeego数字减影血管造影机检查和图像采集进行前列腺动脉栓塞的38例患者,用Dyna CT技术明确前列腺癌供血动脉与其他侧支的情况,Embolization Guidance技术指导进行安全性的前列腺癌供血动脉栓塞。结果 38例患者经两名高年资主任医师指导分别进行前列腺癌动脉栓塞术。Dyna CT联合DSA确认前列腺动脉65侧,比例达85.5%(65/76),其中24例患者显示双侧前列腺动脉,10例确认单侧前列腺动脉;前列腺动脉开口起源于髂内动脉38条,起源于闭孔动脉11条,起源于膀胱下动脉9条,起源于阴部内动脉5条,起源于直肠下动脉2条。利用Embolization Guidance技术完成前列腺动脉栓塞89.2%(58/65),其中24例患者完成双侧栓塞,10例完成单侧栓塞,4例因血管迂曲不能进行超选择栓塞。结论 Dyna CT联合Embolization Guidance技术能够准确地显示前列腺优势供血动脉,在前列腺动脉栓塞治疗中具有重要的应用价值。     

The course and branching pattern of pudendal nerve in fetus

The pudendal nerve is a considerably large branch of the sacral plexus. There are many articles in the literature concerning the pudendal nerve in adults, but as far as we know, there is none on the branching pattern and variations in pudendal nerve anatomy in fetus. This study investigates the pudendal nerve trunking with respect to the piriformis muscle in 25 formalin-fixed fetuses (50 sides of pelves, 15 females, 10 males), ranging from 20 to 37 weeks of gestation. We investigate pudendal nerve trunking in four types: Type I-a is defined as single-trunk with the inferior rectal nerve branching proximal to the dorsal nerve of penis/clitoris (38%), Type I-b is also single-trunk with the dorsal nerve of penis/clitoris branching proximal to the inferior rectal nerve (24%), Type II is double-trunk with medial trunk as an inferior rectal nerve (34%), and Type III is triple-trunk (4%). We measured the average diameter of the main trunk of pudendal nerve in Type I-a and I-b groups to be 0.98 +/- 0.33 mm. We also measured the average length of the pudendal nerve trunks before the dorsal nerve of penis/clitoris branch to be 7.35 +/- 3.50 mm. There was no significant statistical difference in the average length, diameter, number of trunks, and pudendal nerve variations between male and female and also right and left sides of the pelves. This first and detailed fetal study of pudendal nerve trunking with respect to the piriformis muscle would be useful for educational anatomy dissections and anatomical landmark definitions for relevant clinical procedures.     

Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament

The pudendal nerve (S3-S5) is a major branch of the sacral plexus. After branching from the sacral plexus, the pudendal nerve travels through three main regions: the gluteal region, the pudendal canal, and the perineum. In the gluteal region, the pudendal nerve lies posterior to the sacrospinous ligament. The relationship of the pudendal nerve to the sacrospinous ligament has important clinical ramifications, but there is a lack of literature examining the variations in pudendal nerve anatomy in the gluteal region. This study investigates the pudendal nerve trunking in relation to the sacrospinous ligament in 37 cadavers (73 sides of pelves) of 21 males and 16 females, ranging from 18-83 years of age. Pudendal nerve trunking could be grouped into five types: Type I is defined as one-trunked (41/73; 56.2%), Type II is two-trunked (8/73; 11%), Type III is two-trunked with one trunk as an inferior rectal nerve piercing through the sacrospinous ligament (8/73; 11%), Type IV is two-trunked with one as an inferior rectal nerve not piercing through the sacrospinous ligament (7/73; 9.5%), and Type V is three-trunked (9/73; 12.3%). In summary, 56.2% of pudendal nerves adjacent to the sacrospinous ligament were one-trunked, 31.5% were two-trunked and 12.3% were three-trunked. Fifteen inferior rectal nerves originated independently from the S4 root and never joined the main pudendal nerve. Eight of fifteen inferior rectal nerves pierced through the sacrospinous ligament, perhaps making it prone for entrapment. We measured the average diameter of the main trunk of the pudendal nerve to be 4.67 +/- 1.17 mm. We also measured the average length of the pudendal nerve trunks before terminal branching to be 25.14 +/- 10.29 mm. There was no significant statistical difference in the average length, average diameter, number of trunks, and pudendal nerve variations between male and female or right or left sides of the pelves. A detailed study of pudendal nerve trunking in relationship to the sacrospinous ligament would be useful for instruction in basic anatomy courses and in relevant clinical settings as well.     

The nerve branches to the external anal sphincter: the macroscopic supply and microscopic structure

The study was performed using 45 pelvic half section specimens (41 fetal ones and four adults). The macroscopic dissection followed the nerve branches from their spinal roots up to the external anal sphincter. Three nerve branches were found: the anterior ramus arising from the external perineal nerve, the inferior rectal nerve and an independent posterior branch. The anterior and the inferior rectal nerve branches always emerged from the pudendal plexus. The posterior branch arising either from S4 or from the inferior rectal nerve was only found in (31%) of our cases. Five anatomical distributions are described, percentages of every type notified. The fibre content of these nerve bundle branches was evaluated through histological sections using Heidenhain's azan stain and Luxol fast blue. The branches consisted of 2,896 to 2,137 fibres, 20% of them being unmyelinated and 80% containing various myelinated fibres. The nomenclature of these nerve branches has to be debated. The terms of anterior, middle and posterior anal nerves seem more suitable.     

Arterial supply to the sciatic nerve in the gluteal region

The arterial supply to the sciatic nerve was investigated in 20 human lower limbs (10 right, 10 left) from 20 cadavers (14 females, aged 84 +/- 9.6 years, range 66-95 years: 6 males, aged 80 +/- 8.2 years, range 70-90 years). In all limbs examined at least 1 sciatic artery could be identified supplying the sciatic nerve in the gluteal region. In total 28 sciatic arteries were identified, of which 14 arose from the medial circumflex femoral artery, 11 from the inferior gluteal artery, 2 from the first perforating artery, and 1 from the internal pudendal artery. In 5 limbs, 2 sciatic arteries were observed, being independent branches from the medial circumflex femoral and inferior gluteal arteries in 4 limbs and separate branches of the medial circumflex femoral artery in 1 limb. In 1 limb, 4 sciatic arteries were observed: 1 from the inferior gluteal artery, 2 from the medial circumflex femoral artery, and 1 from the first perforating artery. In the remaining 14 limbs a single sciatic artery was observed, which in one case arose from the internal pudendal artery, a previously unreported observation.     

国人直肠上动脉的介入解剖研究

目的观察直肠上动脉的形态、分布并测量相关数据,为临床经直肠上动脉的介入诊疗提供基础资料。方法随机选取成人尸体20具,婴幼儿尸体15具,行巨微解剖观测。结果直肠上动脉供应整个直肠及部分肛管的血液,向上参与乙状结肠末段的血供;直肠上动脉本干及左、右、背侧支起点的内管径均值均大于0.8mm,各分支与本干间下夹角均值均小于50°。结论直肠上动脉本干及其一级分支的角度及管径等,均可满足临床介入手段的需要;直肠上动脉作为直肠供血动脉中最重要、最恒定的一支,是动脉插管的首选途径。     

Reflex responses of neurons in the inferior mesenteric ganglion to mechanical stimulation of the colon, rectum, anal canal, and urinary bladder in the dog

Unitary discharges were recorded from the inferior mesenteric ganglion of decerebrate dogs. Eighty-one units were identified as sympathetic postganglionic neurons innervating the colon and rectum by collision test performed by stimulation of the lumbar colonic nerve. Discharges of four units were enhanced simultaneously with an increased outflow of the renal nerve by pinching a toe. Thus, those units were regarded as vasoconstrictors of colonic blood vessels. Sixty-five units whose discharges were depressed or not affected by the pinching were regarded as neurons innervating colonic smooth muscle or mucosa (colonic units). Discharges were enhanced in the majority of the colonic units by colonic, rectal, and vesical distension, and mechanical stimulation of the anal canal, while discharges were depressed in a few units by rectal and vesical distension, and the anal canal stimulation. The number and percentage of the depressed units increased not only after cutting the hypogastric nerves and descending branches of the lumbar colonic nerve but also after transection of the caudal pons. The reflex depressions disappeared after transection at the bulbospinal junction, but the reflex enhancements remained. These results indicate that the colonic units are enhanced through a spinal reflex by the inflows from the distal colon, rectum, anal canal, and urinary bladder through the lumbar colonic, hypogastric, pelvic, and pudendal nerves, while a few are inhibited through a supraspinal reflex by inflows through the pelvic and pudendal nerves.     

Distribution of the internal pudendal artery in male and female llama (Lama glama)

The aim of this research has been to describe the internal pudendal artery distribution in male and female llama and to compare it with that of other domestic animals including the one-humped camel (Camelus dromedarius). The arterial system was perfused with a solution of 14% coloured plaster and preserved in a solution of a 10% formalin, 3% carbolic acid and 3% glycerine. The systematic dissection was made using traditional working techniques and standard instruments. The internal pudendal artery is the ventral terminal branch of the internal iliac artery at the level of the third sacral vertebra. The main supply of the pelvic organs comes from the prostatic or vaginal arteries; notwithstanding these arteries arise from the internal pudendal artery, showing an important difference between ruminants and pig (long iliac type). Similarities between the distribution of the internal pudendal artery of the llama and those obtained in the camel provide strong evidence of a common phylogenetic origin.     

Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy

Development of prostatic arterial embolization (PAE) to treat benign prostatic hyperplasia (BPH) has raised interest in the variations of the prostatic arteries (PA). The aim of this study is to identify these vascular variations, to compare them with previous data, and to propose a simple classification. Ten adult male pelvis sides from embalmed cadavers were dissected, ages 69 to 92 years, and 10 PA were examined. In a retrospective analysis of 34 DSA pelvic angiographies on 28 patients aged 50 to 90 years, 48 PA were identified. A total of 58 PA were therefore analyzed. Six types are defined. Type I: PA originates from the anterior division (AD) of the internal iliac artery (IIA), 20.7%; Type II: PA emerges from the obturator artery (OA), 5.2%; type III: PA arises from the gluteal‐pudendal trunk (GPT), 27.5%; Type IV: PA originates from the internal pudendal artery (IPA), 29.3%; Type V: PA comes from the middle rectal artery (MRA), 15.5%. Other origins, not observed in our sample but described in the literature, were amalgamated under Type VI. The AD/GPT/IPA stem is the main source of the PA. Analysis of the definitions of IIA branches and the associated terminology is necessary for interpreting the results reported by several authors on different samples, but in general the results fit the meta‐analysis well. A new, simple, and complete classification for vascular variations of the PA is proposed. Clin. Anat. 30:71–80, 2017. © 2016 Wiley Periodicals, Inc.     

骨盆骨折出血动脉栓塞的解剖学基础

目的：了解骨盆动脉侧枝吻合特点，探讨骨盆骨折损伤血管的动脉栓塞的方法。方法：20具新鲜成人骨盆，采用前后双侧入路解剖，观察髂内外血管的走行特点、各动脉间的侧枝吻合情况。结果：骨盆动脉起点口径小于3mm的血管有闭孔动脉、髂腰动脉、骶外侧动脉。骨盆动脉起点口径3～5mm的血管有臀上动脉、臀下动脉、阴部内动脉。骨盆动脉起点口径大于5mm的血管有髂总动脉、髂内动脉、髂外动脉。距骨壁距离大于10mm的血管有髂总动脉、髂内动脉、髂外动脉。距骨壁距离小于10mm的血管有闭孔动脉、髂腰动脉、骶外侧动脉、臀上动脉、臀下动脉。骨盆动脉分支间有广泛的吻合支。结论：骨盆骨折动脉损伤应栓塞损伤的动脉及其主要的侧枝循环。     

臀下神经转位阴部神经的应用解剖

目的：为重建单纯脊髓圆锥或阴部神经损伤后的会阴部功能提供解剖学基础。方法：对成人尸体的臀下神经和阴部神经进行了观测。结果：臀下神经以1支(45．00％)或2支(46．67％)从盆腔穿出为多，其中85．00％穿梨状肌下孔；其穿出点的位置主要在髂后上棘与坐骨结节连线的中1／3(50．00％)或上、中1／3交界处(48．33％)。神经干的长大于3cm，与阴部神经穿出处相距仅约2cm。阴部神经出盆处主要在髂后上棘与坐骨结节连线中1／3(46．67％)或中、下1／3交界(50．00％)。结论：两神经出盆处位置接近，臀下神经的长度足以直接与阴部神经缝接，用脊髓起源节段高的臀下神经转位脊髓起源节段低的阴部神经，切实易行。     

Nerves in the intersphincteric space of the human anal canal with special reference to their continuation to the enteric nerve plexus of the rectum

In the intersphincteric space of the anal canal, nerves are thought to “change” from autonomic to somatic at the level of the squamous‐columnar epithelial junction of the anal canal. To compare the nerve configuration in the intersphincteric space with the configuration in adjacent areas of the human rectum, we immunohistochemically assessed tissue samples from 12 donated cadavers, using antibodies to S100, neuronal nitric oxide synthase (nNOS), and tyrosine hydroxylase (TH). Antibody to S100 revealed a clear difference in intramuscular nerve distribution patterns between the circular and longitudinal muscle layers of the most inferior part of the rectum, with the former having a plexus‐like configuration, while the latter contained short, longitudinally running nerves. Most of the intramural ganglion cells in the anal canal were restricted to above the epithelial junction, but some were located just below that level. Near or at the level of the epithelial junction, the nerves along the rectal adventitia and Auerbach's nerve plexus joined to form intersphincteric nerves, with all these nerves containing both nNOS‐positive parasympathetic and TH‐positive sympathetic nerve fibers. Thus, it was histologically difficult to distinguish somatic intersphincteric nerves from the autonomic Auerbach's plexus. In the intersphincteric space, the autonomic nerve elements with intrapelvic courses seemed to “borrow” a nerve pathway in the peripheral branches of the pudendal nerve. Injury to the intersphincteric nerve during surgery may result in loss of innervation in the major part of the internal anal sphincter. Clin. Anat. 26:843–854, 2013. © 2013 Wiley Periodicals, Inc.     

Region-related modular nerve-dependent motor activity in anorectum--cholinergic and nitrergic contribution to rat model

Disturbances of enteric nerve-mediated anorectal evacuation mechanisms have medical and social impact. The study aimed at further eliciting the contribution of cholinergic and nitrergic neurotransmission systems to modular nerve networks in different regions of Wistar rat anorectum. Electrical field stimulation (EFS, 0.8 ms, 40 V, 2, 5 or 10 Hz, 20 s), computerized mechanographic on-line setup and drugs were used to evaluate the motor responses of isolated rings from circular muscle of rectum (proximal, middle, and distal part), internal anal sphincter, and anal canal. Twitch-like frequency-dependent contractions, more pronounced in rectal preparations, characterized the modular motor responses of rectal circular muscle rings and anal canal. Depending on the frequency of stimulation, the motor activity of internal anal sphincter varied from deep long-lasting relaxation to initial short-lasting relaxation, followed by a contraction. Electrically-evoked responses of anorectal preparations were tetrodotoxin (0.1 microM)-sensitive. In the presence of atropine (0.3 microM) the contractions of rectal rings decreased, relaxation of internal anal sphincter increased and inhibition of the contractions of the anal canal occurred, followed by relaxation. During atropine treatment, NG-nitro-L-arginine (0.5 microM) increased the contractile responses and suppressed internal anal sphincter relaxations. L-arginine (0.5 microM) decreased the contractions and extended the relaxations of internal anal sphincter and anal canal. Our results suggest that cholinergic and nitrergic systems are not equally involved in modular nerve networks of various regions of anorectum. Cholinergic transmission is more expressed in distal rectum, underlying its contractile potency, while nitric oxide-dependent transmission(s) control the relaxation ability of the internal anal sphincter and anal canal.     

骨盆骨折血管损伤的解剖学基础

目的：探讨骨盆骨折血管损伤的机制。方法：20具新鲜成年国人骨盆标本，采用前后双侧入路解剖，观察髂内外血管的走行特点、分型与骨盆韧带、骶丛神经的关系，观察血管在骨盆壁上的投影位置，测量每一根血管到骨壁的垂直距离，观察各动脉间的侧支吻合情况。结果：骨盆动脉血管根据口径可分为3类：(1)小口径动脉，直径小于3．0mm。(2)中等口径动脉，直径3．0～5．0mm。(3)大口径动脉，直径大于5．0mm。据血管距骨壁的距离可分为靠近骨壁的血管(平均距离小于10．0mm)及远离骨壁的血管(平均距离大于10．0mm)。阴部内动脉与骨壁关系不明显。骨盆动脉分支间有广泛的吻合支。结论：骨盆动脉解剖学特点决定了在骨盆骨折中损伤的机率，骨盆动脉有广泛吻合支是骨盆动脉出血止血困难的原因。     

髋臼周围动脉的解剖学研究及其临床意义

目的：探讨髋臼周围动脉的解剖学特点,为临床髋臼骨折手术治疗提供解剖学基础。方法：在15具成年男性尸体标本30侧髋臼上对髋臼周围动脉的形态学特点及毗邻关系进行观测。结果：臀上动脉、阴部内动脉以及臀下动脉贴近髂骨外骨板走行,臀上动脉距离坐胃大切迹顶点最近,侧卧化时髂后上棘、坐骨火切迹顶点、大粗隆顶点三者之间的连线体表投影构成以坐骨大切迹顶点为顶点的等腰三角形,臀上动脉位于三角形顶角区。结论：涉及坐骨大切迹顶点的髋臼骨折易损伤臀上动脉及变异的臀下动脉,侧卧位时依其等腰三角形可改进髋臼骨折手术人路,减少术中出血。     

鼻内镜下泪囊鼻腔吻合术的解剖学基础

目的为提高内镜下泪囊鼻腔吻合术的有效率和减少并发症提供解剖学基础。方法 15具(30侧)头颈部标本经双侧颈总动脉灌注红色乳胶,在国产手术显微镜下进行解剖,1具保留骨骼的头颈部血管铸型标本。结果①外鼻的动脉:分布到外鼻的动脉非常丰富,主要有鼻背动脉、鼻外侧动脉、鼻翼动脉、鼻翼下缘动脉及上唇动脉的分支等,且在鼻端处它们之间形成非常丰富的吻合;②鼻中隔动脉:鼻中隔血供属多源性,主要来自鼻后中隔动脉上支、下支,筛前?筛后动脉,筛前、筛后动脉主要分布于鼻中隔上部;③鼻腔外侧壁的动脉:蝶腭动脉大多(90%)在蝶腭孔处已分为鼻后外侧动脉和鼻后中隔动脉,鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉;下鼻甲动脉沿途分支分布于下鼻甲及下鼻道,且有分支与中鼻甲动脉吻合。结论本文结果对鼻内镜下泪囊鼻腔吻合术具有参考价值。