人海绵体神经的应用解剖及临床意义

海绵体神经起源于盆神经丛的次级神经丛-前列腺丛,含有交感神经纤维和副交感神经纤维两种成分。该神经与尿道血管形成神经血管束,沿前列腺两侧向远端走形,穿尿生殖膈后,发出分支进入海绵体,或与阴茎背神经交通,最后管理阴茎勃起组织。在盆内手术如膀胱、前列腺的根治性手术和全直肠系膜切除术后因海绵体神经损伤而导致患者术后勃起功能障碍时有发生。熟悉海绵体神经及其分支的走行特点及其与周围结构的关系,能降低手术并发症。在海绵体神经损伤后的重建方面也取得了一定的成果。     

阴茎海绵体神经丛的应用解剖学观察

目的探讨常规手术入路修复尿道对阴茎海绵体神经丛损伤的解剖学基础。方法通过解剖成人男尸标本15具,观察阴茎海绵体神经丛走行及其分支与周围血管神经组织的毗邻关系;通过解剖新鲜成人男尸3具,模拟不同手术入路修复尿道,探讨降低阴茎海绵体神经损伤的术式。结果阴茎海绵体神经与尿道膜部和尿道前列腺部关系密切,神经呈网束状经过尿生殖膈,其宽度(12.11±2.32)mm。结论经耻骨联合和经会阴途径来重建尿道,都有损伤阴茎海绵体神经丛的可能,需紧贴中线的操作才最大限度降低损伤。     

前列腺动脉的解剖观测及临床应用

目的　研究成人前列腺动脉的来源、行程、进入前列腺的部位及其与神经丛的关系,为前列腺手术提供解剖学基础。方法　在解剖显微镜下对3 0侧常规防腐固定的3 5～60岁成年男性尸体前列腺动脉及神经丛作解剖、观测。结果　3 0侧均有恒定的前列腺动脉,共有12 5支,来源丰富,主要来自膀胱下动脉(92 /12 5 ,73 .6% ) ,行程较恒定,在距膀胱前列腺间沟(2 2±8)mm处呈丫爪状分支,多数分支在膀胱前列腺间沟内进入前列腺底,按时钟顺序,各点钟处均有动脉进入,以3～5或7～9点居多(87/12 5 ,69.6% )。前列腺神经丛由膀胱神经丛延续而来,在接近膀胱前列腺间沟处与前列腺动、静脉相互交织成网,进入前列腺包膜中。结论　在距膀胱前列腺间沟2 0～3 0mm处,环周结扎前列腺动脉,止血更为彻底,也可避免损伤神经丛。     

阴茎海绵体组织工程的研究进展

阴茎是男性外生殖器的重要构成部分.先天疾病或外伤可能会导致阴茎发育畸形或缺损,最终需要重建.随着组织工程学的发展,阴茎海绵体组织工程学研究也日益成为阴茎重建的核心内容.目前阴茎海绵体组织工程学研究主要集中在支架制备以及移植细胞(包括血管内皮细胞和平滑肌细胞)的研究.近几年,随着干细胞技术、基因技术以及神经再造技术等的联合发展,将组织工程阴茎海绵体的发展又推上了另一个高度.组织工程的研究为修复阴茎海绵体结构及重建其正常功能提供了可能.拟对近年组织工程在阴茎海绵体重建方面的相关研究进展作一综述.     

老年人前列腺的医疗保健

前列腺位于阴茎根部的膀胱颈处,尿道从前列腺中间穿过,当前列腺发生病变时,就会出现相应的刺激性或梗阻性症状,如尿频、尿急、尿痛和尿不净等.常见的前列腺病变有:前列腺炎,前列腺增生(或称肥大)和前列腺癌.它们是老年男性的常见病、多发病,会严重影响老年人身心健康,故应积极防治.     

坐骨海绵体肌和球海绵体肌的作用

<正> 会阴部的坐骨海绵体肌因其作用与外生殖器官有密切的联系,故又称为外阴肌。一、坐骨海绵体肌 M.ischiocavernosus 位于坐骨下支,覆盖于阴茎或阴蒂海绵体的根部。起始于坐骨下支或坐骨结节。抵止肌纤维束从内、外、下侧包统阴茎(蒂)海绵体的阴茎(蒂)脚部,并沿其行进,逐渐变成扁平的薄腱附着于海绵体外侧和下侧的白膜。另一部分到阴茎(蒂)海绵体背面与对侧的彼部相连,附着在阴茎(蒂)海绵体的背面。     

结扎膀胱下动脉前列腺摘除术的外科解剖和临床应用

在32侧成人标本上解剖观察了前列腺的动脉和神经的起源和分布。供应前列腺的动脉主要为膀胱下动脉的分支,平均每侧有5.6支(2～6)。其分出点于膀胱前列腺间沟的4(8)及3(9)点钟之上24±10mm((?)±SD),各支可经膀胱前列腺间沟的任何一处进入前列腺实质或其包膜。至海绵体组织的植物性神经主要集中于膀胱前列腺间沟及前列腺表面的4点和8点钟外。作者认为,于膀胱前列腺连接部的侧面盲目缝扎包膜,试图结扎其中的动脉而达止血的目的,未必奏效。我们在7例良性前列腺增生的手术摘除术中,采用直视下膀胱下动脉结扎的方法,结扎动脉干可靠,术中术后出血量显著减少。因不会误扎神经,可避免术后病人性功障碍。     

阴阴茎动脉起于髂内动脉1例

在解剖一男性尸体标本盆会阴部时 ,见髂内动脉发阴茎动脉及其他分支变异 (附图 ) ,报道如下 :1　阴茎动脉变异变异的阴茎动脉起于髂内动脉前干 ,其起始处管径为 1.6ｍｍ ,发出后于盆腔侧壁与直肠下段和前列腺之间行向前下方 ,沿途依次发支至直肠和前列腺 ,发支后的动脉主干管径为 1.2ｍｍ ,此于在耻骨联合的后下方 ,经盆膈裂孔进入尿生殖区 ,分出尿道球动脉后再进一步分为阴茎深动脉 (管径 1.18ｍｍ)、阴茎背深动脉 (管径 1.4 6ｍｍ)两终支。阴茎深动脉经阴茎脚后端进入阴茎海绵体 ,阴茎背深动脉行于深阴茎筋膜和阴茎白膜之间。本例的阴部内…     

人阴茎海绵体微血管构筑的研究

目的：阐明人阴茎海绵体微血管构筑及其生理意义。方法：阴茎血管铸型扫描电子显微镜下观察。结果：阴茎海绵体内纵行的动脉发出无数树状分支,其中部分分支为毛细血管,此毛细血管汇合后注入白膜下静脉丛;部分形成螺旋动脉,与海绵窦相交通。在阴茎海绵体表面,环动脉的分支亦部分与海绵窦相通,部分分为毛细血管。引流海绵窦血液的窦后小静脉相互吻合形成白膜下静脉丛,白膜下静脉丛汇合后形成导静脉。结论：①在阴茎海绵体内有营养性的毛细血管系统和功能性的螺旋动脉系统;②在阴茎海绵体表面存在白膜下静脉丛。     

阴茎海绵体造影42例临床分析

目的探讨阴茎海绵体造影在勃起功能障碍中的作用。方法阴茎海绵体注入血管活性药物诱导勃起,3～5min后快速注入阴茎海绵体38%的泛影葡胺40～100ml,于30、60、90、120及900s分别摄片。结果未见静脉瘘影像12例,占28.6%,背深静脉瘘16例,占38.1%;背浅静脉瘘4例,占9.5%;脚静脉瘘8例,占19%;海绵体静脉瘘2例,占4.8%。结论阴茎海绵体造影在静脉性勃起功能障碍的诊断和治疗方法的选择上具有重要意义。     

Papillary carcinoma of choroid plexus

Summary Two cases of papillary carcinoma, one in a 23-month-old girl and the other in a 25-month-old boy who both died within a relatively short time after operation, were studied histologically and electron microscopically. Both tumors originated in the right trigone of the lateral ventricle and spread widely via the cerebrospinal fluid. Histologically, the tumors consisted mostly of a differentiated papillary architecture closely resembling choroid plexus papilloma. Some carcinoma cells, showing cellular atypism, displayed a multilayer arrangement. The amount and distribution of PAS-, Alcian blue- or orcein-positive substances on the cell surface and/or in the interstitial elements of the carcinomas differed from that of choroid papillomas examined in our laboratory. Electron microscopically, the carcinoma cells in some areas showed a loss of apical-basal polarity, and the formation of both microvilli and desmosome-like structures was indistinct. Papillary carcinoma is reviewed on the basis of the literature from 1906 till 1980.The authors thank Dr. S. Nagayoshi, Dr. N. Hirabayashi and Dr. I. Asamoto, who performed the autopsies, for their permission to publish.     

A supraomohyoidal plexus block designed to avoid complications

Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel’s method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage. The needle is inserted in the axis of the plexus with an angle of approximately 35° to the skin, and advanced in lateral and caudal direction. Distribution of solution was determined in ten cadavers after bilateral injection of colored solution (20 and 30 ml) and followed by dissection. In an eleventh cadaver, computerized tomography and 3D reconstruction after radio contrast injection was performed. In additional five cadavers we performed Winnie’s technique with bilateral injection (20 and 30 ml).Concerning the supraomohyoidal block the injection mass reached the infraclavicular region surrounded all trunks of the brachial plexus in the supraclavicular region and the suprascapular nerve in all cases. The solution did not spread medially beyond the lateral margin of the anterior scalene muscle into the scalenovertebral triangle. Therefore, phrenic nerve, stellate ganglion, laryngeal nerve nor the vertebral artery were exposed to the injected solution. Distribution was comparable with the use of 20 and 30 ml of solution. Injections on five cadavers performing the interscalene block of Winnie resulted in an extended spread medially to the anterior scalene muscle.We conclude that our method may be a preferred approach due to its safety, because no structures out of interest were reached. Solution of 20 ml is suggested to be enough for a successful block.     

臂神经丛联合阻滞的应用

目的总结＂四针法＂臂丛神经联合阻滞的经验,指导神经刺激仪的合理应用。方法回顾性分析臂神经丛阻滞356例,根据阻滞方法分为联合组（n=148）,联合组同时实施肌间沟阻滞加腋路阻滞加肋间臂神经阻滞;传统组（n=208）,传统组只实施肌间沟阻滞（n=176）,或腋路阻滞（n=32）,不行肋间臂神经阻滞。结果联合组麻醉效果优占97.3%,穿刺异感占47.3%;传统组优占87.0%,穿刺异感占69.7%。联合组与传统组比较,具有显著差异（P〈0.01）。结论 ＂四针法＂臂神经丛联合阻滞可提高臂神经丛阻滞的成功率。     

臂丛根部的显微解剖学研究及其临床意义

目的:对臂丛根部及其周围组织进行显微解剖,为臂丛撕脱伤的诊治提供解剖学基础。方法:在15例防腐成人尸体的颈胸段标本上,观测臂丛根部的形态特点及其与周围组织的关系,2例新鲜标本行组织学检查,观察臂丛根部穿椎间孔时与周围组织的联系。结果:①臂丛前后根之间有齿状韧带相间隔;相应的后根比前根粗,后根间存在着复杂的纤维联系。②臂丛C5、C6神经根分出角小于前支分出角,C7、C8、T1神经根分出角大于前支分出角。③臂丛C5、C6神经根在椎间孔处与前、中斜角肌起点处的腱性组织交织,并与上半椎韧带融合,且有薄层纤维筋膜鞘样结构,将椎动脉、椎静脉与之包裹一起;C7、C8、T1少见或未见与前述结构的联系。结论:臂丛神经根解剖结构的差异是臂丛C5、C6神经根较C7、C8、T1神经根不易形成根性撕脱的主要原因,熟悉臂丛根部的显微解剖有助于临床臂丛根性撕脱伤的诊治。     

颈丛麻醉的应用解剖

目的为临床麻醉医师提供有关颈丛麻醉的解剖学基础。方法解剖观察成人尸体28侧(男18侧女10侧)颈前外侧区,以胸锁乳突肌锁骨头起点为A点,颞骨乳突的最低点为B点,颈丛浅支穿出胸锁乳突肌后缘范围中点定为O点,第4颈椎横突肋结节定为C4,测量有关临床颈丛麻醉的6项数据。结果AB线的长度为(12·6±1·1)cm,OB的距离为(6·8±0·6)cm,C4B的距离为(6·5±0·8)cm,SO的最短距离为(0·8±0·1)cm,SC4的最短距离为(2·0±0·2)cm。结论临床颈丛阻滞麻醉,进针部位应在胸锁乳突肌后缘距乳突最低点(6·8±0·6)cm处,进针的深度,颈丛浅支阻滞麻醉应为(0·8±0·1)cm,颈丛深支阻滞麻醉应为(2·0±0·2)cm。     

Redefining the coccygeal plexus

The coccygeal plexus is variably described in anatomy texts and has rarely been studied despite the idiopathic nature of coccydynia in up to one‐third of affected patients. The plexus was therefore investigated using a combination of microdissection and histology. The distal sacrum and coccyx in continuity with ischiococcygeus were removed en bloc from 16 embalmed cadavers (mean age 78 ± 10 years, 7 females) with no local disease. Ten specimens underwent microdissection of the coccygeal plexus and the remaining six were examined histologically after staining with hematoxylin and eosin and S100 immunohistochemistry to demonstrate nerve fibers. The coccygeal plexus is formed within ischiococcygeus from the ventral rami of S4, S5, and Co1 with a contribution (gray rami communicantes) from the sacral sympathetic trunk. It gives rise to anococcygeal nerves which pierce ischiococcygeus and the sacrospinous ligament to supply the subcutaneous tissue on the dorsal aspect of the coccyx. Some branches from the plexus pass medially anterior to the coccyx. The coccycgeal plexus is formed within ischiococcygeus rather than on its pelvic surface and appears to supply skin in the anococcygeal region. It probably also contributes to the innervation of ischiococcygeus, the sacrospinous ligament, coccygeal ligaments, and periosteum. It deserves to be considered as a potential pain generator that may be implicated in some patients with coccydynia. Clin. Anat. 27:254–260, 2014. © 2013 Wiley Periodicals, Inc.     

The fine structure of choroid plexus carcinoma

The ultrastructural findings of two cases of choroid plexus carcinoma occurring in infants 11 and 24 months old are discussed. Both had a similar ultrastructural pattern which demonstrated a clear polygonal cytoplasm, cell polarity towards the lumina, junctional complexes and evidence of a basement membrane, all of which point to an epithelial origin for the proliferating cells. Abundant immature cellular characters such as polyribosomes, glycogen granules and hypertrophied rough endoplasmic reticulum were found. The importance of the differential dignosis from ependymoblastoma and benign choroid plexus papilloma is emphasized. In the former, the major differentiating features are the existence of abundant glial neuropil and cellular characters of glial differentiation, whilst in the latter, cytoplasmic features demonstrate cellular maturity.     

臂丛及其有关血管的研究

目的 为了获得臂丛的解剖学资料,并为手术提供定位数据。方法 对３２具尸体的臂丛进行调查和测量。结果 将６４例臂丛的类型,位置,变异等情况进行分析归类并与临床的关系进行探讨。结论本研究结果对臂丛神经根损伤的诊治具有积极的指导意义。     

腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术

目的　探讨腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术的可行性。 方法　60例患者随机均分为3组,A组：腋窝顶定位穿刺锁骨下位点阻滞麻醉;B组：插管全麻;C组：腋窝顶定位穿刺锁骨下位点阻滞复合插管全麻,术后用PCIA泵镇痛和VAS评价镇痛程度。评估术中除共同项目外,麻醉技术、耗材和药品所产生的医疗费用。 结果　3组患者一般情况比较差异无统计学意义（P>0.05）;术中全麻丙泊酚和瑞芬太尼每小时应用剂量、术后唤醒和拔管定向力恢复时间,B组显著多或长于C组（P<0.01）;麻醉前准备、操作完成时间A组相似文献   

臂丛神经的应用解剖

目的通过对臂丛神经的解剖学大体观察和测量,为临床骨科医生对臂丛神经损伤的手术治疗提供解剖学数据,并为解剖学积累新资料。方法对40具国人尸体标本(26具,女14具),80侧臂丛神经,进行研究。首先对标本进行大体观察,描述其解剖学形态,进行分型、分类及内、外、后束合成部位与第一肋外缘的关系;用相关的测量工具(电子游标卡尺)测量上、中、下三干前、后股的比例及根干束的长度并进行统计学分析。结果根干束的长度,C5根:男(33.85±7.07)mm,女(30.30±5.25)mm,C7根和中干:男(52.46±10.55)mm,女(44.15±6.68)mm;C8根:男(25.55±5.88)mm,女(19.91±5.09)mm;T1根:男(23.81±5.58)mm,女(19.16±4.02)mm;上干:男(24.69±9.91)mm,女(18.86±4.93)mm,下干:男(33.13±9.21)mm,女(25.44±9.41)mm;后束:男(31.21±13.93)mm,女(37.36±9.93)mm。结论除C4根、C6根、T2根、内侧束和后束外,性别不同,其臂丛神经解剖学长度差异均有统计学意义。提示在临床麻醉及手术治疗臂丛神经损伤时一定要注意。