阴部神经的解剖学观测及其临床意义

目的　从神经胚胎发育的角度对阴部神经的来源、组成、走行、分支进行解剖学观测，为临床会阴部手术提供依据。 方法　16具（32侧）成人尸体标本解剖观察阴部神经的组成、形态、走行、分支及其毗邻关系，测量阴部神经与毗邻结构距离等的数据。 结果　阴部神经主要由S2、S3和S4前支混合后组成，但仍有部分由S2和S3前支混合后组成。阴部神经在下行过程中有坐骨神经及股后皮神经的分支加入，三者之间相互交通的关系较为复杂；在阴部管及坐骨直肠窝，阴部神经的毗邻不同；阴部神经分为盆内和盆外分支。阴部神经在阴部管内距坐骨结节前缘下方的距离为（男25.47±3.18 mm， 女26.38±2.56 mm）；阴部神经在坐骨棘处距皮肤的距离为（男75.67±8.37 mm, 女76.89±9.48 mm）。 结论　阴部神经与毗邻神经交通复杂，细致的解剖对临床相关手术及治疗具有指导意义。

Study of pudendal nerve and its clinical significance

Objective　This study aims to provide an anatomic basis for surgeries accompanied with the pudendal nerve and some explanations about the formation of thepudendal nerve.　Methods　The pudendal nerve was dissected from its origin to end branches in 16 human cadavers. Its formation, shape, tract, branches and relationship with vessels were observed. The data related to the pudendal nerve were also measured.　Results　The formation of pudendal nerve is discrepant from what we acknowledged before. The trunk of pudendal nerve is formed by the anterior branches of S2, S3 and S4 with S4 being absent in some cases. In the descending course, the trunk of the pudendal nerve is combined with some fibers from the posterior femoral cutaneous nerve and the sciatic nerve in its course. The intricate shape of the pudendal nerve owes to its relation with the posterior femoral cutaneous nerve and the sciatic nerve, and the relations among its branches also contribute to that. The relationship with vessels varies during its course in the inferior border of piriformis and the pudendal canal. The branches of the pudendal are divided into the branches in the pelvis and the branches out of the pelvis. The distance from the pudendal nerve in the Alcock’s canal to the bottom of the ischial tuberosity’s anterior border is (25.47±3.18) mm in male and (26.38±2.56) mm in female. The distance from the pudendal nerve at the ischial spine to the skin is (75.67±8.37) mm in male and (76.89±9.48) mm in female.　Conclusion　The detailed dissection of the pudendal nerve can guide clinician in the surgeries associated with pudendal nerve in some degree.