男性盆丛的局部解剖特点及其对膀胱前列腺根治性切除的意义

目的:了解男性盆丛神经(IHP)及其分支的局部解剖特点,减少膀胱前列腺根治性切除术中对IHP的医源性损伤。方法:通过解剖12具成年男性尸体骨盆标本,了解IHP及其分支的分布特点。结果:IHP位于腹膜后精囊腺的后外侧,是均一排列的矩形神经丛;IHP纤维分为上、中、下支,上支支配膀胱,中支支配前列腺和精囊,下支纤维支配直肠下部;精囊腺的各面均有IHP纤维支配,以后外侧面为主。IHP的纤维位于膀胱颈的侧面,支配膀胱的侧后壁,膀胱的前表面没有神经支配;IHP与血管形成VAN结构,静脉位于最侧面。海绵体神经起源于IHP的前下方,于前列腺的后外侧形成宽约6mm的神经血管束,在血管的外侧向前下方走行。结论:精囊可作为术中重要的解剖标志,沿精囊和IHP之间的解剖平面分离,可避免对IHP的损伤;紧靠前列腺被膜向下分离至前列腺尖部,并充分显露尿道,可有效地保护海绵体神经血管束。

Topography of the male inferior hypogastric plexus and its significance in radical cystectomy and prostatectomy

Objective:To understand topography of the male inferior hypogastric plexus(IHP)and its branches,and decrease the iatrogenic impairment to IHP.Methods:Cadaveric dissections of 12 male specimens were undertaken to understand the characteristics of IHP and its branches.Results:IHP was located at the posteriorlateral of the seminal vesicle,and was a uniformly disposed,rectangular nerve plexus.The fibers of IHP included upper,middle,and lower branch,and innervated bladder,prostate and seminal vesicle,and lower part of rectum,respectively;IHP innervated all sides of the seminal vesicle,particularly the posteriorlateral side.The fibers of IHP was in the lateral of bladder neck,and innervated the posteriorlateral wall.There was no innervation on the anterior wall of bladder.IHP and its acompanying blood vessel formed the construction "VAN",which meant vein was located at the most lateral.Corpus cavernosum arised from anteroinferior of IHP,and formed a neurovascular bundle at the posteriorlateral of prostate,which was about 6mm in breadth and extended towards the anteroinferior.Conclusions:The seminal vesicle can be used as an important anatomical marker to avoid the injury of IHP in radical cystectomy and prostatectomy.Dissection close to the capsule of prostate and sufficient exposure of urethra on the tip of prostate can preserve the neurovascular bundle effectively.