前列腺增生腺体的局部解剖观察和临床应用

目的：了解认识前列腺增生腺体的局部解剖结构，改进治疗前列腺增生的手术方式。方法：解剖观察10例耻骨上经膀胱前列腺剜除术的完整标本，在标本上模拟设计尿道外增生腺体摘除的手术方法，在12例实际手术中验证方法。结果：10例标本的尿道起始部与增生腺体前上部分腺体之间存在一隐窝，是两侧增生腺体前面的内侧缘弧线形相交形成的夹角区域，为无增生腺体覆盖的三角形尿道裸区，由这一区域分离尿道与增生腺体，可将增生腺体解剖为外层包绕的薄层组织和两侧增生腺体的主体，并由增生腺体中完整分离出尿道，予以完整保留。实际手术中，12例尿道外全部摘除增生的腺体，完整保留尿道，2例尿道有小的纵行裂口。结论：前列腺存在一个无增生腺体覆盖的尿道裸区，利用这个解剖标志可建立一种新的彻底摘除前列腺增生腺体并保留尿道手术的方法。

An anatomical study ofbenign prostatic hyperplasia and its clinical application

Objective:To understand the anatomical feature of benign prostatic hyperplasia and to improve the prostatectomy.Methods: Local anatomical features of benign prostatic hyperplasia were investigated on 10 specimens whose prostatic hyperplasia were removed through suprapubic transvesical approach.A new method of removing the whole prostatic hyperplasia without impairing the urethra was designed and tested on specimens.Furthermore,the method was applied on clinical operation of 12 patients.Results: Between the proximal urethral segment and anterior prostate,there was a fovea region without being surrounded by adenomatous tissue,where the urethra could be exposed directly after excising the prostatic hyperplasia.The whole adenomatous tissue could be anatomically divided into 3 parts:2 lateral masses and a surrounding adenomatous tissue in out layer.12 cases of benign prostatic hyperplasia underwent the new method of prostatectomy.The urethra of 10 cases were preserved intact,and 2 cases were injured slightly.Evaluated by IPSS score and uroflowmetry,all cases got good results of fluent urinary stream without any complications.Conclusion: The region not surrounded by adenomatous tissue is a useful anatomical symbol,with which a new method of prostatectomy can be designed to treat the benign prostatic hyperplasia.