经会阴修复重建男性尿道的应用解剖

CLINICAL ANATOMIC STUDY ON URETHRAL REPAIR VIA PERINEAL APPROACH

目的 探讨经会阴修复重建男性尿道的解剖学基础 ,寻求减少损伤的方法。 方法 防腐成年男尸12具 ,经会阴逐层解剖至尿道前列腺尖部 ,观察层间结构和联系、尿道前列腺尖部和膜部周围结构 ,测量有关数据 ;另用新鲜男尸 3具 ,模拟经会阴修复重建男性尿道手术操作。 结果 支配阴囊、会阴及尿道球部的动、静脉及神经均是从两外侧走向中线 ;前尿道海绵体的腹、背侧与相邻组织间有致密纤维组织相连接。阴茎海绵体神经呈网状紧贴前列腺表面从底部走向尖部 ,穿过尿生殖膈 ,呈网格状展开 ,神经束网宽为 ( 12 .11± 2 .32 ) mm。 结论 会阴结构复杂 ,手术时靠中线操作可减少损伤 ;在膜部尿道外侧 5 mm的范围内操作 ,从前外侧紧贴前列腺表面分离前列腺尖部组织 。

Objective To provide the anatomic basis for the posterior urethral repair via the perineal approach. Methods The anatomic constructions and their relationships of the perineal approach from skin to the membranous and prostate apical urethra were observed and some related data were measured in 12 adult male specimens by microanatomy, and the procedures of urethral repair via the perineal approach were carried out in 3 fresh male specimens. Results All the blood vessels and nerves, which supplied the scrotum, the perineum, and bulbourethra, passed lateral medially. The cavernous nerves coursed posterolaterally from the bottom to the apex of the prostate, pierced the urogenital diaphragm and passed laterally to the membranous urethra in a status of gridding, whose width was (12.11±2.32) mm. Conclusion The structures of the perineum and around the posterior urethra are complicated. The strategy for diminishing the damages to them is that all structures must be dissected strictly in the midline. Confining the dissections strictly to the range of 5 mm from the membranous urethra and resecting the apical prostatic tissues anterolaterally could avoid impairments of the cavernous nerves.