阴茎背神经阻滞麻醉包皮环切术的解剖学基础及临床应用

Anatomic evidence of dorsal penile nerve block for circumcision and its clinical applications

目的：探讨阴茎背神经阻滞麻醉用于包皮环切术的解剖学基础及其临床应用。方法：甲醛浸泡的男尸9具，包括成年男尸1具，童尸3具，婴幼儿尸3具，新生儿尸1具，胎儿尸1具，阴茎局部解剖显露阴茎背侧的血管及神经组织，利用解剖显微镜、放大镜以及肉眼观察阴茎背神经、血管的分布和走行。阴茎背神经的解剖学基础决定麻醉位点的选择，10例包茎患儿经阴茎背神经两点阻滞麻醉实施包皮环切术。使用VAS（视觉模拟分析）来判断麻醉效果。结果：阴茎背神经自耻骨联合下阴茎根部2点及10点处发出，沿阴茎长轴延伸至阴茎头。阴茎背动脉位于神经的内侧，阴茎背静脉位于阴茎的中央。实施阴茎背神经两点阻滞麻醉后即刻的VAS值为0～4mm（即无痛至轻度疼痛），7—15min包皮环切术结束后，VAS值为0～1mm。结论：两点法阴茎背神经阻滞麻醉（耻骨联合下阴茎根部2点及10点）遵循了该神经的解剖学基础，麻醉效果肯定。

Objective：To study the anatomic evidence and its clinical applications of dorsal penile nerve block （DPNB） for circumcision. Methods：Nine male cadavers including one adult, three children, three infants, one newborn and one fetus freshened with formalin were dissected to show the exact anatomy of dorsal nerves and vasculatures of penile. Anatomic microscope, magnifying glass and eye-observation were used to observe the distribution and running of the above structures. The anatomic evidence of dorsal penile nerve deciding the exact points of analgesia, ten children suffered from phimosis received circumcision with two points DPNB anesthesia. VAS （visual analysis of simulation） was used to evaluate the anesthesia effectiveness. Results：Dorsal penile nerves presented beneath the pubic symphysis at the root of penile in the position of two and ten o＇lock, extending and ending to the glan of penis longitudinally. Dorsal penile deep arteries presented to the medial of nerves on both sides, and dorsal penile deep vein was in the middle of penis. Injecting to the two exact points of nerves at the root of penis just beneath the pubic symphysis, we got VAS of 0mm to 4mm （no pain to mild pain） after analgesia immediately. With 7 to 15 minutes operation period, VAS presented with 0rmn to lmm. Conclusion： DPNB of injection to the exact two points （2 and 10 o＇clock beneath the pubic symphysis at the root of penis） in circumcision has its anatomic evidence with good clinical effects.