女性解剖性前盆腔脏器清除术对控尿机制的影响

Anatomical anterior exenteration and the injury of female urinary continent mechanism

目的:探讨女性解剖性前盆腔脏器清除术对控尿机制的影响,以进一步指导相关临床工作和研究。方法:对符合研究需要的成人女性尸体20具进行控尿神经的大体解剖,然后模拟行经耻骨后解剖性前盆腔脏器清除术,以明确可能会损伤控尿神经的操作,并提出相应的防范措施。结果:女性盆丛的阴道丛和尿道丛有神经分支进入尿道,其中膀胱尿道丛量较少,紧贴盆侧壁几乎与尿道上缘平行走向尿道。阴部神经的阴蒂背神经和阴部神经发出神经支配尿道,以阴部神经为主要。明确上述控尿神经,模拟手术表明:紧贴盆壁的操作、尿道近端切除>0.5cm、吻合尿道-新膀胱进针过深等均易于损伤控尿神经和肌肉操作。结论:手术中应针对易于损伤的控尿神经、肌肉操作因素进行防范,有助于女性控尿机制的保护。

Objective： To study the impact of anatomic anterior exenteration on female urinary continence mechanism, which could direct our further study and clinical operation in this area. Methods： The gross anatomy had been done on 20 female cadavers. In each cadaver, after the nerve （the continence nerve） to the urethra being exposed, mock operations of anatomical anterior exenteration through the retropubic were performed to identify any surgical maneuvers that might damage the continent nerves and the urethral muscles. Results：The gross anatomy showed that the pelvic plexus sents the bundles to rectum, vagina and the urinary bladder-urethra. The vagina sents the bundles to the urethra. And the bundles to bladder-urethra goes along the side of pelvis The terminal branches of the pudendal nerve, some also of clitoris dorsal nerve, were found to run to the urethra. On the basis of these anatomic findings, the mock operation showed that the dissection closely to the pelvic, the resection of urethra 〉0. 5 cm, anastomosing the neo-bladder-urethra deeply, and so on, might damage the continent nerve and muscles easily. Conclusions： It is helpful for protecting female urinary continence to keep away those maneuvers which might damage the female urinary continent miehanism.