前列腺周围筋膜及其毗邻结构的三维断层解剖研究

Three-dimensional sectional anatomy of paraprostatic fascia and its adjacent structures

目的阐明前列腺周围筋膜及其毗邻结构的形态特点,为前列腺癌根治术手术分离平面的选择提供解剖学基础。方法 6例福尔马林固定的成年男性盆腔标本,制成横、矢、冠状连续断层切片,观察前列腺周围筋膜及其毗邻结构的形态学特点。结果①盆腔壁层筋膜在前列腺前方增厚形成耻骨前列腺韧带;背深静脉复合体位于两侧耻骨前列腺韧带之间、耻骨尿道韧带之上,前缘与前列腺筋膜、后缘与前列腺连接紧密;前列腺筋膜前方为填充脂肪组织的耻骨后间隙。②前列腺包囊、前列腺静脉丛和前列腺筋膜三者在前列腺两侧相互融合形成前列腺纤维鞘,纤维鞘内侧缘与前列腺连接紧密,外侧缘与盆腔壁层筋膜之间为一疏松的、无血管神经的筋膜间隙。③Denonvilliers筋膜和直肠固有筋膜在前列腺后方构成直肠膀胱隔,两层筋膜之间为一无血管神经的间隙;在前列腺后外侧,两层筋膜分离走行,与外侧的盆腔壁层筋膜构成神经血管束三角。结论前列腺根治术手术中紧贴前列腺筋膜和Denonvilliers筋膜的外侧面分离,有利于减少手术中神经、血管的损伤。

Objective To illustrate anatomical configration of periprostatic tissues for radical rebropubic prostatectomy.Methods The pelvics from 6 male adult cadavers were serially sectioned transversely,sagittally and coronally respectively,with the thickness of 3mm.Identical levels on three plane were selected to observe the configuration of the periprostatic fascia and its adjacent structures.Results ① Puboprostatic ligament was formed by the end of parietal fascia which fixed the prostate to the pubis;Dorsal vein complex was on the pubourethral ligament between bilateral puboprostatic ligaments,with closely adhering to prostatic fascia anteriorly and to prostate posteriorly.② Lateral part of prostatic capsule,venous plexus and prostatic fascia were interlaced each other,which were closely adhered to prostate and loosened to parietal fascia.③ Rectovesical septum was composed of Denonvillier＇s fascia and fascia propria in which a potential fascia space was found between them.The former coursed laterally stretching to prostatic fascia and the latter the lateral part of the fascia propria.Denonvillier＇s fascia,fascia propria and parietal fascia constituted the triangle of neurovascular bundle.Conclusions Dissecting along the prostatic fascia and Denonvillier＇s fascia,with less bleeding and nerve damage,is the key in radical rebropubic prostatectomy.