良性前列腺增生症患者的前列腺动脉解剖特点

Angiographic anatomic findings of prostatic arteries in patients with benign prostatic hyperplasia

目的 探讨良性前列腺增生症（BPH）患者前列腺动脉（PA）血管造影的解剖特点.方法 回顾性分析行经导管超选择性PA DSA和超选择性前列腺动脉栓塞术,可显示双侧前列腺动脉的55例BPH患者.患者均行髂内动脉及超选择PA造影,观察PA的数目、起源、直径、微小血管形态及与邻近动脉的吻合支.结果 55例髂内动脉（110支）造影共显示114支PA,其中106支（96.4％,106/110）髂内动脉有1支PA、4支（3.6％,4/110）髂内动脉有2支独立的PA.36例两侧的PA起源不对称（65.5％,36/55）,19例两侧对称（34.5％,19/55）.37例（67.3％,37/55） PA的供血呈现一侧优势型.45支（39.5％,45/114） PA起源于臀-阴部动脉干,37支（32.6％,37/114）起源于膀胱上动脉,32支（27.9％,32/114）起源于阴部内动脉.82支（72.1％,82/114）为高位开口,32支（27.9％,32/114）为低位开口.43支髂内动脉（39.1％,43/110）中,PA与邻近器官动脉存在吻合支.PA直径为0.5～ 1.5 mm,平均（0.9±0.4） mm.20例前列腺体积≥100 cm3的患者中,17例可见PA显著增粗（直径＞1.2 mm）和螺旋样小动脉.结论 良性前列腺增生患者PA的直径、起源和形态有较高的变异,PA与邻近动脉具有丰富的吻合.

Objective To describe the prostatic arterial anatomy of patients with benign prostatic hyperplasia（BPH） on arterial angiography.Methods In a retrospective study of selective prostatic artery （PA） DSA for prostatic arterial embolization（PAE）,bilateral PA were indicated in 55 patients with BPH.All the patients underwent selective angiography in the internal iliac arteries and PAs.Each internal iliac artery was evaluated regarding the number of PAs and their origins,trajectory,diameters,and anastomoses with adjacent arteries.Results One hundred and ten internal iliac arteries gave rise to a total of 114 PAs.One hundred and six internal iliac arteries（96.4％,106/110） had only a PA,and 4 internal iliac arteries（3.6％,4/110） had two independent PAs.The left and right PA origin were asymmetric in 36 patients（65.5％,36/55） and symmetric in the other 19 patients（34.5％,19/55）.In 37 patients（67.3％,37/55）,the prostate was dominantly vascularized by unilateral PA.Forty five PAs（39.5％,45/114） originated from the glutealpudendal trunk,37 PAs（32.6％,37/114） originated from the superior vesical artery,and 32 PAs（27.9％,32/114） originated from the internal pudendal artery.Eight two PAs（72.1％,82/114） had a superior origin and 32（27.9％,32/114） had an inferior origin.In 43（39.1％,43/110） internal iliac arteries,PAs had the anastomoses to adjacent arteries.The mean PA diameter was（0.9±0.4） mm（ranged from 0.5 to 1.5 mm）.In the 17 of 20 patients with prostate volume more than 100 cm3,the PA was seen with a larger diameter （＞ 1.2 mm） and a corkscrew pattern of intra-prostate arteriola.Conclusions Angiography of prostatic arteries in patients with benign prostatic hyperplasia showed the prostatic arterial origin,diameter and pattern were variable.PA had abundant anastomoses to adjacent arteries.