耻骨联合下部切除修复男性后尿道术后尿失禁及勃起功能障碍的解剖学基础

An anatomic basis of urinary incontinence and erectile dysfunction after repair of posterior urethra by inferior pubectomy

目的:探讨耻骨下部切除修复重建男性后尿道的解剖学基础,寻求避免损伤,造成术后尿失禁和勃起功能障碍等并发症的方法。方法:防腐成人男尸15具,去除耻骨联合后观察尿道前列腺尖部和膜部周围结构;新鲜尸体3具,模拟耻骨下部切除修复重建男性尿道手术。结果:耻骨结节下缘连线相对应于前列腺前后径中点,耻骨联合下缘相对应于尿道膜部后分;耻骨后为前列腺静脉丛和尿道横纹括约肌的纵行纤维;阴茎海绵体神经束紧靠尿道膜部穿过尿生殖膈,呈立体网格状展开。结论:切除耻骨的范围是两侧耻骨结节下缘连线以下、内侧缘垂直线以内,适宜尿道前列腺部的前分和尿道膜部后分病变;此术式可损伤尿道横纹括约肌和阴茎海绵体神经;靠中线操作可减少损伤。

AIM:To investigate the anatomic basis of the repair and reconstruction of posterior urethra via inferior pubectomy so as to explore the approaches to avoiding injury,the complications of urinary incontinence and erectile dysfunction after operation. METHODS:The anatomic constructions around the membranous and prostate apical urethra were observed in 15 preserved adult male specimens by microanatomy after resection of pubic symphysis,and the urethral repair and reconstruction by inferior pubectomy were carried out in 3 fresh male specimens. RESULTS:The line between the two lowest edges of the pubic tubercle corresponded to the middle point of the front-back span of the prostate,and the inferior margin of pubic symphysis to the back part of the membranous urethra.The longitudinal muscular fibres of the rhabdosphincter of urethra and the prostatic venous plexus were located behind the pubic symphysis.The cavernous nerves of penis pierced the urogenital diaphragm and passed lateral to the membranous urethra in a status of gridding. CONCLUSION:The range of inferior pubectomy is below the pubic tubercles and between the inner edges of the pubic tubercles,which is fit for the anterior dissection of prostatic portion of urethra and posterior dissection of membranous portion of urethra.The rhabdosphincter and the cavernous nerves of penis may be damaged by this approach,and the damage can be diminished by midline dissection.