前列腺增生症微创外科治疗的应用解剖及其临床应用

The anatomic study on the treatment of benign prostatic hyperplasia by minimally traumatic surgery and its clinical application

目的:为改进经尿道内窥镜下前列腺切除术提供形态学基础.方法:在内窥镜下分别观察测量200例正常成人男性和80例Ⅰ°、Ⅱ°,70例Ⅲ°前列腺增生病人的后尿道形态学特点.结果:①尿道膜部后上缘至精阜之间有一弧形粘膜皱襞,在前列腺增生患者呈环形;②前列腺两侧叶裂隙顶部恒定位于11～1点处之间;③尿道前列腺部上、下径,膀胱颈最高点至精阜距离,精阜上、下径,尿道膜部上缘至精阜的距离在正常组、Ⅰ°、Ⅱ°、Ⅲ°前列腺增生组分别为(3.62±0.65),(4.36±0.59),(4.76±0.50)cm;(4.30±0.65),(5.41±0.56),(6.12±0.78)cm;(0.66±0.12),(0.72±0.16),(0.79±0.16)cm;(1.29±0.15),(1.17±0.16),(1.00±0.18)cm.结论:精阜及其相对位置的准确定位、精阜至尿道膜部上缘的距离是经尿道前列腺切除术关键.

Objective: To improve the transurethral prostatetomy by observin g the posterior urethra under urethroscope. Methods: The anatomical characterist ics of the posterior urethra were observed on 200 normal adult man and 80 cases of Ⅰ°?Ⅱ° and 70 cases of Ⅲ°BPH(benign prostatic hyperplasia)patients respe ctively. Results:①There was a curve mucosa plica between the colliculus seminal is and the proximal membranons urethra in normal adult man, but a curve mucoas p lica was changed into a circular mucosa plica in BPH.②The fissure top of two si de-leave prostate was fairly fixed between 11~1 o'clock position under urethrosc ope.③The superior-inferior caliber at the prostatic part of urethra was 3.62±0 .65cm in normal group and 4.36±0.59cm in Ⅰ°?Ⅱ°BPH group, 4.76±0.50 cm in Ⅲ° BPH group respectively. The distance between the peak point of vesical neck and colliculus seminalis was 4.30±0.65 cm, 5.41±0.56 cm, 6.12±0.78 cm, and t he superior-inferior caliber of the colliculus seminalis was 0.66±0.12 cm, 0.72 ±0.16 cm, 0.79±0.16 cm, the distance between the colliculus seninalis and the proximal membranous urethra was 1.29±0.15 cm, 1.17±0.16 cm and 1.00±0.18 cm respectively. Conclusions: The key of transurethral prostatectomy is correct loc ation of the colliculus seminalis and the corresponding position and observation of the distance between the proximal membranous urethra and the colliculus semi nalis.