前列腺周围盆筋膜内神经网尸体解剖的分布特征

朱再生; 施红旗; 周鹏飞; 徐礼臻; 朱伊祎; 陈加俊

doi:10.16098/j.issn.0529-1356.2020.05.023

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解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 778-783. DOI: 10.16098/j.issn.0529-1356.2020.05.023

解剖学

前列腺周围盆筋膜内神经网尸体解剖的分布特征

朱再生^1* 施红旗² 周鹏飞¹ 徐礼臻¹ 朱伊祎³ 陈加俊³

作者信息 +

Anatomical localization of the pelvic fascia neural network around the prostate on the cadavers

ZHU Zai-sheng^1* SHI Hong-qi²ZHOU Peng-fei¹XU Li-zhen¹ ZHU Yi-yi³ CHEN Jia-jun³

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文章历史 +

摘要

目的探讨位于前列腺及其周围区域盆筋膜层内的神经网络较确切解剖定位和神经纤维的数目分布。方法使用6具盆腔结构正常的男性尸体，每具尸体取10处邻近前列腺周围的盆筋膜组织样本，每个样本 1 cm×1 cm大小，按时钟的点位编号并分区。分布如下：前列腺尖部（与膜部尿道交界）区域：1区1点钟，2区11点钟；前列腺中部区域：3区2点钟（右侧骨盆侧面），4区10点钟（左侧骨盆侧面），5区4点钟，6区8点钟；前列腺基底部（与膀胱颈交界）：7区5点钟，8区7点钟；9区（位于前列腺尖部尿道后背侧）6点钟，10区（位于前列腺基底部腹侧）12点钟。比较这10个解剖区域单位面积（1 cm²）内的神经数目和直径大小。结果共获得60个盆筋膜组织样本。神经数目平均为（13.4 ± 13.3）束。前列腺基底腹侧12点钟10区（平均5.3束）与前列腺中部8点钟侧6区（平均9.8束）神经数目分布较少，两区之间差异无统计学意义（P>0.05）；10区与其他8个区均有统计学差异（P<0.05）；剩余各区之间分布均衡（P>0.05）。神经纤维直径平均为（90.4 ± 61.8）μm。前列腺尖部1点钟1区（平均119.2 μm）和中部2点钟3区（平均101.3 μm）神经纤维较粗， 1区与中部10点钟4区（平均77.7 μm）、尖部背侧6点钟9区（平均81.1 μm）、基底部腹侧12点钟10区（平均79.4 μm）之间差异有统计学意义（P<0.05）；4区（平均77.7 μm）与对侧2点钟3区之间（平均101.3 μm）差异也有统计学意义（P<0.05）；其他各区之间分布均衡（P>0.05）。结论前列腺周围盆筋膜内神经网分布表现为在前列腺基底部（与膀胱颈交界）腹侧12点钟区域神经纤维数目较少，其他区域均匀分布；神经纤维直径在尖部腹侧区域朝向顶点较粗，左右不对称分布。骨盆筋膜是根治性前列腺切除术中保留神经的关键性解剖标志。

Abstract

Objective To investigate the exact localization of neural pathway and the frequency of nerve fibers,which are located in the pelvic facial layers in the prostate and periprostatic regions. Methods Six cadavers with normal pelvic structures were used in this trial. Ten tissue samples, each 1 cm ×1 cm in size, were obtained from each cadaver and zone division separately. The locations of these samples were as follows. Prostate tip (at the junction with the urethra of the membrane): zone 1 from 1 o’clock (apical region), zone 2 from 11 o’clock (apical region). Middle part of the prostate: zone 3 from 2 o’clock(lift far pelvic lateral), zone 4 from 10 o’clock (right far pelvic lateral), zone 5 from 4 o’clock, zone 6 from 8 o’clock, zone 7 from 5 o’clock, zone 8 from 7 o’clock. Base of the prostate (bladder neck junction): zone 9 from 6 o’clock (located on the posterior side of the prostate urethra), 12 o’clock in the 10th zone (located on the ventral side of the prostate).Nerve distribution, frequency and diameters of these 10 zones were compared to each other. Results Sixty specimens were obtained from 6 cadavers. Mean number of nerve fibers was 13.4 ± 13.3. In the 10th zone (prostate basal ventral 12 o’clock), the number of nerves was less distributed (average 5.3 bundles), and there was no statistical significance between the zone 10 and the 6th zone (P>0.05), and the other 8 regions were statistically significant (P<0.05).The average diameter of the nerve fibers was (90.4 ± 61.8)μm, zone 1 of the prostate tip (1 o’clock, average 119.2 μm) and zone 3 of the middle (2 o’clock, average 101.3 μm) nerve fibers are thicker. Zone 1 and 4 at left side of the pelvis (10 o’clock, average 77.7 μm), zone 9 (6 o’clock, average 81.1 μm), and the 10 area at ventral base of the prostate(12 o’clock, average 79.4 μm) (P<0.04, separately) were statistically significant. There was also a statistical difference between the 4 zones (average 77.7 μm) and the contralateral 2 o’clock 3 zones (average 101.3 μm) (P<0.05); Balanced distribution in other regions (P>0.05). Conclusion The distribution of nerve network in the pelvic fascia around the prostate: the number of nerve fibers in the ventral 12 o’clock region of the prostate is small, and the other regions are evenly distributed; The diameter of the nerve fibers is thicker toward the apex in the ventral region of the tip and the left and right are asymmetrically distributed. The pelvic fascia is a key anatomical landmark for the preservation of the nerve during radical prostatectomy.

导出引用

朱再生施红旗周鹏飞徐礼臻朱伊祎陈加俊. 前列腺周围盆筋膜内神经网尸体解剖的分布特征[J]. 解剖学报. 2020, 51(5): 778-783 https://doi.org/10.16098/j.issn.0529-1356.2020.05.023

ZHU Zai-sheng SHI Hong-qi ZHOU Peng-fei XU Li-zhen ZHU Yi-yi CHEN Jia-jun. Anatomical localization of the pelvic fascia neural network around the prostate on the cadavers[J]. Acta Anatomica Sinica. 2020, 51(5): 778-783 https://doi.org/10.16098/j.issn.0529-1356.2020.05.023

中图分类号： R699.8

参考文献

［1］ Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention［J］. J Urol, 1982, 128(3): 492-497.
［2］ Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention ［J］. J Urol， 2017，197(2):165-170.
［3］ Walsh PC. Anatomic radical prostatectomy:evolution of the surgical technique［J］. J Urol, 1998, 160(6Pt2): 2418-2424
［4］ Walz J, Epstein JI, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update ［J］. Eur Urol, 2016, 70 (2):301-311.
［5］ Porpiglia F, Bertolo R, Manfredi M, et al. Total anatomical reconstruction during robotassisted radical prostatectomy: implications on early recovery of urinary continence［J］. Eur Urol 2016，69(3):485-495.
［6］ Pavlovich CP，Rocco B，Druskin SC，et al. Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes ［J］. BJU Int,2017,120(2)：185-196.
［7］ Zhu ZSh,Shi HQ,Zhou PF,et al.Application of pubovesical complex preserving technique during laparoscopic radical prostatectomy ［J］. Chinese Journal of Urology, 2018, 39(6):515-521. (in Chinese)
朱再生，施红旗，周鹏飞,等.保留耻骨膀胱复合体技术在腹腔镜根治性前列腺切除术中的应用［J］.中华泌尿外科杂志，2018，39(6):515-521.
［8］ Haglind E, Carlsson S, Stranne J, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial ［J］. Eur Urol, 2015, 68(2): 216-225.
［9］ Alsaid B, Bessede T, Diallo D, et al. Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction［J］. Eur Urol, 2011, 59(6): 902-909.
［10］ Clarebrough EE, Challacombe BJ, Briggs C, et al. Cadaveric analysis of periprostatic nerve distribution: an anatomical basis for high anterior release during radical prostatectomy ［J］? J Urol, 2011, 185(4): 1519-1525.
［11］ Shin T, Ukimura O, Gill IS. Three-dimensional printed model of prostate anatomy and targeted biopsy-proven index tumor to facilitate nerve-sparing prostatectomy［J］. Eur Urol,2016,69(2):377-379.
［12］ Yadav R, Mukherjee S, Hermen M,et al. Multiphoton microscopy of prostate and periprostatic neural tissue: a promising imaging technique for improving nerve-sparingprostatectomy［J］. J Endourol, 2009, 23(5): 861-867.
［13］ Mauroy B, Demondion X, Drizenko A, et al. The inferior hypogastric plexus (pelvic plexus): its importance in neural preservation techniques ［J］. Surg Radiol Anat, 2003, 25(1): 6-15
［14］ Miyake H, Behnsawy HM, Hinata N,et al. Objective assessment of residual nerve tissues in radical prostatectomy specimens by immunohistochemical staining of neuronal nitric oxide synthase-positive nerves and its impact on postoperative erectile function ［J］. Urology, 2014, 84(6):1395-1401.
［15］ Ganzer R, Stolzenburg JU, Neuhaus J, et al. Anatomical study of pelvic nerves in relation to seminal vesicles,prostate and urethral sphincter: immunohistochemical staining, computerized planimetry and 3-dimensional reconstruction ［J］. Urol, 2015, 193 (5): 1205-1212.
［16］ Ganzer R, Blana A, Gaumann A, et al. Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry ［J］. Eur Urol, 2008, 54(2): 353-360

［17］ Pisipati S, Ali A, Mandalapu RS, et al. Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy ［J］. Indian J Urol, 2014, 30(4):399-409.

［18］ Lee SB, Hong SK, Choe G, et al. Periprostatic distribution of nerves in specimens from non-nerve-sparing radical retropubic prostatectomy ［J］. Urology, 2008, 72(4): 878-881.

［19］ George M, Prasad RB, Olayinka G, et al. The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting-a prospective observational comparative study ［J］. BJU Int,2018,121(6):854-862.
［20］ Costello AJ, Dowdle BW, Namdarian B, et al. Immunohistochemical study of the cavernous nerves in the periprostatic region ［J］. BJU Int, 2011, 107(8): 1210-1215
［21］ Kiyoshima K, Yokomizo A, Yoshida T, et al. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens ［J］. Jpn J Clin Oncol, 2004, 34(8): 463-468.