Variation in course of cavernous nerve with special reference to details of topographic relationships near prostatic apex: Histologic study using male cadavers
Variation in course of cavernous nerve with special reference to details of topographic relationships near prostatic apex: Histologic study using male cadavers
复制标题
DOI：
10.1016/j.urology.2004.08.028
复制
发表时间：
2005-01-01
期刊：
影响因子：
2.1
通讯作者：
Fujisawa, M
中科院分区：
文献类型：
--
作者：
Takenaka, A;Murakami, G;Fujisawa, M
目标。研究横纹括约肌及前列腺尖部附近海绵状神经走行的个体间变异，为完善保留神经的根治性前列腺切除术提供依据。海绵状神经的不同解剖结构可能解释了保留神经的根治性前列腺切除术后不同的效力率。我们检查了20个男性骨盆的连续组织学切片（7个正面切片，8个矢状切片和5个轴状切片），并进行了5次新鲜尸体解剖。在新鲜的解剖中，宏观识别的神经血管束一致显示沿尿道近端到远端几乎是笔直的。然而，在组织学分析中，神经路线的类型被划分为额（7个标本中的2个），矢状（8个标本中的3个）和轴向。（2 / 5）。在额部和矢状部，神经穿过横纹肌和提肛肌之间狭窄电位间隙的结缔组织。在显示轴向的标本中，神经在空间上与前列腺不同，在直肠旁间隙中向腹内行。因此，神经可以表现出一种长而曲折的路线，在其最厚的部分穿过直尿道肌肉。此外，支配横纹肌括约肌区域的神经成分似乎伴随海绵状神经。神经血管束，以前在外科方面的定义，可能与海绵神经的实际路线不同，当它是轴向的，穿过直肠旁间隙和直肠尿道肌。为了避免海绵状神经损伤，必须在耻骨后入路和会阴入路小心处理直喉肌。(C) 2005爱思唯尔公司
Objectives. To study interindividual variation in the cavernous nerve course near the rhabdosphincter and the apex of the prostate as a basis for refining nerve-sparing radical prostatectomy. The varying anatomy of the cavernous nerve might account for the disparate potency rates after nerve-sparing radical prostatectomy.Methods. We examined serial histologic sections from 20 male pelves (7 frontal, 8 sagittal, and 5 axial sections) and performed 5 fresh cadaver dissections.Results. In the fresh dissections, the macroscopically identified neurovascular bundle consistently showed an almost straight proximal-to-distal course along the urethra. However, on histologic analysis, the types of the nerve course were classified as frontal (2 of 7 specimens), sagittal (3 of 8), and axial.(2 of 5). In the frontal and sagittal courses, the nerves passed through the connective tissue of a narrow potential space between the rhabdosphincter and the levator ani. In the specimens showing an axial course, the nerves were spatially distinct from the prostate, coursing ventromedially in the pararectal space. Thus, the nerves could display a long, tortuous course, passing through the rectourethral muscle at its thickest portion. In addition, a nerve component supplying the area of the rhabdosphincter seemed to accompany the cavernous nerve.Conclusions. The neurovascular bundle, previously defined in terms of surgery, is likely to differ from the actual course of the cavernous nerve when this is axial, passing through the pararectal space and rectourethral muscle. To avoid cavernous nerve injury, the rectourethral muscle must be managed carefully in both the retropubic and the perineal approaches. (C) 2005 Elsevier Inc.