Anatomical studies of the human clitoris
Anatomical studies of the human clitoris
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DOI：
10.1016/s0022-5347(01)68052-2
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发表时间：
1999-09-01
影响因子：
6.6
通讯作者：
Cunha, GR
中科院分区：
文献类型：
--
作者：
Baskin, LS;Erol, A;Cunha, GR
目的：妊娠期胎儿暴露于内源性或外源性睾酮可导致外生殖器男性化。手术矫正需要对正常女性解剖结构有清楚的了解。我们报告的意见，从我们的解剖解剖上，我们的基础上，我们的做法，以减少clitoroplasty.Materials和方法：共14个正常人胎儿阴蒂标本在8至24周的妊娠福尔马林固定后连续切片。每10个切片用Masson三色、平滑肌α-肌动蛋白和神经元标记物PGP 9.5或S-100染色。使用成像软件的计算机重建允许对神经、皮质体和阴蒂头进行三维分析。结果：正常胎儿阴蒂由两个皮质体和一个中线隔组成。雌虫皮质体的超微结构与雄虫相似。阴蒂头在变窄的皮质体的远端顶端形成一个帽。有一个中线隔膜开始于腹侧，大约延伸到龟头的一半。大束神经沿着皮质体走行，在背侧或顶部密度最高。在12点钟位置没有发现神经，尽管神经以类似于胎儿阴茎的方式完全围绕图尼卡延伸。阴茎头的神经支配是由多个穿支进入皮质体和阴茎头的背侧连接处提供的。龟头中的神经密度最低的是在与龟头隔膜并列的腹侧。在手术标本中获得的先天性肾上腺皮质增生症患者的神经邻近切除的图尼卡的correctorbodies，特别是在外侧aspects.Conclusions：一个清晰的了解人体阴蒂的解剖手术重建是很重要的。与人类阴茎一样，阴蒂中的神经在皮质体的图尼卡周围形成广泛的网络，在中线12点钟位置处有一个无神经区。应注意保护所有神经。阴蒂头的缩小不应侵犯阴蒂头背侧的广泛神经支配。正常的阴蒂有一个较小但类似于阴茎的皮质体。当考虑广泛切除时，可以考虑它们的功能。
Purpose: Endogenous or exogenous testosterone exposure to the fetus during gestation may result in masculinization of the external genitalia. Surgical correction requires a clear understanding of normal female anatomy. We report observations from our anatomical dissections on which we base our approach to reduction clitoroplasty.Materials and Methods: A total of 14 normal human fetal clitoral specimens at 8 to 24 weeks of gestation were serially sectioned after formalin fixation. Every tenth section was stained with Masson's trichrome, smooth muscle alpha-actin and the neuronal markers PGP 9.5 or S-100. Computer reconstruction using imaging software permitted 3-dimensional analysis of the nerves, corporeal bodies and glans clitoris. These specimens were compared with 2 obtained postnatally at feminizing genitoplasty.Results: The normal fetal clitoris consists of 2 corporeal bodies with a midline septum. The ultrastructure of the female corporeal bodies is similar to that of the male counterpart. The glans clitoris forms a cap on top of the distal end of the narrowed corporeal bodies. There is a midline septum starting on the ventral aspect and extending approximately halfway into the glans. Large bundles of nerves course along the corporeal bodies with the highest density on the dorsal aspect or top. No nerves were noted at the 12 o'clock position, although nerves extend completely around the tunica in a fashion similar to that of the fetal penis. Glans innervation is provided by multiple perforating branches entering at the dorsal junction of the corporeal body and glans. The lowest density of nerves in the glans is on the ventral aspect in juxtaposition to the glans septum. In surgical specimens obtained from patients with congenital adrenal hyperplasia nerves were adjacent to the excised tunica of the corporeal bodies, especially on the lateral aspect.Conclusions: A clear understanding of the anatomy of the human clitoris is important for surgical reconstruction. As in the human penis, nerves in the clitoris form an extensive network around the tunica of the corporeal body with a nerve-free zone at the midline 12 o'clock position. Care should be taken to preserve all nerves. Reduction of the glans clitoris should not violate the extensive innervation that predominates on the dorsal aspect of the glans. The normal clitoris has corporeal bodies that are smaller but analogous to those of the penis. One may consider their function when extensive resection is considered.