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目的:了解男性盆丛神经(IHP)及其分支的局部解剖特点,减少膀胱前列腺根治性切除术中对IHP的医源性损伤。方法:通过解剖12具成年男性尸体骨盆标本,了解IHP及其分支的分布特点。结果:IHP位于腹膜后精囊腺的后外侧,是均一排列的矩形神经丛;IHP纤维分为上、中、下支,上支支配膀胱,中支支配前列腺和精囊,下支纤维支配直肠下部;精囊腺的各面均有IHP纤维支配,以后外侧面为主。IHP的纤维位于膀胱颈的侧面,支配膀胱的侧后壁,膀胱的前表面没有神经支配;IHP与血管形成VAN结构,静脉位于最侧面。海绵体神经起源于IHP的前下方,于前列腺的后外侧形成宽约6mm的神经血管束,在血管的外侧向前下方走行。结论:精囊可作为术中重要的解剖标志,沿精囊和IHP之间的解剖平面分离,可避免对IHP的损伤;紧靠前列腺被膜向下分离至前列腺尖部,并充分显露尿道,可有效地保护海绵体神经血管束。
OBJECTIVE: To understand the local anatomical characteristics of male pelvic plexus (IHP) and its branches and to reduce iatrogenic injury to IHP in radical prostatectomy. Methods: The distribution characteristics of IHP and its branches were studied by dissecting the pelvis from 12 adult male cadaver. IHP was located in the posterolateral of the retroperitoneal seminal vesicle, which was a uniform arrangement of rectangular plexus. IHP fibers were divided into upper, middle and lower branches, the superior branch supporting the bladder, the middle branch supporting the prostate and the seminal vesicle, the lower branch supporting the lower part of the rectum; Seminal vesicle of the face IHP fibers are dominated, after the lateral surface-based. The IHP fibers are located on the side of the bladder neck, dominate the posterior wall of the bladder, and have no innervation of the anterior surface of the bladder; IHP forms a VAN structure with the blood vessels, with the veins on the flanks. The cavernous nerve originates in the anterior and inferior part of the IHP and forms a 6mm wide neurovascular bundle on the posterolateral side of the prostate gland and runs forward and downward on the outside of the blood vessel. Conclusion: Seminal vesicles can be used as important intraoperative anatomic landmarks, separated along the anatomic plane between the seminal vesicle and the IHP, to avoid IHP damage; the immediate separation of the prostate capsule from the prostatic apex and the full revealing of the urethra can be effective Protect the cavernous nerve vascular bundle.