摘要
目的通过对成年男性精道远端区域精细解剖结构的深入观察和相关生理数据的准确测量,为临床更加精确地开展精道内镜技术提供依据。方法收集35例行根治性前列腺切除(laparoscopic radical prostatectomy,LRP)及11例行全膀胱切除(laparoscopic radical cystectomy,LRC)术后完整的组织标本,对其精道远端解剖结构进行精细观察和测量,并结合患者术前MRI,对精道远端结构的MRI影像特征与实际测量结果进行对比分析;对109例前列腺增生(benign prostatic hyperplasia,BPH)患者行经尿道内镜手术前双侧精囊按摩,直视下观察射精管开口与前列腺小囊开口的解剖特征。结果 46例术后标本的精细解剖结果:精囊长度:左侧(39.7±7.4)mm,右侧(41.4±8.6)mm;宽度:左侧(16.5±3.3)mm,右侧(16.4±3.0)mm;厚度:左侧(7.8±2.4)mm,右侧(7.8±2.3)mm;射精管长度:左侧(15.0±2.5)mm,右侧(14.9±2.4)mm;内径:左侧(1.2±0.2)mm,右侧(1.1±0.2)mm。47.8%(22/46)标本可见前列腺小囊,深度(6.7±1.7)mm。MRI图像下所测精囊长度:左侧(39.4±6.6)mm,右侧(41.3±7.6)mm;宽度:左侧(17.1±3.4)mm,右侧(16.4±2.9)mm,显示与实体标本测量数据高度吻合。内镜下观察显示:78.9%(86/109)显示前列腺小囊开口于精阜隆起部,21.1%(23/109)未发现明确前列腺小囊开口,射精管通常开口于前列腺小囊开口两侧旁约2 mm处,与其构成三角形或直线排列关系。结论本研究获得的精道远端区域的解剖数据对临床开展相关内镜技术具有重要指导意义,MRI对该区域具有良好分辨价值。
Objective To obtain important chnical data for the transurethral endoscopic operation to the seminal tract by accurately measuring the physiological data on the distal regions of adult male genital tract. Methods All the intact postoperative histological specimens from 35 cases of prostate cancer （Pea） treated by laparoscopic radical prostatectomy （LRP） and 11 cases of bladder cancer （Boa） treated by laparoseopie radical cystectomy （LRC） were collected for accurate observation and precise measurement for its fine structure. A comparative analysis was performed to the results of their preoperative pelvic magnetic resonance imaging （MRI） with the anatomic data from postoperative histological specimens. The morphological characteristics of prostatic utricle, and the relationship with the bilateral ejaculatory duct orifice were observed by transurethral endoscopy on 109 patients with benign prostatic hyperplasia who were treated by transurethral resection of prostate. Results The anatomic data on the postoperative specimens showed that the lengths of seminal vesicles （SVs） were 39.7 ± 7.4 mm for the left, and 41.4 ± 8.6 mm for the right side, the widths were 16.5 ± 3.3 mm for the left and 16.4± 3.0 mm for the right side, and the thickness were 7.8± 2. 4 mm for the left and 7.8 ± 2.3 mm for the right side. The lengths of ejaculation ducts were 15.0 ±2.5 mmfor the left and 14.9 ±2.4 mm for right side, the diameters were 1.2 ±0.2 mm for the left and 1.1±0.2 mm for the right side. The prostatic utricle was observed in 47.8% （22/46） cases with the depth of （6.7 ± 1.7） mm. Measurement of SV on MR images showed that their lengths were 39.4 ±6.6 and 41.3 ±7.6 mm respectively for the left and right sides, and their widths were 17.1 ± 3.4 and 16.4 ± 2.9 mm respectively. The data of SYS sizes were highly consistent between the results from preoperative MR images and postoperative specimens. Endoscopic observation showed that 78.9% （86/109） cases had obvious prostate utricle openings located at the top of the verumontanum, and the other cases （21. 1%, 23/109） had no obvious openings. The ejaculatory duct orifices were commonly located at bilateral sides in about 2 mm away from the prostatic utricle openings, and they formed a triangular or linear arrangement. Conclusion Our obtained data on the anatomical structure of male distal genital tract are of important guiding significance for endoscopic techniques in clinical practice. MR imaging shows better distinguishing value for this region.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2015年第23期2373-2377,共5页
Journal of Third Military Medical University
基金
大坪医院全军计划生育优生优育中心人精子蛋白与男性不育关系研究课题资助(505-1539)~~
关键词
精囊
射精管
前列腺小囊
解剖
MRI影像
seminal vesicle
ejaculatory duct
prostatic utricle
anatomy
MR image
