前列腺周围神经区间量化分析与前列腺癌手术方式改良的关系

中国临床解剖学杂志 ›› 2012, Vol. 30 ›› Issue (2): 157-160.

前列腺周围神经区间量化分析与前列腺癌手术方式改良的关系

雒向宁¹, 　陈凌武 ¹,　关伟明²

中山大学附属第一医院　 1.泌尿外科,　2.病理科, 广州 510080

收稿日期:2011-08-11 出版日期:2012-03-25 发布日期:2012-04-17
通讯作者: 陈凌武，教授，主任医师，博士生导师，E-mail:chenlingwu@hotmail.com E-mail:yalxn@hotmail.com
作者简介:雒向宁（1979-），男，主治医师、讲师，在读博士，研究方向：保留勃起神经的前列腺癌根治手术改良与创新

Quantitative analysis of the periprostatic nerve distribution and the improvement of prostatectomy

LUO Xiang-ning¹, CHEN Ling-wu¹,GUAN Wei-ming²

1.Department of Urology, 2.Department of Pathology, The First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China

Received:2011-08-11 Online:2012-03-25 Published:2012-04-17

摘要/Abstract

摘要：

目的　量化分析正常前列腺包膜周围神经纤维的典型分布模式。方法取15例正常前列腺及其周围筋膜标本，每例分别切取前列腺尖部、中部与基底部层面，行HE染色，显微镜下对各层面行“12区间法”统计各区神经纤维数目及比率。结果　前列腺包膜外神经纤维大致呈对称性分布，64.4%~75.7%可计数神经纤维位于4/5与8/9区间，而24.3%~30.5%的神经则位于前列腺包膜前外侧与腹侧。结论　1/4~1/3的神经纤维分支分布于前列腺包膜的前外侧及腹侧位置，本研究结果将为保留勃起功能的前列腺癌根治术的进一步改良提供理论依据。

关键词: , 前列腺, 勃起神经, 手术

Abstract:

Objectives　To determine the typical pattern of nerve distribution along the prostatic capsule by counting in each sector.　Methods　Serial sections of 15 normal prostate specimens were investigated. A total of 90 slides taken from the apex, mid-part, and base of the prostate were analyzed under microscopy. Before microscopic observation, slides were divided into 12 sectors. Every single nerve and ganglion between the prostatic capsule and the periprostatic tissue was counted in each sector.　Results　The majority of nerves found in the sectors corresponded to the typical location of the NVB at the rectolateral sides of the prostate (4/5 or 8/9 o'clock sectors). In these two sectors, a median of 64.4~75.7% of counted nerves per slide was found. However, a signifcant amount of nerves (24.3%~30.5%) was detected above the horizontal line.　Conclusions　We conclude that 1/4-1/3 of nerves can be found along the ventral circumference of the prostatic capsule. To preserve a maximum number of nerves, we therefore recommend a modifcation of the surgical technique for nerve sparing on the ventral parts of the prostate.

Key words: Prostate, Cavernosal nerve, Surgery

中图分类号:

R697.3

雒向宁, 陈凌武, 关伟明. 前列腺周围神经区间量化分析与前列腺癌手术方式改良的关系[J]. 中国临床解剖学杂志, 2012, 30(2): 157-160.

LUO Xiang-Ning, CHEN Ling-Wu, GUAN Wei-Meng. Quantitative analysis of the periprostatic nerve distribution and the improvement of prostatectomy[J]. Chinese Journal Of Clinical Anatomy, 2012, 30(2): 157-160.

参考文献

[1] Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations
[J]. Prostate, 1983, 4(1):473-485.

[2] Zippe C, Nandipati K, Agarwal A, et al. Sexual dysfunction after pelvic surgery
[J]. Int J Impot Res, 2008, 18(1):1-18.

[3] Berryhill R Jr, Jhaveri J, Yadav R, et al. Robotic prostatectomy: a review of outcomes compared with laparoscopicand open approaches
[J]. Urology, 2008, 72(1):15-23.

[4] Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies
[J]. Eur Urol, 2009, 55(2):1037-1063.

[5] Lunacek A, Schwentner C, Fritsch H, et al. Anatomical radical retropubic prostatectomy: ‘curtain dissection’ of the neurovascular bundle
[J]. BJU Int, 2005, 95(3): 1226-1231.

[6] Montorsi F, Salonia A, Suardi N, et al. Improving the preservation of the urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy
[J]. Eur Urol, 2005, 48(2):938-945.

[7] Graefen M, Walz J, Huland H. Open retropubic nerve sparing radical- prostatectomy
[J]. Eur Urol, 2008, 49(3):38-48.

[8] 顾新伟,肖新民,丁自海,等, 前列腺周围结构的解剖组织学特征
[J]. 中国临床康复,2006, 10(36):104-106.

[9] Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves
[J]. BJU Int, 2004, 94(1):1071-1076.

[10] Noldus J, Michl U, Graefen M, et al. Patient-reported sexual function after nerve sparing radical retropubic prostatectomy
[J]. Eur Urol, 2002, 42(2):118-124.

[11] Eastham JA, Kattan MW, Rogers E, et al. Risk factors for urinary incontinence after radical prostatectomy
[J]. J Urol, 1996, 156(4):1707-1713.

[12] Takenaka A, Murakami G, Soga H, et al. Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy
[J]. J Urol, 2004, 172(2): 1032-1035.

[13] 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.

[14] Lunacek A, Schwentner C, FritschH,et al.Anatomical radical retropubic prostatectomy: ‘curtain dissection’ of the neurovascular bundle
[J]. BJU Int, 2005, 95(2): 1226-1231.

[15] Yasuhiro Kaiho, Haruo Nakagawa, Hideo Saito，et al. Nerves at the Ventral Prostatic Capsule Contribute to Erectile Function: Initial Electrophysiological Assessment in Humans
[J]. Eur Urol, 2009, 55(1):148-155.

[16] Mani Menon , Alok Shrivastava, Sanjeev Kaul, et al. Vattikuti Institute Prostatectomy: Contemporary Technique and Analysis of Results
[J]. Eur Urol, 2007, 51(2)：648-658.

[17] Mani Menon, Alok Shrivastava, Mahendra Bhandari，et al. Vattikuti Institute Prostatectomy: Technical Modifications in 2009
[J]. Eur Urol, 2009, 56(1):89-96.

[18]Anastasios D, Asimakopoulos, Filippo Annino, et al. Complete Periprostatic Anatomy Preservation During Robot-Assisted Laparoscopic Radical Prostatectomy (RALP): The New Pubovesical Complex-Sparing Technique
[J]. Eur Urol, 2010,58(2):407-417.