球海绵体肌解剖学研究及临床应用  

Surgical anatomy and clinical application of the female bulbocavernous muscle

作　　者：边炜[1] 徐祗顺[1] 史本康[1] 傅强[1] 刘玉强[1] 

机构地区：[1]山东大学齐鲁医院泌尿外科,山东济南250012

出　　处：《中华泌尿外科杂志》2007年第9期635-637,共3页Chinese Journal of Urology

摘　　要：目的对球海绵体肌及其供应血管进行详细的解剖学研究，探讨带蒂球海绵体肌瓣在修补女性复杂尿瘘中的应用价值。方法对15例成年女性固定尸体球海绵体肌及其血管进行解剖。对球海绵体肌的形态、长度、宽度、球海绵体肌的血管供应进行解剖学描述和测量。应用带蒂球海绵体肌瓣尿瘘修补术治疗15例女性复杂尿瘘患者，平均年龄31（21-45）岁，均有手术修补史（1-3次）。结果球海绵体肌呈长带形肌瓣，长度：左侧（9．1±1．8）cm，右侧（9．0±1．9）cm；宽度：左侧（1．5±0．2）cm，右侧（1．5±0．4）cm。球海绵体肌动脉均为终末肌支，与周围没有侧支循环；血管蒂包括1-2个分支，长度（2．5±0．6）cm，于球海绵体肌下1／2外缘入肌。15例患者均治愈，术后随访6个月-10年，均无尿瘘复发，排尿功能、性功能正常。结论球海绵体肌及其血管供应的解剖学知识可以为临床应用提供依据并降低肌瓣坏死的可能性，提高手术的成功率。Objective To give an exact anatomic description of the bulbocavernous muscle and its blood supply and explore the value of a pedicled bulbocavernous muscle flap for the repair of com- plex urinary fistulas in female patients. Methods The bulbocavernous muscles with blood vessels were studied by dissecting the perineum regions of 15 perfusion-fixed female cadavers. The relative observation and measurement of the muscles and their pedicles were performed. Fifteen women with a mean age of 31 years （range 21 to 45） had failing prior attempted repairs （range 1 to 3 times）. Fistula closure was performed in all patients followed by a pedicled bulbocavernous muscles flap transposition. Results The bulbocavernous muscle was a long band of muscular tissue. The length and breadth of the muscles on left sides was （9.1±1.8）cm, （1.5±0.2）cm, respectively; on the right side they were measured as （9.0±1.9）cm, （1.5±0.4）cm, respectively. The pedicles of the muscles contained 1 to 2 branches and they were found as end muscular branches, entering the lower 1/2 lateral aspect of the muscles. The length of the pedicles was （2.5±0.6）cm. Fistula repairs with the bulbocavernous muscles flap were successful in all 15 cases. No fistula recurred. At a followup of 6 months to 10 years, no urinary incontience, urethral stricture and sexual dysfunction were found. Conclusions The knowledge of the exact anatomy of the bulbocavernous muscle and its blood supply can provide a basis prerequisite for its use as a pedicle muscle flap for the repair of female fistulas and help to minimize the risk of flap necrosis after surgical procedures.

关 键 词：球海绵体肌 外科解剖 复杂尿瘘 

分 类 号：R686[医药卫生—骨科学]