背静脉复合体的应用解剖学研究  

Applied anatomical study of the dorsal vein complex

作　　者：刘建和[1] 李炯明[1] 赵润恒 张劲松[1] 王光[1] 郭海翔[1] 杨博伟[1] 李宇航[1] 石鑫[1] 

机构地区：[1]昆明医科大学第二附属医院泌尿外科,650101

出　　处：《现代泌尿生殖肿瘤杂志》2016年第4期212-214,230,共4页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：云南省科技厅联合专项(2013FB162)

摘　　要：目的探讨背静脉复合体(dorsal vein complex,DVC)的解剖学形态、分支、走行、回流途径及周围组织关系,以指导膀胱癌、前列腺癌根治性切除手术中对DVC的准确处理。方法解剖6具男性成年尸体盆腔标本,记录DVC、耻骨前列腺韧带、阴茎背深静脉(deep dorsal vein,DDV)及阴部内静脉等组织结构、走行特点。结果 6具标本DVC分深、浅两层结构,浅层为前列腺浅表静脉,深层为前列腺静脉丛。前列腺浅表静脉在左右耻骨前列腺韧带之间,前列腺前面为单干,在膀胱颈处形成分支;前列腺静脉丛在前列腺筋膜深面局限于两耻骨前列腺韧带之间,平均宽度20.52mm。DVC远端与阴部内静脉、DDV及闭孔静脉存在多种形式的广泛交通,近端则分别进入两侧膀胱前列腺静脉丛,可通过阴部内静脉、闭孔静脉及膀胱前列腺静脉丛回流入髂内静脉。结论 DVC局限于前列腺前面两耻骨前列腺韧带之间。耻骨前列腺韧带前列腺附着部可作为确定DVC位置及范围的解剖标志,在耻骨前列腺韧带外侧游离前列腺可有效避免DVC损伤。DVC与阴部内静脉、DDV、膀胱前列腺静脉丛及闭孔静脉存在广泛交通。在前列腺尖部贯穿左右耻骨前列腺韧带外侧缝扎才能将DVC主干完全阻断,有效减少出血。Objective To guide proper dorsal vein complex（DVC）manipulation during radical cystectomy for bladder cancer and prostatectomy,we investigate anatomic morphology,branches,courses,reflux pathways as well as relationship with peripheral tissues of DVC. Methods Pelvic specimens from 6adult male corpses were anatomized to record histologies and course features of DVC,puboprostatic ligaments,deep dorsal vein（DDV）of penis and internal pudendal vein,etc.Results In all the 6specimens,DVC was a two-tier structure which includes the superficial layer which had prostatic superficial vein and the deep layer,which was named the prostatic venous plexus.The prostatic superficial vein between bilateral puboprostatic ligaments was a single trunk,and then it branched at urinary bladder neck.Meanwhile,the prostatic venous plexus at deep prostatic fascia was confined between bilateral puboprostatic ligaments,with a mean width of 20.52 mm.Distal DVC had extensive and various communications with internal pudendal vein,DDV and obturator vein,while the proximal DVC entered the bilateral vesicoprostatic venous plexus,which refluxed into the internal iliac vein through internal pudendal vein,obturator vein and vesicoprostatic venous plexus.Conclusions DVC is confined between bilateral puboprostatic ligaments in front of the prostate.Prostate adherent part of puboprostatic ligaments can be considered an anatomic marker for determining location and scope of DVC.Dissecting prostate from the lateral puboprostatic ligaments can effectively prevent DVC injury.DVC has extensive communication with internal pudendal vein,DDV,vesicoprostatic venous plexus and obturator vein.Suturing lateral puboprostatic ligaments at bothsides through the prostatic apex can completely block the DVC trunk and effectively reduce bleeding.

关 键 词：解剖 背静脉复合体 前列腺静脉丛 

分 类 号：R322.6[医药卫生—人体解剖和组织胚胎学] R737[医药卫生—基础医学]