Baskin L S, Erol A, Li Y W, Liu W H, Kurzrock E, Cunha G R
Department of Urology, University of California School of Medicine, San Francisco 94143-0738, USA.
J Urol. 1999 Sep;162(3 Pt 2):1015-20. doi: 10.1016/S0022-5347(01)68052-2.
Endogenous or exogenous testosterone exposure to the fetus during gestation may result in masculinization of the external genitalia. Surgical correction requires a clear understanding of normal female anatomy. We report observations from our anatomical dissections on which we base our approach to reduction clitoroplasty.
A total of 14 normal human fetal clitoral specimens at 8 to 24 weeks of gestation were serially sectioned after formalin fixation. Every tenth section was stained with Masson's trichrome, smooth muscle alpha-actin and the neuronal markers PGP 9.5 or S-100. Computer reconstruction using imaging software permitted 3-dimensional analysis of the nerves, corporeal bodies and glans clitoris. These specimens were compared with 2 obtained postnatally at feminizing genitoplasty.
The normal fetal clitoris consists of 2 corporeal bodies with a midline septum. The ultrastructure of the female corporeal bodies is similar to that of the male counterpart. The glans clitoris forms a cap on top of the distal end of the narrowed corporeal bodies. There is a midline septum starting on the ventral aspect and extending approximately halfway into the glans. Large bundles of nerves course along the corporeal bodies with the highest density on the dorsal aspect or top. No nerves were noted at the 12 o'clock position, although nerves extend completely around the tunica in a fashion similar to that of the fetal penis. Glans innervation is provided by multiple perforating branches entering at the dorsal junction of the corporeal body and glans. The lowest density of nerves in the glans is on the ventral aspect in juxtaposition to the glans septum. In surgical specimens obtained from patients with congenital adrenal hyperplasia nerves were adjacent to the excised tunica of the corporeal bodies, especially on the lateral aspect.
A clear understanding of the anatomy of the human clitoris is important for surgical reconstruction. As in the human penis, nerves in the clitoris form an extensive network around the tunica of the corporeal body with a nerve-free zone at the midline 12 o'clock position. Care should be taken to preserve all nerves. Reduction of the glans clitoris should not violate the extensive innervation that predominates on the dorsal aspect of the glans. The normal clitoris has corporeal bodies that are smaller but analogous to those of the penis. One may consider their function when extensive resection is considered.
孕期胎儿暴露于内源性或外源性睾酮可能导致外生殖器男性化。手术矫正需要清楚了解正常女性解剖结构。我们报告了我们在解剖研究中的观察结果，这些观察结果是我们进行阴蒂缩小成形术方法的基础。
共14例妊娠8至24周的正常人类胎儿阴蒂标本，经福尔马林固定后进行连续切片。每十张切片用马松三色染色法、平滑肌α-肌动蛋白以及神经元标志物PGP 9.5或S-100染色。使用成像软件进行计算机重建，以便对神经、阴蒂体和阴蒂头进行三维分析。将这些标本与2例在女性化生殖器成形术后获得的标本进行比较。
正常胎儿阴蒂由两个阴蒂体和一个中线隔膜组成。女性阴蒂体的超微结构与男性的相似。阴蒂头在变窄的阴蒂体远端顶部形成一个帽状结构。有一个中线隔膜从腹侧开始，大约延伸到阴蒂头的一半处。大量神经束沿着阴蒂体走行，在背侧或顶部密度最高。在12点位置未发现神经，尽管神经以类似于胎儿阴茎的方式完全围绕白膜延伸。阴蒂头的神经支配由多个穿支在阴蒂体和阴蒂头的背侧交界处进入提供。阴蒂头中神经密度最低的是在与阴蒂头隔膜相邻的腹侧。在从先天性肾上腺增生患者获得的手术标本中，神经与切除的阴蒂体白膜相邻，尤其是在外侧。
清楚了解人类阴蒂的解剖结构对手术重建很重要。与人类阴茎一样，阴蒂中的神经在阴蒂体白膜周围形成广泛的网络，在中线12点位置有一个无神经区。应注意保留所有神经。阴蒂头的缩小不应侵犯在阴蒂头背侧占主导的广泛神经支配。正常阴蒂的阴蒂体较小但类似于阴茎的阴蒂体。在考虑广泛切除时可以考虑它们的功能。
