Hsu Geng-Long, Hsieh Cheng-Hsing, Wen Hsien-Sheng, Hsu Wen-Long, Wu Chih-Hsiung, Fong Tsorng-Harn, Chen Shyh-Chyan, Tseng Guo-Fang
Microsurgical Potency Reconstruction Center, Taiwan Adventist Hospital, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China.
J Androl. 2004 May-Jun;25(3):426-31. doi: 10.1002/j.1939-4640.2004.tb02810.x.
To investigate the anatomy of the ischiocavernosus muscle, bulbospongiosus muscle, and tunica albuginea and to determine their relationships to smooth muscle, which is a key element of penile sinusoids, we performed cadaveric dissection and histologic examinations of 35 adult human male cadavers. The tunica of the corpora cavernosa is a bilayered structure that can be divided into an inner circular layer and an outer longitudinal layer. The outer longitudinal layer is an incomplete coat that is absent between the 5-o'clock and 7-o'clock positions where 2 triangular ligamentous structures form. These structures, termed the ventral thickening, are a continuation of the anterior fibers of the left and right bulbospongiosus muscles. On the dorsal aspect, between the 1-o'clock and 11-o'clock positions, is a region called the dorsal thickening, a radiating aspect of the bilateral ischiocavernosus muscles. In the corpora cavernosa, skeletal muscle contains and supports smooth muscle, which is an essential element in the sinusoids. This relationship plays an important part in the blood vessels' ability to supply the blood to meet the requirements for erection, whereas in the corpus spongiosum, skeletal muscle partially entraps the smooth muscle to allow ejaculation when erect. In the glans penis, however, the distal ligament, a continuation of the outer longitudinal layer of the tunica, is arranged centrally and acts as a trunk of the glans penis. Without this strong ligament, the glans would be too weak to bear the buckling pressure generated during coitus. A significant difference exists in the thickness of the dorsal thickening, the ventral thickening, and the distal ligament between the potent and impotent groups (P < or =.01). Together, the anatomic relationships between skeletal muscle and smooth muscle within the human penis explain many physiologic phenomena, such as erection, ejaculation, the intracavernous pressure surge during ejaculation, and the pull-back force against the glans penis during anal constriction. This improvement in the modeling of the anatomic-physiologic relationship between these structures has clinical implications for penile surgeries.
为了研究坐骨海绵体肌、球海绵体肌和白膜的解剖结构，并确定它们与平滑肌的关系（平滑肌是阴茎窦的关键组成部分），我们对35具成年男性尸体进行了尸体解剖和组织学检查。海绵体白膜是一种双层结构，可分为内层环形层和外层纵行层。外层纵行层是一层不完整的包膜，在5点和7点位置之间不存在，此处形成两个三角形韧带结构。这些结构称为腹侧增厚，是左右球海绵体肌前部纤维的延续。在背侧，1点和11点位置之间是一个称为背侧增厚的区域，是双侧坐骨海绵体肌的放射状部分。在海绵体内，骨骼肌包含并支撑平滑肌，平滑肌是窦的重要组成部分。这种关系在血管供应血液以满足勃起需求的能力中起重要作用，而在尿道海绵体中，骨骼肌部分包裹平滑肌以在勃起时允许射精。然而，在阴茎头中，远端韧带是白膜外层纵行层的延续，位于中央并充当阴茎头的主干。没有这条强韧的韧带，阴茎头将过于脆弱，无法承受性交时产生的屈曲压力。在有勃起功能和无勃起功能的两组之间，背侧增厚、腹侧增厚和远端韧带的厚度存在显著差异（P≤0.01）。总之，人类阴茎内骨骼肌和平滑肌之间的解剖关系解释了许多生理现象，如勃起、射精、射精时海绵体内压力激增以及肛门收缩时对阴茎头的回拉力。这些结构之间解剖-生理关系模型的改进对阴茎手术具有临床意义。
