Lu Sheng, Xu Yong-qing, Chang Shan, Zhang Yuan-zhi, Shi Ji-hong, Ding Zi-hai, Li Zhong-hua, Zhong Shi-zhen
Department of Orthopedics, Kunming General Hospital, Chengdu Military Region, PLA, Kunming, China.
Surg Radiol Anat. 2009 Jul;31(6):425-30. doi: 10.1007/s00276-009-0461-7. Epub 2009 Feb 4.
Male genital dysfunction was recognized as a complication following anterior approach lumbar surgery. Disruption of efferent sympathetic pathways such as the abdominal aortic plexus (AAP) and superior hypogastric plexus (SHP) which lied pre-abdominal aorta and iliac artery had been thought as the main reason. Though there were some clinical reports of retrograde ejaculation, the applied anatomic study of the autonomic nerve anterior to the lumbar was little. The purpose was to find out a lumbar surgery approach which was ejaculation preservation through the detailed study of the anatomy and histology observation of the autonomic nerve anterior to the lumbar vertebrae.
The lumbar region of ten male cadavers was dissected and analyzed. We investigated the relationship between the peritoneum and abdominal aorta, iliac artery and sacral promontory fascia, as well as the trend and distribution of the autonomic nerve and SHP anterior to the L5-S1. We also observed the distribution of autonomic nerve at retroperitoneum through hematoxylin and eosin (HE)-stained tissues pre-aorta, para-aorta, and pre-vertebrae sacrales.
Superior hypogastric plexus, which deviated to left, located in a triangle formed by the common iliac arteries and its bilateral branches, its truck sited anterior to the lumbarsacral space in seven cases (70%), and anterior to sacrum in three cases (30%); at the aortic bifurcation, SHP strided over left iliac artery from left-hand side, then located in front of sacrum in four cases (40%), and sifted to the left at the lumbar sacral promontory in six cases (60%); from both anatomic and histological view, the autonomic nerve plexus lying in an fascia layer of retroperitoneum.
At the anterior approach lumbar surgery of trans-peritoneum, we should choose the right-hand side incision; the SHP should be pushed aside carefully from right to left along intervertebral disc. The accurate surgical plane was at the deeper layer of autonomical nerve fascia; we also could lift the complete autonomical nerve layer which lies behind the aorta and lumbar sacral promontory, so that the autonomic nerve could be preserved.
男性生殖功能障碍被认为是前路腰椎手术后的一种并发症。传出交感神经通路的破坏，如位于腹主动脉和髂动脉前方的腹主动脉丛（AAP）和上腹下丛（SHP），被认为是主要原因。尽管有一些逆行射精的临床报道，但对腰椎前方自主神经的应用解剖学研究较少。目的是通过对腰椎前方自主神经的解剖学和组织学观察进行详细研究，找出一种能保留射精功能的腰椎手术入路。
对10具男性尸体的腰椎区域进行解剖和分析。我们研究了腹膜与腹主动脉、髂动脉和骶岬筋膜之间的关系，以及L5 - S1前方自主神经和SHP的走行及分布。我们还通过苏木精-伊红（HE）染色观察了主动脉前、主动脉旁和骶前椎骨处后腹膜组织中自主神经的分布。
上腹下丛向左偏移，位于由髂总动脉及其双侧分支形成的三角形内，其主干在7例（70%）位于腰骶间隙前方，3例（30%）位于骶骨前方；在主动脉分叉处，SHP从左侧跨过左髂动脉，然后4例（40%）位于骶骨前方，6例（60%）在腰骶岬处向左移位；从解剖学和组织学角度看，自主神经丛位于后腹膜的筋膜层内。
在经腹前路腰椎手术中，应选择右侧切口；应沿椎间盘从右向左小心推开SHP。准确的手术平面位于自主神经筋膜的深层；我们也可以提起位于主动脉和腰骶岬后方的完整自主神经层，从而保留自主神经。
