Cornu Jean-Nicolas, Phé Véronique, Fournier Georges, Delmas Vincent, Sèbe Philippe
Urology Department, Tenon Hospital, University Paris 6, 4 rue de la Chine, 75970, Paris Cedex 20, France.
Surg Radiol Anat. 2010 Aug;32(7):663-7. doi: 10.1007/s00276-010-0668-7. Epub 2010 Apr 29.
Nerve-sparing radical prostatectomy (NSRP) is based on anatomical considerations that are still controversial. The aim of this study is to define and describe the anatomy of the fascias surrounding the prostate in a histoembryologic model and during open and laparoscopic approaches to assess their importance in surgical practice.
An anatomical dissection of three fresh cadavers was conducted to reproduce an open approach. Complementary data under laparoscopic conditions were obtained from images captured from the video feed during a laparoscopic NSRP performed via a transperitoneal approach. A histological study of one fresh 25-week human male fetus, obtained following miscarriage, was also conducted to document the embryologic development of the identified fascias.
Three fascias surrounding the prostate can clearly be individualized both in histologic and clinical conditions. The endopelvic fascia (EF), the prostatic fascia (PF) and the Denonvilliers' fascia (DF) recover the prostate gland and structure the periprostatic environment. Neurovascular bundles are situated in a triangle formed by PF, EF and DF. Interfascial dissection (between EF and PF) allows nerve-sparing surgery.
When performing radical prostatectomy, it is mandatory to locate EF, PF and DF precisely to respect the neurovascular bundles. Nevertheless, cancer extension and anatomic variations can lead to more extensive procedures.
保留神经的根治性前列腺切除术（NSRP）基于仍存在争议的解剖学考量。本研究的目的是在组织胚胎学模型以及开放手术和腹腔镜手术入路过程中定义和描述前列腺周围筋膜的解剖结构，以评估它们在手术实践中的重要性。
对三具新鲜尸体进行解剖以重现开放手术入路。腹腔镜条件下的补充数据来自于经腹膜入路进行腹腔镜NSRP手术时视频馈送所捕获的图像。还对一例流产后获得的25周新鲜人类男性胎儿进行了组织学研究，以记录所识别筋膜的胚胎发育情况。
在组织学和临床情况下，前列腺周围的三种筋膜均可清晰区分。盆内筋膜（EF）、前列腺筋膜（PF）和狄氏筋膜（DF）包绕前列腺并构成前列腺周围环境。神经血管束位于由PF、EF和DF形成的三角形内。筋膜间分离（在EF和PF之间）可实现保留神经的手术。
进行根治性前列腺切除术时，必须精确确定EF、PF和DF的位置以保护神经血管束。然而，癌症侵犯和解剖变异可能导致更广泛的手术操作。
