Long Liu Yan, Qiang Pan Fu, Ling Tao, Wei Zhang Yan, Long Zhang Yu, Shan Meng, Rong Li Shi, Li Li Hong
Department of Plastic and Cosmetic Surgery, Chongqing Southwest Hospital, Third Millitary Medical University, Chongqing, China.
Department of Radiology, Chongqing Southwest Hospital, Third Millitary Medical University, Chongqing, China.
Anat Rec (Hoboken). 2015 Aug;298(8):1465-71. doi: 10.1002/ar.23094. Epub 2014 Dec 5.
The present study was to examine the distribution of lymphatic vessels in the penis of normal adult males, which could provide an anatomical basis for improvement of incisions in penile lengthening surgery, and may also help to prevent postoperative refractory edema. Thirteen normal adult male volunteers were recruited for this study. Contrast agent was injected subcutaneously in the foreskin of the penis, and after two minutes magnetic resonance lymphangiography (MRL) was performed. The acquired magnetic resonance images were analyzed to determine the changes in the number and diameter of lymphatic vessels in different parts of the penis. Maximum intensity projections (MIP) and materializes interactive medical image control system (MIMICS) were applied to analyze the overall distribution of lymphatic vessels in the penis. Magnetic resonance imaging (MRI) showed that the lymphatic vessels were in conspicuous contrast with surrounding tissues and could be clearly identified. Penile lymphatic vessels were clearly visible in the root of the penis. At the junction of the penis and the abdominal wall, all lymphatic vessels were found to be concentrated in the dorsal part of the penis. MIP two-dimensional reconstruction showed that the overall distribution of relatively large lymphatic vessels in the dorsal and ventral parts of the penis could be seen clearly on bilateral 45° position, but not inside the abdominal wall because some of lymphatic vessels were overlapped by other tissues in the abdomen. MIMICS three-dimensional reconstruction was able to reveal the overall spatial distribution of lymphatic vessels in the penis from any angle. The reconstruction results showed that there were 1-2 main lymphatic vessels on the root of dorsal penis, which coursed along the cavernous to the first physiological curvature of the penis. Lymphatic vessels merged on both sides of the ventral penis. At the root of the penis, lymphatic vessels gradually coursed to the dorsal surface of the penis and folded at the abdominal wall to the outside, and finally merged into the inguinal lymph nodes. The changes in distribution, number and diameter of the lymphatic vessels in the penis were observed by MRI. MIP and MIMICS reconstructions directly revealed the anatomical features of penile lymphatic vessels such as spatial distribution, overall alignment, and the relations to adjacent structures, drainage and reflux. The study will provide the anatomical basis for penile surgery, penile lymphatic reflux disorders caused by trauma or lymphatic vessels obstruction, and lymph node metastasis in penile cancer.
本研究旨在观察正常成年男性阴茎淋巴管的分布情况，为改进阴茎延长手术切口提供解剖学依据，也有助于预防术后顽固性水肿。本研究招募了13名正常成年男性志愿者。在阴茎包皮下皮下注射造影剂，两分钟后进行磁共振淋巴管造影（MRL）。对获取的磁共振图像进行分析，以确定阴茎不同部位淋巴管数量和直径的变化。应用最大强度投影（MIP）和医学图像处理系统（MIMICS）分析阴茎淋巴管的整体分布。磁共振成像（MRI）显示，淋巴管与周围组织形成明显对比，可清晰识别。阴茎根部的淋巴管清晰可见。在阴茎与腹壁交界处，所有淋巴管均集中于阴茎背侧。MIP二维重建显示，在双侧45°位置可清晰看到阴茎背侧和腹侧相对较大淋巴管的整体分布，但在腹壁内看不到，因为腹部一些淋巴管被其他组织重叠。MIMICS三维重建能够从任何角度揭示阴茎淋巴管的整体空间分布。重建结果显示，阴茎背侧根部有1-2条主要淋巴管，沿海绵体走向阴茎的第一个生理弯曲。淋巴管在阴茎腹侧两侧汇合。在阴茎根部，淋巴管逐渐走向阴茎背侧表面，并在腹壁处向外折叠，最终汇入腹股沟淋巴结。通过MRI观察阴茎淋巴管分布、数量和直径的变化。MIP和MIMICS重建直接揭示了阴茎淋巴管的解剖特征，如空间分布、整体排列以及与相邻结构、引流和反流的关系。本研究将为阴茎手术、创伤或淋巴管阻塞引起的阴茎淋巴回流障碍以及阴茎癌的淋巴结转移提供解剖学依据。
