Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
J Urol. 2016 Jun;195(6):1841-7. doi: 10.1016/j.juro.2015.11.041. Epub 2015 Nov 26.
An understanding of the microsurgical anatomy of the spermatic cord and spermatic fascia is important for surgeons during microsurgical varicocelectomy and denervation. We examined the distribution of the lymphatics, and the sensory and autonomic nerves of the spermatic cord.
We collected spermatic cords from 11 men undergoing orchiectomy for localized testicular tumors and we biopsied a third of the spermatic fascia from 36 men undergoing microsurgical varicocelectomy. Immunohistochemical staining of the pan-neuronal marker PGP 9.5 (protein gene product 9.5), the sensory nociceptor marker CPRP (calcitonin gene-related peptide), the sympathetic marker TH (tyrosine hydroxylase), the parasympathetic marker VIP (vasoactive intestinal polypeptide) and the lymphatic marker D2-40 was performed. We counted the number of nerves and lymphatics.
PGP 9.5 staining revealed dense nerve distributions in the spermatic cord and fascia. Sensory and autonomic nerve fibers were basically co-localized in the same nerve. Of the nerves 50% were identified near the vas deferens and 20% were identified in the spermatic fascia. Sensory and sympathetic nerve fibers represented most of the nerves but a few parasympathetic nerve fibers were observed. Of the lymphatics 36 per patient were identified in the spermatic cord but only a few were identified in the spermatic fascia.
Sensory and sympathetic nerves accounted for the majority of the nerves. Although the functional aspects of the nerves remain undetermined, information on the distribution of nerves and lymphatics is useful when dealing with nerves and preserving lymphatics during microsurgical varicocelectomy or denervation.
了解精索和精索筋膜的显微解剖结构，对于精索静脉曲张显微结扎术和去神经术的外科医生非常重要。我们检查了淋巴管、感觉和自主神经的分布。
我们从 11 名因局部睾丸肿瘤而接受睾丸切除术的男性中收集精索，并从 36 名接受精索静脉曲张显微结扎术的男性中活检精索筋膜的三分之一。对泛神经元标志物 PGP 9.5（蛋白基因产物 9.5）、感觉伤害感受器标志物 CPRP（降钙素基因相关肽）、交感神经标志物 TH（酪氨酸羟化酶）、副交感神经标志物 VIP（血管活性肠肽）和淋巴管标志物 D2-40 进行免疫组织化学染色。我们计算了神经和淋巴管的数量。
PGP 9.5 染色显示精索和筋膜中有密集的神经分布。感觉和自主神经纤维基本上在同一神经中存在共定位。在神经中，有 50%位于输精管附近，20%位于精索筋膜中。感觉和交感神经纤维占大多数神经，但也观察到少数副交感神经纤维。在精索中，每个患者有 36 个淋巴管，而在精索筋膜中只发现了少数淋巴管。
感觉和交感神经纤维占大多数神经。尽管神经的功能方面仍不确定，但在进行精索静脉曲张显微结扎术或去神经术时，有关神经和淋巴管分布的信息对于处理神经和保留淋巴管非常有用。
