Muro Satoru, Tsukada Yuichiro, Harada Masayo, Ito Masaaki, Akita Keiichi
Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan.
Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, 277-8577, Japan.
Clin Anat. 2018 Nov;31(8):1167-1176. doi: 10.1002/ca.23254. Epub 2018 Oct 20.
The anatomy of the rectourethralis muscle is essential for performing radical prostatectomy and proctectomy. The rectourethralis muscle is known to continue to the rectal wall posteriorly and to the membranous urethra anteriorly. However, the lateral extent of the rectourethralis muscle remains unclear. This study aimed to verify the hypothesis that the rectourethralis muscle laterally extends and directly adheres to the levator ani. Eight male cadavers were used for macroscopic dissection, and three male cadavers were used for immunohistological analysis using anti-smooth muscle and anti-skeletal muscle antibodies. The rectourethralis muscle laterally extended smooth muscle fibers both superoposteriorly and inferoanteriorly toward the levator ani. The smooth muscle fibers sandwiched the levator ani superoanteriorly and inferoanteriorly. A few smooth muscle fibers of the rectourethralis muscle inserted into the levator ani. This study clarified the spatial distribution of the rectourethralis muscle and its detailed positional relationship with the levator ani. The findings are valuable especially to urologists and anorectal surgeons for dissecting an optimal layer around the urethra and the rectum, and for avoiding rectal or urethral injuries during surgery. Clin. Anat. 31:1167-1176, 2018. © 2018 Wiley Periodicals, Inc.
直肠尿道肌的解剖结构对于实施根治性前列腺切除术和直肠切除术至关重要。已知直肠尿道肌向后延续至直肠壁，向前延续至膜性尿道。然而，直肠尿道肌的外侧范围仍不明确。本研究旨在验证直肠尿道肌向外侧延伸并直接附着于肛提肌的假说。使用八具男性尸体进行宏观解剖，并使用抗平滑肌和抗骨骼肌抗体对三具男性尸体进行免疫组织学分析。直肠尿道肌的平滑肌纤维向外侧超后上方和下前方向延伸至肛提肌。平滑肌纤维在上前方向和下前方向夹着肛提肌。直肠尿道肌的一些平滑肌纤维插入肛提肌。本研究阐明了直肠尿道肌的空间分布及其与肛提肌的详细位置关系。这些发现对于泌尿外科医生和肛肠外科医生在尿道和直肠周围解剖最佳层面以及避免手术期间直肠或尿道损伤尤其有价值。临床解剖学。2018年第31卷：1167 - 1176页。©2018威利期刊公司。
