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[尿道横纹括约肌。1:尿道横纹括约肌知识回顾]

[The striated sphincter of the urethra. 1: Recall of knowledge on the striated sphincter of the urethra].

作者信息

de Leval J, Chantraine A, Penders L

出版信息

J Urol (Paris). 1984;90(7):439-54.

PMID:6543371
Abstract

The first part of this report is devoted to the anatomy, nerve supply, and physiology of the striated sphincter, three subjects which greatly aroused a great deal of controversies. The conclusions of the authors are as follows. The striated sphincter of the urethra is a muscle of the perineum, arising from the cloacal sphincter. The deep transverse, bulbo-cavernous, anal sphincter, ischio-cavernous and superficial transverse muscles have the same embryological origin and together with the sphincter of the urethra form the accessory pelvic diaphragm. The embryological origin of the levator ani muscles is different. These arise from the caudal muscles and form the principal pelvic diaphragm. The striated sphincter of the urethra is unequally distributed in the male and female fetus. According to our anatomical concept, the urethral sphincter includes two structures: the para-urethral sphincter and the peri-urethral sphincter. The para-urethral sphincter form an integral part of the urethra and is distributed principally along the membranous part of urethra but extends approximately to the bladder neck and distally under the perineum aponeurosis. In the adult as in the fetus, the para-urethral striated sphincter is unequally distributed along the urethra, according to sex. In the male, it surrounds the membranous urethra and is absent from the posterior face of the prostatic urethra. By contrast, in the female, the sphincter surrounds the proximal third of the urethra and the rings are incomplete on the distal third. The peri-urethral striated sphincter includes the other muscles of the perineum and of the principal pelvic diaphragm. These two structures differ from a microscopic stand point; the para-urethral striated sphincter contains only narrow calibre slow fibers, with the absence of the neuro-muscular spindles. By contrast, the peri-urethral sphincter consists of slow and rapid fibers and contains neuro-muscular spindles. The nerve supply of the peri-urethral striated sphincter is insured by internal pudendal nerves. The para-urethral striated sphincter is supplied in great part of the same internal pudendal nerves arising from neurones situated in the nucleus of Onuf. However, the pelvic nerves may contain a group of accessory fibers from the same origin. There is no proof available as to the role played by the sympathetic nervous system. When micturition comes to an end, the para-urethral sphincter causes a constriction of the membranous urethra in the male, and single flattening of the middle part of the urethra in the female.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

本报告的第一部分致力于探讨横纹括约肌的解剖结构、神经支配及生理学,这三个主题引发了大量争议。作者的结论如下:尿道横纹括约肌是会阴肌,起源于泄殖腔括约肌。深层横肌、球海绵体肌、肛门括约肌、坐骨海绵体肌及浅层横肌具有相同的胚胎学起源,与尿道括约肌共同构成盆膈下筋膜。肛提肌的胚胎学起源不同,它起源于尾侧肌,形成盆膈。尿道横纹括约肌在男性和女性胎儿中的分布不均。根据我们的解剖学概念,尿道括约肌包括两个结构:尿道旁括约肌和尿道周括约肌。尿道旁括约肌是尿道的一个组成部分,主要分布在尿道膜部,向上延伸至膀胱颈,向下延伸至会阴浅筋膜下方。在成人和胎儿中,尿道旁横纹括约肌在尿道上的分布因性别而异。在男性,它环绕膜部尿道,前列腺尿道后壁没有该括约肌。相比之下,在女性,括约肌环绕尿道近端三分之一,远端三分之一处的肌环不完整。尿道周横纹括约肌包括会阴和盆膈的其他肌肉。这两个结构在微观层面存在差异:尿道旁横纹括约肌仅包含窄口径的慢肌纤维,且没有神经肌梭。相比之下,尿道周括约肌由慢肌纤维和快肌纤维组成,并含有神经肌梭。尿道周横纹括约肌由阴部内神经提供神经支配。尿道旁横纹括约肌大部分由起源于Onuf核神经元的相同阴部内神经支配。然而,盆神经可能包含一组相同起源的副纤维。目前尚无证据表明交感神经系统发挥了何种作用。排尿结束时,尿道旁括约肌会导致男性膜部尿道收缩,女性尿道中部变平。(摘要截选至400词)

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