大鼠腰6神经解剖学观察及盆神经节-尿道外括约肌之间神经通路研究
（中文摘要）
硕士研究生：李书强
导师：李兵副教授
脊髓及外周神经神经损伤所造成的下尿路排尿功能障碍在临床上较为常见，如截瘫患者的膀胱功能障碍，盆腔手术或创伤造成的膀胱、尿道括约肌协同功能障碍等，严重影响了患者的生活质量。尤其是晚期所引起的并发症，如泌尿系感染及肾脏功能损害等，是造成患者死亡的重要原因。为解决这一医学难题，国内外学者进行了大量的动物实验及临床研究。然而，由于下尿路的神经支配十分复杂，且先前大多实验仅仅局限于某一部位的一个或几个神经分支，对其中的神经变异情况，仍有待进一步明确。为了系统性地了解下尿路的神经分布情况，我们借助显微解剖技术对SD大鼠的下尿路主要支配神经——腰6神经（lumbar 6，L6）进行了较为详细的研究；而且，借助于神经追踪技术，我们发现尿道外括约肌在接受体神经支配的同时，也接受盆神经节节后纤维的支配，进一步完善了尿道外括约肌神经支配的构成。
在公园散步论文分为两部分：
第一部分
SD大鼠腰6神经走行及分支变异的解剖学观察
青铜器买卖合法吗
目的：明确SD大鼠腰6神经（L6）的走行路径及其分支变异情况，同时观察其在走行过程中与其他周围神经之间的相互联系，为神经泌尿学研究提供较为详细的解剖学依据。
方法：在体视显微镜下，对50只雄性SD大鼠双侧L6及其分支沿其走行路径由近及远进行解剖，观察、测量并记录神经走行路径、长度、分支数量、变异等相关数据。
结果：L6的前后根均由发自脊髓侧方的神经小束汇合而成，在硬脊膜内呈叠瓦状排列，走行长度为腰1椎体下缘至腰6椎体下缘。出椎间孔后，89%的标本中L6
与腰骶干之间发生神经联系，11%的标本中L6与腰骶干之间没有神经联系。
95%的L6接受骶1（S1）部分神经纤维加入形成L6-S1干，然后L6-S1干（或L6）发出盆神经和阴部神经，阴部神经走行一段距离后与腰骶干形成骶丛。骶丛分支较多，支配范围广泛，其中支配尿道外括约肌的运动支分支在尿道外括约肌外呈放射状排列，并从侧方进入尿道外括约肌。盆神经节接受盆神经和腹下神经支配，节后纤维支配盆腔脏器，其中膀胱支和海绵体神经较为粗大。结论：1．椎管内，L6神经前后根走行较长，活动度较大，且与其他神经根呈叠瓦状排列，易于进行再植或重建等操
台风眼作；
气功带什么武器2．椎管外，L6分支较多，部分分支较为粗大，易于神经损伤模型的建立；
3．L6分支的变异及与其他外周神经联系的变异较为明显；
4．SD大鼠是进行神经泌尿学研究的良好动物模型。
第二部分
大鼠盆神经节--尿道外括约肌神经传导通路的研究扎实
目的以显微解剖及神经追踪技术研究大鼠盆神经节(MPG)与尿道外括约肌(EUS)之间的神经传导通路。
方法正常组：体视显微镜下暴露并观察盆神经节至尿道外括约肌段，分别在大鼠膀胱逼尿肌、尿道外括约肌注入荧光金(FG）、快蓝(FB)，于盆神经节内检测阳性神经元；盆神经节内注入结合麦芽凝集素的辣根过氧化物酶(WGA-HRP)，于尿道外括约肌内检测阳性神经末梢；尿道离断组：在膀胱底和尿道外括约肌交界处切断二者联系后，重复上述正常组的后面两个步骤。
结果正常组：荧光显微镜下可见盆神经节内分布有大量金黄色及蓝色阳性神经元细胞，并有少许阳性双标神经元；普通光学显微镜下尿道外括约肌内可见大量棕黑色阳性神经末梢。尿道离断组：盆神经节内只见荧光金单标神经元而未见快蓝标记的神经元，尿道外括约肌内也未见阳性神经末梢。
结论盆神经节与尿道外括约肌之间存在神经传导通路，此通路可能对尿道外括约肌起到一定的支配作用，从而协调膀胱逼尿肌和尿道外括约肌在排尿储尿过程中的活动。
【关键词】腰6神经；神经泌尿；显微解剖；神经追踪；盆神经节；尿道外括约肌Abstract
Anatomical obrvation of Lumbar nerve 6 and identification of the neural pathway between major pelvic ganglion and external urethral
sphincter in SD rat
Lower urinary tract dysfunction caud by Spinal cord and/or peripheral nerve injury is common in clinical practice, such as bladder dysfunction in patients with paraplegia, the coordination dysfunction of bladder and urethral sphincter caud by pelvic surgery or trauma, and riously affected the patient's quality of life. The late complications, especially the urinary tract infection and renal failure, are the major cau of death of patients. To solve the medical problems, domestic and f
oreign schol ars have done a lot of animal experiments and clinical rearch. However, since the innervation of the lower urinary tract is very complex and the most previous experiments confined to one or some certain parts of one or veral nerve branches, the origination of such nerve fibers has not been very clear. In order to systematically understanding the innervation of the lower urinary tract, we have taken a more detailed study on the L6 which mainly dominated the lower urinary tract in SD rat by employing the microdisction technique; meanwhile, by means of neural tracking technology, it was found that the external urethral sphincter is not only innervated by the somatic nerves, but also by the postganglionic fibers of the major pelvic ganglion, which is also a new understanding to the traditional point of view.
The disrtation is divided into two parts:
Part Ⅰ
Anatomical obrvation of the lumbar nerve 6 from roots to terminations土豆卷
in SD rat
【关键词】腰6神经；神经泌尿；显微解剖；神经追踪；盆神经节；尿道外括约肌Abstract
羊排火锅
Anatomical obrvation of Lumbar nerve 6 and identification of the neural pathway between major pelvic ganglion and external urethral
sphincter in SD rat
Lower urinary tract dysfunction caud by Spinal cord and/or peripheral nerve injury is common in clinical practice, such as bladder dysfunction in patients with paraplegia, the coordination dysfunction of bladder and urethral sphincter caud by pelvic surgery or trauma, and riously affected the patient's quality of life. The late complications, especially the urinary tract infection and renal failure, are the major cau of death of patients. To solve the medical problems, domestic and foreign schol ars have done a lot of animal experiments and clinical rearch. However, since the innervation of the lower urinary tract is very complex and the most previous experiments confined to one or some certain parts of one or veral nerve branches, the origination of such nerve fibers has not been very clear. In order to systematically understanding the innervation of the lower urinary tract, we have taken a more detailed study on the L6 which mainly dominated the lower urinary tract in SD rat by employing the microdisction technique; meanwhile, by means of neural tracking technology, it was found that the external urethral sphincter is not only innervated by the somatic nerves, but also by the postganglionic fibers of the major pelvic ganglion, which is also a new unders
tanding to the traditional point of view.
四芯网线
The disrtation is divided into two parts:
Part Ⅰ
Anatomical obrvation of the lumbar nerve 6 from roots to terminations
in SD rat
Objective: Identifying the travelling line and the variation of the branches of the lumbar nerve 6 (L6) in SD rat , and obrving the linkages between the branches of L6 and the other peripheral nerves, to provide some information on more detailed anatomy for neurourology rearch.
Methods: Under the stereomicroscope, obrve, measure and record the ne ural pathways, length, branch numbers and variation of L6 from origination of spinal cord to terminations in 50 male SD rats .
Results: The ventral and dorsal roots of L6 were issued from the anterior horn and the dorsal horn of the spinal cord under the lower edge of L1 vertebral body, respectively, and ran within the spinal can
al clo to the ventrolateral and dorsolateral spinal dura mater to the lower edge of the L6 vertebral body with a total length of about 3.6cm, showing a imbricated arrangement from top to bottom with other nerve roots. At a distance of about 0.5cm away from the intervertebral foramen, L6 and the lumbosacral trunk travelled cloly, and there was a contact between L6 and the lumbosacral trunk in a majority of specimens(89%). In the 95 specimens, L6 accepted the joining of a branch derived from the sacral nerve 1(S1) beyond the contact between L6 and the lumbosacral trunk. After issueing the pelvic nerve, the L6-S1 trunk (or L6) was referred to as the pudendal nerve. Then the pudendal nerve connected to the lumbosacral trunk to form a bridge-like structure, called the sacral plexus. The nerve branches of the sacral plexus travelling here were highly complicated. The major pelvic ganglion(MPG) was dominated by both the pelvic nerve and the hypogastric nerve. The postganglionic nerves distributed to the urinary bladder, vas deferens, minal vesicle and cavernosum, etc..
Conclusion: 1. Inside the s pinal canal, The ventral and dorsal roots of L6 had a long walking line , a large active range, and a imbricated arrangement with other nerve roots. So, it was easy to carry out operations such as replantation or reconstruction.
2. Outside the spinal canal, there were many branches issued from L6. Since some
branches were relatively thick, it was v ery suitable for the establishment of animal
