杭州会讲稿.pptVIP

/wikipedia/commons/1/1a/Gray828.png * 交感神经T11、12、L1、2，支配膀胱逼尿肌(放松)、尿道括约肌(收缩)，副交感神经经S2～4骶神经支配膀胱逼尿肌(收缩)、尿道括约肌(放松) 腹下神经　它的传出纤维起自脊髓胸12～腰1、2段侧柱，属于交感神经系。支配膀胱及尿道内括约肌等。能传导兴奋以增强尿道内括约肌的紧张性和减弱膀胱逼尿肌的紧张性，这与膀胱贮尿机能有关。它的传入纤维传导膀胱的痛觉。 ? 盆神经　它的传入纤维传导膀胱和尿道内括约肌的充胀感觉。它的传出纤维起自脊髓骶2～4段侧柱，属于副交感神经系，支配膀胱与尿道后括约肌。它传导的兴奋能引起逼尿肌收缩和尿道括约肌松弛，促进排尿。 ? 阴部神经　它的传入纤维传导后尿道的感觉（包括痛觉）。它的传出纤维起自脊髓骶2～4段前角细胞，为躯体神经，支配尿道外括约肌和会阴部的横纹肌，能引起尿道外括约肌的紧张性收缩。阻止膀胱排尿；排尿时，它的紧张性兴奋受抑制，从而减弱尿道外括约肌的紧张性，尿液受逼尿肌驱动，由舒张的尿道流出体外；排尿过程中,可以有意识地使它兴奋而收缩尿道外括约肌,中断排尿；排尿终止后，它又立即恢复其紧张性兴奋，以维持尿道外括约肌的紧张性收缩。 * Nerves involved in the control of urination include the hypogastric, pelvic, and pudendal (Figure 3). Voluntary micturition requires an intact spinal cord and functional pudendal nerve arising from the sacral micturition center. Since the external urinary sphincter is voluntary skeletal muscle, actions by cholinergic neurons maintain contraction (and thereby continence) during filling of the bladder. At the same time, sympathetic nervous activity via the hypogastric nerves suppresses contraction of the detrusor muscle. With further bladder stretch, afferent signals traveling over sacral pelvic nerves activate parasympathetic neurons. This activates efferent neurons to release acetylcholine at the neuromuscular junctions, producing detrusor contraction and bladder emptying. * Pudendal neuralgia (only one part of the pudendal canal syndrome) has been described as a very severe pain on one side of the perineum typically increased during sitting and reduced on a toilet seat. ????But the pain (perineodynia) produced by pudendal neuropathy can be different:????- proctalgia : repetitive acute anal pain of short duration??- bilateral pain??- light pain or itching on one side of the perineum without visible skin disease (at the beginning)??- vulvodynia??- dyspareunia??- cystalgia * TCs病理生理 囊肿与硬膜囊一般有交通孔，交通孔为瓣膜样 囊肿内脑脊液压力增高，压迫周围骶神经、骨质，严重者可引起骨质破坏 如果囊肿持续性压迫周围神经纤维，严重患者会出现感觉、运动功能障碍、甚至大小便功能异常。罕见囊肿破裂引起化学性炎症者 骶管囊肿的解剖 盆腔的神经支配 骶管囊肿致盆腔神经病理性疼痛的临床表现 TCs致阴部神经痛的治疗和预防 骶