Особенности кровоснабжения предстательной железы человека (обзор литературы)

Abstract

В даній роботі було проведено огляд наукових джерел щодо кровопостачання простати залози людини. Виявлено, що наявна велика кількість даних щодо джерел кровопостачання простати, детально описані особливості топографії та архітектоніки екстраорганних джерел її кровопостачання. Наявні суперечливі дані відносно джерел утворення капсулярного артеріального сплетення залози, відсутні систематизовані дані про анастомози та їх точну локалізацію. Разом з тим, практично відсутні дані щодо ланок гемомікроциркуляторного русла та особливостях його просторової організації; В данной работе был проведен обзор научных источников о кровоснабжении простаты человека. Выявлено, что имеется большое количество данных относительно источников кровоснабжения простаты, подробно описаны особенности топографии и архитектоники экстраорганних источников ее кровоснабжения. Имеются противоречивые данные относительно источников образования капсулярного артериального сплетения железы, отсутствуют систематизированные данные об анастомозах и их точной локализации. Вместе с тем, практически отсутствуют данные о звеньях гемомикроциркуляторного русла и особенностях его пространственной организации; Fundamental and modern knowledge about the blood supply of the human’s prostate is very important not only theoretical but also for practical meaning, since this organ is the site of both open and minimally invasive surgical interventions. In addition, some morphological methods in modern modifications allow us to expand our knowledge about the blood supply of the internal organs, including the prostate. The scientific literature contains a description of the various options for blood supply to the prostate. According to them, the main sources of blood supply to the prostate are the inferior vesical arteries, the middle rectal and prostatic arteries. Additional sources of blood supply include: the internal pudendal, obturator, arteries of the vas deferens, middle rectal, superior rectal, superior vesical, middle vesical, arteries of the penis and lateral sacral arteries. The arterial approach to the gland is usually symmetrical. The places of introduction of the arteries, their further course and the direction of the branches are very volatile. In this case, from one to four trunks can approach to the gland, the branches of which follow from back to front or from top to bottom. Multiple anastomoses are observed between the primary and secondary sources of blood supply and their branches. They are usually arcuate. The most pronounced anastomoses between the branches of the inferior vesical and oburator arteries. More rarely they are detected between the inferior vesical artery and the dorsal artery of the penis. Small branches extend from the arcuate anastomoses, which penetrate into the thickness of the gland. The presence of arterial arcuate anastomoses with many branches at the junction of the bladder neck into the prostate and at the top of the gland is explained by the functional features of the muscle bundles of the prostate, which form the inner and outer sphincters of the bladder. The above arterial vessels widely anastomose in the thickness of the capsule of the prostate and form the capsular plexus, which is most pronounced on the lower-lateral surfaces of the prostate. The plexus gives rise to branches, among which many researchers distinguish capsular, radial and urethral arteries. Capsular arteries form the plexus, which is located under the capsule of the gland. Radial arteries run radially with respect to the urethra. Urethral arteries are vessels which located under the mucous membrane of the urethra. Radial vessels have a small caliber, their number is insignificant and they penetrate into the thickness of the prostate at a right angle. In the parenchyma of the gland, they give branches that are located in the stromal-muscular spaces and are called interglandular arteries. Branches of the interglandular arteries give off a lot of capillaries, which encircle the secretory complexes by a dense network, closely adjoining the epithelium of the glandular tubules. Also, a rather dense plexus of arteries is located around the prostatic part of the urethra, especially in the area of its crest. Thus, in the literature we have studied, there are many data and their interpretations regarding the sources of blood supply to the prostate, and the features of topography and architectonics of extraorgan (primary and secondary) sources of blood supply in the age aspect are described in sufficient detail. There are scattered data about the sources of formation of the capsular arterial plexus of the gland; there are no systematic data about the anastomoses and their exact localization. At the same time, there is practically no data about the links of the hemomicrocirculatory bed and the features of its spatial organization.