修改后盆部解剖

December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,盆 部,内容：一、盆壁二、盆部的血管、神经三、盆腔脏器,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第一节 概述,盆部(pelvis)以骨盆作为支架，由覆盖于其内的盆壁肌、盆底肌及其筋膜共同围成盆腔和盆腔内的脏器所组成。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,境界与分区,前界耻骨联合上缘、耻骨嵴、耻骨结节、腹股沟韧带、髂嵴前份连线于腹部分界。后界髂嵴后份和髂后上棘至尾骨尖的连线与腰区和骶区分界。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,两侧髂嵴最高点连线平第4腰椎棘突，不仅可作为腰穿定位的标志，还可作为计数腰椎的标志。两髂后上棘连线平对第2骶椎中部，为蛛网膜下隙下端平面的标志。,表面解剖,髂嵴、髂前上棘 、髂后上棘 耻骨联合上缘、耻骨嵴、耻骨结节、 耻骨弓 、 坐骨结节和尾骨尖。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,界线：骶骨岬向两侧经弓状线、耻骨梳、耻骨结节至耻骨联合上缘,骨盆构成：左右髋骨、骶、尾骨、其间的骨连结。分部：大骨盆 、小骨盆 小骨盆构成上口界线 骨盆下口尾骨尖、骶结节韧带、坐骨结节、坐骨支、耻骨下支和耻骨联合下缘。,第二节 盆 部 Pelvis,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,骶髂关节 髋骨与脊柱间的韧带连结 髂腰韧带 骶结节韧带 骶棘韧带,耻骨联合髋骨的固有韧带闭孔膜骨盆,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,二、盆壁肌,。,梨状肌 闭孔内肌 肛提肌腱弓,耻骨联合后面至坐骨棘间连线的筋膜增厚形成为肛提肌及盆膈上下筋膜的附着处,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,肛提肌 Levator ani 前列腺提肌 (耻骨阴道肌) 耻骨直肠肌 耻尾肌 髂尾肌 尾骨肌 Coccygeus,三、盆底肌 Muscles of floor of pelvis,耻骨直肠肌在直肠与肛管移行处，两侧肌束构成“U”形袢，是肛直肠环的主要组成部分。施行肛瘘的手术时，如切断肛直肠环可导致大便失禁。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,组成：盆膈上筋膜 肛提肌、尾骨肌 盆膈下筋膜作用：封闭盆底，对盆腔 脏器起衬托。通过结构：盆膈前份有盆膈裂孔，在男性孔内有尿道通过；在女性则有尿道和阴道通过。盆膈后部有肛管通过。,盆膈pelvic diaphragm：,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,四 、盆筋膜 Pelvic fascia,盆壁筋膜 Parietal pelvic fascia 骶前筋膜 梨状肌筋膜 闭孔筋膜 盆膈上筋膜 盆膈下筋膜,骶前筋膜与骶骨之间含有丰富的静脉丛，直肠切除时，应在直肠筋膜鞘与骶前筋膜之间进行，而不应将骶前筋膜从骶骨前面剥离，否则极易撕破骶前静脉丛，引起难以控制的出血。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,盆脏筋膜 Visceral pelvic fascia 前列腺鞘 Fascial sheath of prostate 直肠膀胱隔 Rectovesical septum 直肠阴道隔 Rectovaginal septum 韧带,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(1)耻骨后隙（膀胱前隙）位于耻骨联合与膀胱之间，内有结缔组织、静脉丛，临床上常在耻骨上方作膀胱手术和剖腹产手术。,五、盆腔筋膜间隙,2)直肠后隙（骶前间 隙）位于直肠筋膜与骶前筋膜之间，向上通腹膜后隙，内有骶丛、奇神经节、直肠上血管、骶淋巴结、结缔组织。若有感染，向上可扩散到腹膜后隙。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,六、盆部的血管、淋巴及神经,1.髂外动脉 external iliac artery2.髂内动脉 internal iliac artery,（一）动脉 artery,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,静脉、淋巴、神经：自学,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,七、盆腔脏器,盆腔脏器分属泌尿、生殖和消化系统。它们在盆内大致的排列关系是 前部 泌尿系统器官 中间 生殖系统器官 后部 消化系统器官,盆腔脏器的排列关系,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,直肠rectum2.膀胱urinary bladder3.前列腺 prostate 4.子宫 uterus5.输精管盆段、射精管及精囊（自学）6.输尿管盆段，壁内段（自学） 7.卵巢，输卵管，阴道（自学）,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1. 直肠 rectum,1） 位置、形态2）毗邻 后:骶前筋膜、骶骨、尾骨、梨状肌，骶前间隙内的血管、神经。两侧:借直肠侧韧带连于盆侧壁 前:男性邻膀胱、前列腺、精囊等; 女性邻子宫、阴道,直肠的动脉：（静脉回流与动脉伴行）,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,直肠的淋巴引流：,直肠上段的淋巴管沿直肠上血管注入肠系膜下淋巴结。 直肠下段的淋巴管沿直肠下血管注入髂内淋巴结和骶淋巴结。,淋巴管道转移是直肠癌主要的扩散途径,手术要彻底清除。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,直肠的神经（自学）,神经：直肠和肛管齿状线以上由交感神经和副交感神经支配。 副交感神经是直肠机能的主要神经，纤维来自盆内脏神经，经盆丛并通过直肠侧韧带而分布于直肠和肛管。与排便反射有关的传入纤维也经由盆内脏神经传入。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1. 位置、形态2. 毗邻 前下方耻骨后间隙、耻骨联合 上方腹膜覆盖、小肠袢（男） 腹膜覆盖、子宫（女） 后下方输精管壶腹、精囊、前列 腺、直肠膀胱隔、直肠（男） 膀胱阴道隔、子宫颈、阴道前壁(女）,2.膀胱 urinary bladder,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2. 膀胱内面观 膀胱三角两侧角为左、 右 输尿管口，下角为 尿道内口。为结核 和肿瘤的好发部位。 输尿管间襞两输尿管口之间横 行的黏膜皱襞。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,空虚时为腹膜外位器官,充盈时为腹膜间位器官,膀胱位置变化及其与腹膜的关系：,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,位置：位于膀胱与尿生殖膈之间，包绕尿道的起始部。形态：底、尖、体、沟 分叶：前、中、后、两侧5叶 毗邻：上膀胱底下尿生殖膈 前耻骨前列腺韧带后直肠 前列腺鞘 前列腺囊（固有）,3. .前列腺 prostate,鞘与囊之间有丰富的静脉丛，行前列腺切除时，腺体应由囊内取出，以免损伤静脉丛。,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,直肠指诊,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,形态：底、体、峡、颈位置：前倾、前屈,前倾,前屈,4. 子宫 uterus,毗邻： 前面膀胱 后面直肠子宫陷凹、直肠 两侧输卵管、子宫阔韧带、 卵巢固有韧带等,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,子宫颈阴道部子宫颈 子宫颈阴道上部 子宫峡,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,子宫的韧带： 子宫阔韧带 子宫主韧带 子宫圆韧带 骶子宫韧带,除上述韧带外，盆底肌和阴道的承托以及周围结缔组织的牵拉等对子宫位置的固定也起很大作用。,子宫的固定装置,December, 2008,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1）子宫动脉：在子宫颈侧缘约 2cm 处，越过输尿管的前上方与其交叉， 称为“桥下流水 2）子宫静脉：起自子宫阴道丛，在平子宫口高度汇合成子宫静脉，汇入髂内静脉。,子宫的血管,December, 2008,Copyright Depart