盆部与会阴局部解剖学Pelvis and perineum

Pelvic,山东大学医学院解剖教研室李振华,Bonypelvis,Composition:formedbypairedhipbones,sacrum,coccyx,andtheirarticulationsTwoportionsGreaterpelvisLesserpelvisTerminalline(pelvicinlet):formedbypromontoryofsacrum,arcuateline,pectinofpubis,pubictubercle,upperborderofpubicsymphysisPelvicoutlet:formedbytipofcoccyx,sacrotuberousligament,ischialtuberosity,ramusofischium,inferiorramusofpubicsymphysis,Musclesofpelvicwall,Piriformm.Obturatorinternusm.,Musclesoffloorofpelvisandpelivicdiaphragm,MusclesoffloorofpelvisLevatorani肛提肌Levateoprostate前列腺提肌(pubovaginalis耻骨阴道肌)Puborectalis耻骨直肠肌Pubococcygeus耻尾肌andiliococcygeus髂尾肌Coccygeus尾骨肌,Pelivicdiaphragm盆膈Superiorfasciaofpelvicdiaphragm盆膈上筋膜Levatorani肛提肌Coccygeus尾骨肌Inferiorfasciaofpelvicdiaphragm盆膈下筋膜,Pelvicfascia,ParietalpelvicfasciaAcontinuationofthetransversefasciaintothepelvis.ItcovesthepiriformisandobturatorinternusAttachestothearcuatelineofthepubisandilium,thickensovertheobturatorinternustoformthearcustendineus,theoriginofportionsofthelevatoranimuscleAtthetendinousarchoflevatoraniitsplitstocovebothsuperiorandinferiorsurfacesofthelevatoraniassuperiorandinferiorfasciaofpelvicdiaphragm,VisceralpelvicfasciaLiesbetweentheperitoneumandthepelvicvisceraItisacontinuationoftheextraperitonealconnectivetissueEnsheathesretroperitonealvisceraandformsseptabetweenretroperitonealorgansRectovesicalseptum直肠膀胱隔Rectovaginalseptum直肠阴道隔,Retropubicspace耻骨后隙LiesbetweenpubicsymphysisandurinarybladderPararectalspace直肠周间隙LiesaroundtherectusRetrorectalspace直肠后隙,Commoniliacartery髂总动脉,CommoniliacarteryContinuationofabdominalaortaatlevelofL4vertebraTerminatesinfrontofsacroiliacjointbydividingintointernalandexternaliliacarteries,Internaliliacartery髂内动脉,ParietaliliacarteryObturatora.闭孔动脉Iliolumbera.髂腰动脉Lateralsacrala.骶外侧动脉Superiorgluteala.臀上动脉Inferiorgluteala.臀下动脉,VisceralbranchesUmbilicala.脐动脉superiorvesicala.膀胱上动脉Inferiorvesicala.膀胱下动脉Uterinea.子宫动脉Inferiorrectala.直肠下动脉Internalpudendala.阴部内动脉,Uterinea.子宫动脉about2cmfromneckofuterusitcrossesaboveandinfrontofureter,Internalpudendalartery阴部内动脉PerinealarteryAnalarteryDorsalarteryofpenis(clitoris),Externaliliacartery,InferiorepigastricarteryDeepiliaccircumflexartery,Veinsofpelvis,Internaliliacvein髂内静脉Parietaltributaries:accompanywitharteriesVisceraltributariessuperiorrectalveininferiormesentericv.Rectalvenousplexusinferiorrectalveininternaliliacv.直肠静脉丛analveininternalpudendalv.Vesicalvenousplexus膀胱静脉丛vesicalv.Uterinevenousplexus子宫静脉丛uterinev.,Externaliliacvein髂外静脉accompanythearteryCommoniliacvein髂总静脉formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4L5byunitingeachothertoforminferiorvenacava,Thelymphaticdrainageofpelvis,InternaliliaclymphnodeSurroundinternaliliacvesselsReceiveafferentsfrompelvicviscera,perineum,buttockandbackofthighExternaliliaclymphnodesLiealongexternaliliacarteryReceiveafferentsfromlowerlimbandsomepartsofpelvicvisceraSacrallymphnodeCommoniliaclymphnodeLiealongcommoniliacarteryReceiveafferentsfromalltheabovenodesEfferentspasstolumbarlymphnode,Sacralplexus骶丛,Formation:formedbyanteriorramiofL4andL5spinalnerves(thelumbrosacraltrunk)andanteriorramiofsacralandcoccygealnervesPosition:liesinpelviccavity,anteriortosacrumandpiriformis,BranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommon,Pudendalnerveblock,Autonomicplexusesofplevic,HypogastricplexusSuperiorhypogastricplexus上腹下丛:liesinfrontofL5betweencommoniliacateriesInferiorhypogastricplexus下腹下丛(pelvicplexus):lieoneachsideofrectumSacralsympathetictrunkIscontinuosabovewiththeabdominalpartHas4or5ganglion,Relationshipsofrectus,AnteriorlyInmaleFundusofbladderSeminalvesicleProstateAmpullaductusdeferentisInfemaleneckofuterusVagina,PosteriorlySacrumandcoccyxPiriformisMediansacralvesselsAnteriorbranchesofsacralandcoccygealnervesSacralsympathetictrunkLaterallyPelvicplexusSuperiorandinferiorrectalvesselsLevatorani,Vesselsandlymphaticsofrectum,ArteriesSuperiorrectala.Inferiorrectala.Mediansacrala.LymphaticdraingeLymphaticsfollowarterialbloodsupplytofollowingnodes:Superiorrectalln.Inferiormesentericln.Pararectalln.Internaliliacln.Sacralln.,Perineum,山东大学医学院解剖教研室李振华,GeneralfeaturesRegionofbelowpelvicdiaphragmAdiamond-shapespacewhoseboundariesarethoseofthepelvicoutletLowerborderofsymphysispubisRamiofpubisandischiumIschialtuberositiesSacrotuberousligamentThecoccyx,TwotrianglesAnimaginarylinedrawnbetweenthetwoischialtuberositiesdividesperineumintoanteriorandposteriortrianglesUrogenitalregion尿生殖区(anterior)differsinmaleandfemaleAnalregion肛区(posterior)similarinbothsexes,Analregion肛区,Analsphincters肛门括约肌InternalSmoothmuscle(thickenedcircularmusclecoat)Surroundsuppertwo-thirdsofanalcanalAutonomicnervesupplyExternalStriatedmuscleSurroundslowertwo-thirdsofanalcanalThreepartssubcutaneous,superficialanddeepInnervationbyanalnervesofpudendalnerveandbranchesofS4,Ischioanalfossa坐骨肛门窝,BoundariesApexconjunctiveareaofinferiorfasciaofpelvicdiaphragmandfasciacoveringtheobturatorinternusBaseskinofanalregionMedialsphincteraniexternus,levatorani,coccygeusandinferiorfasciaofpelvicdiaphragmLateralischialtuberosity,obturatorinternusandfascia,Paired,wedge-shaped,fat-filledspacesoneithersideofanalcanal,AnteriorPosteriorborderofurogenitaldiaphragmForwardprojectionofanteriorrecessoffossabetweenpelvicdiaphragmaboveandurogenitaldiaphragmbelowPosteriorbackwardprojectionofposteriorrecessoffossabetweengluteusmaximus,sacrotuberousligamentandcoccyx,ContentsFatInternalpudendalarteryandveinandtheirrectalbranchesPudendalnerveanditsinferiorrectalbranch,Vesselsandnervesenterfromglutealregion,throughlessersciaticforamen,travelonafascialcanalthepudentalcanal阴部管(Alcocks)onthelateralwalloffossa,andextendforwardintourogenitalregion,BranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommon,Pudendalnerveblock,Urogenitalregion尿生殖区,SuperficialfasciahastwolayersThesuperficialorfattylayerThedeepormembranouslayer(superficialfasciaofperineum会阴浅筋膜orCollesfascia)Anteriorlyitiscontinuouswith:DartosofthescrotumFasciaofthepenisMembranouslayerofsuperficialfasciaoftheabdominalwallknownasthefasciaofScarpaDeepfasciahastwolayersSuperiorfasciaofurogenitaldiaphragm尿生殖隔上筋膜Inferiorfasciaofurogenitaldiaphragm尿生殖隔下筋膜,Superiorfasciaofurogenitaldiaphragm,Inferiorfasciaofurogenitaldiaphragm,superficialfasciaofperineum,Deepperinealspace,Superficialperinealspace,会阴深隙：上、下两层膜，中间夹着肉，四周均封闭，尿殖管穿过（如座垫）,会阴浅隙：上、下两层膜，中间东西多，三边都封闭，前上方敞着（如口袋）,Superficialperinealspace会阴浅隙,BoundariesLiesbetweeninferiorfasciaofurogenitaldiaphragmandsuperficialfasciaofperineumSpaceopenanteriorly(Inruptureofcavernouspartofurethra,urinecanextravasatefromscrotumupwardinfrontofsymphysispubisintoanteriorabdominalwalldeeptomembranousfasciaofScarpa),ContentsPosteriorpartsuperficialtransverseperinealmuscleLateralpartcruspenis(male),crusofclitoris(female)andischiocavernoususcoveringthemCentralpartbulbofurethra(male),bulbofvestibule(female)andbulbocavernoususcoveringthemBranchesofpudendalnervesandinternalpudendalvessels,Deepperinealspace会阴深隙,LiesbetweensuperiorandinferiorfasciaofurogenitaldiaphragmContentsDeeptransverseperinealmuscleB