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,andtheirarticulationsTwoportionsGreaterpelvisLesserpelvisTerminalline(pelvicinlet):formedbypromontoryofsacrum,arcuateline,pectinofpubis,pubictubercle,upperborderofpubicsymphysisPelvicoutlet:formedbytipofcoccyx,sacrotuberousligament,ischialtuberosity,ramusofischium,inferiorramusofpubicsymphysisMusclesofpelvicwallPiriformm.Obturatorinternusm.MusclesoffloorofpelvisandpelivicdiaphragmMusclesoffloorofpelvisLevatorani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PelvicfasciaParietalpelvicfasciaAcontinuationofthetransversefasciaintothepelvis.ItcovesthepiriformisandobturatorinternusAttachestothearcuatelineofthepubisandilium,thickensovertheobturatorinternustoformthearcustendineus,theoriginofportionsofthelevatoranimuscleAtthetendinousarchoflevatoraniitsplitstocovebothsuperiorandinferiorsurfacesofthelevatoraniassuperiorandinferiorfasciaofpelvicdiaphragmVisceralpelvicfasciaLiesbetweentheperitoneumandthepelvicvisceraItisacontinuationoftheextraperitonealconnectivetissueEnsheathesretroperitonealvisceraandformsseptabetweenretroperitonealorgansRectovesicalseptum直肠膀胱隔Rectovaginalseptum直肠阴道隔Retropubicspace耻骨后隙LiesbetweenpubicsymphysisandurinarybladderPararectalspace直肠周间隙LiesaroundtherectusRetrorectalspace直肠后隙Commoniliacartery髂总动脉CommoniliacarteryContinuationofabdominalaortaatlevelofL4vertebraTerminatesinfrontofsacroiliacjointbydividingintointernalandexternaliliacarteriesInternaliliacartery髂内动脉ParietaliliacarteryObturatora.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VisceralbranchesUmbilicala.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PerinealarteryAnalarteryDorsalarteryofpenis(clitoris)ExternaliliacarteryInferiorepigastricarteryDeepiliaccircumflexarteryVeinsofpelvisInternaliliacvein髂内静脉Parietaltributaries:accompanywitharteriesVisceraltributaries→superiorrectalvein→inferiormesentericv.①Rectalvenousplexus→inferiorrectalvein→internaliliacv.直肠静脉丛→analvein→internalpudendalv.②Vesicalvenousplexus膀胱静脉丛→vesicalv.③Uterinevenousplexus子宫静脉丛→uterinev.Externaliliacvein髂外静脉–accompanythearteryCommoniliacvein髂总静脉–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacavaThelymphaticdrainageofpelvisInternaliliaclymphnodeSurroundinternaliliacvesselsReceiveafferentsfrompelvicviscera,perineum,buttockandbackofthighExternaliliaclymphnodesLiealongexternaliliacarteryReceiveafferentsfromlowerlimbandsomepartsofpelvicvisceraSacrallymphnodeCommoniliaclymphnodeLiealongcommoniliacarteryReceiveafferentsfromalltheabovenodesEfferentspasstolumbarlymphnodeSacralplexus骶丛Formation:formedbyanteriorramiofL4andL5spinalnerves(thelumbrosacraltrunk)andanteriorramiofsacralandcoccygealnervesPosition:liesinpelviccavity,anteriortosacrumandpiriformisBranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommonPudendalnerveblockAutonomicplexusesofplevicHypogastricplexusSuperiorhypogastricplexus上腹下丛:liesinfrontofL5betweencommoniliacateriesInferiorhypogastricplexus下腹下丛(pelvicplexus):lieoneachsideofrectumSacralsympathetictrunkIscontinuosabovewiththeabdominalpartHas4or5ganglionRelationshipsofrectusAnteriorlyInmaleFundusofbladderSeminalvesicleProstateAmpullaductusdeferentisInfemaleneckofuterusVaginaPosteriorlySacrumandcoccyxPiriformisMediansacralvesselsAnteriorbranchesofsacralandcoccygealnervesSacralsympathetictrunkLaterallyPelvicplexusSuperiorandinferiorrectalvesselsLevatoraniVesselsandlymphaticsofrectumArteriesSuperiorrectala.Inferiorrectala.Mediansacrala.LymphaticdraingeLymphaticsfollowarterialbloodsupplytofollowingnodes:Superiorrectalln.Inferiormesentericln.Pararectalln.Internaliliacln.Sacralln.Perineum山东大学医学院解剖教研室李振华GeneralfeaturesRegionofbelowpelvicdiaphragmAdiamond-shapespacewhoseboundariesarethoseofthepelvicoutletLowerborderofsymphysispubisRamiofpubisandischiumIschialtuberositiesSacrotuberousligamentThecoccyxTwotrianglesAnimaginarylinedrawnbetweenthetwoischialtuberositiesdividesperineumintoanteriorandposteriortrianglesUrogenitalregion尿生殖区(anterior)－differsinmaleandfemaleAnalregion肛区(posterior)－similarinbothsexesAnalregion肛区Analsphincters肛门括约肌InternalSmoothmuscle(thickenedcircularmusclecoat)Surroundsuppertwo-thirdsofanalcanalAutonomicnervesupplyExternalStriatedmuscleSurroundslowertwo-thirdsofanalcanalThreeparts－subcutaneous,superficialanddeepInnervationbyanalnervesofpudendalnerveandbranchesofS4Ischioanalfossa坐骨肛门窝BoundariesApex－conjunctiveareaofinferiorfasciaofpelvicdiaphragmandfasciacoveringtheobturatorinternusBase－skinofanalregionMedia