盆部与会阴局部解剖学-课件

Pelvic

Pelvic1BonypelvisComposition:formedbypairedhipbones,sacrum,coccyx,andtheirarticulationsTwoportions

GreaterpelvisLesserpelvisTerminalline(pelvicinlet):formedbypromontoryofsacrum,arcuateline,pectinofpubis,pubictubercle,upperborderofpubicsymphysisPelvicoutlet:formedbytipofcoccyx,sacrotuberousligament,ischialtuberosity,ramusofischium,inferiorramusofpubicsymphysisBonypelvisComposition:formed2MusclesofpelvicwallPiriformm.Obturatorinternusm.MusclesofpelvicwallPiriform3Musclesoffloorofpelvis

andpelivicdiaphragm

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Musclesoffloorofpelvis

an4Pelivicdiaphragm

盆膈Superiorfasciaofpelvicdiaphragm盆膈上筋膜Levatorani肛提肌Coccygeus尾骨肌Inferiorfasciaofpelvicdiaphragm盆膈下筋膜Pelivicdiaphragm盆膈5Pelvicfascia

ParietalpelvicfasciaAcontinuationofthetransversefasciaintothepelvis.ItcovesthepiriformisandobturatorinternusAttachestothearcuatelineofthepubisandilium,thickensovertheobturatorinternustoformthearcustendineus,theoriginofportionsofthelevatoranimuscleAtthetendinousarchoflevatoraniitsplitstocovebothsuperiorandinferiorsurfacesofthelevatoraniassuperiorandinferiorfasciaofpelvicdiaphragmPelvicfasciaParietalpelvic6Visceralpelvicfascia

LiesbetweentheperitoneumandthepelvicvisceraItisacontinuationoftheextraperitonealconnectivetissueEnsheathesretroperitonealvisceraandformsseptabetweenretroperitonealorgansRectovesicalseptum直肠膀胱隔Rectovaginalseptum直肠阴道隔Visceralpelvicfascia7Retropubicspace耻骨后隙LiesbetweenpubicsymphysisandurinarybladderPararectalspace

直肠周间隙LiesaroundtherectusRetrorectalspace直肠后隙Retropubicspace耻骨后隙8Commoniliacartery髂总动脉CommoniliacarteryContinuationofabdominalaortaatlevelofL4vertebraTerminatesinfrontofsacroiliacjointbydividingintointernalandexternaliliacarteriesCommoniliacartery髂总动脉Common9Internaliliacartery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Internaliliacartery髂内动脉Pari10VisceralbranchesUmbilicala.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Visceralbranches11盆部与会阴局部解剖学--课件12Uterinea.子宫动脉—about2cmfromneckofuterusitcrossesaboveandinfrontofureterUterinea.子宫动脉—about2cmfrom13Internalpudendalartery

阴部内动脉

PerinealarteryAnalarteryDorsalarteryofpenis(clitoris)Internalpudendalartery阴部内动脉14ExternaliliacarteryInferiorepigastricarteryDeepiliaccircumflexarteryExternaliliacartery15VeinsofpelvisInternaliliacvein髂内静脉Parietaltributaries:accompanywitharteriesVisceraltributaries

→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.VeinsofpelvisInternaliliac16

Externaliliacvein

髂外静脉–accompanythearteryCommoniliacvein

髂总静脉–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacavaExternaliliacvein髂17ThelymphaticdrainageofpelvisInternaliliaclymphnodeSurroundinternaliliacvesselsReceiveafferentsfrompelvicviscera,perineum,buttockandbackofthighExternaliliaclymphnodes

LiealongexternaliliacarteryReceiveafferentsfromlowerlimbandsomepartsofpelvicvisceraSacrallymphnodeCommoniliaclymphnode

LiealongcommoniliacarteryReceiveafferentsfromalltheabovenodesEfferentspasstolumbarlymphnodeThelymphaticdrainageofpelv18Sacralplexus骶丛Formation:formedbyanteriorramiofL4andL5spinalnerves(thelumbrosacraltrunk)andanteriorramiofsacralandcoccygealnervesPosition:liesinpelviccavity,anteriortosacrumandpiriformisSacralplexus骶丛Formation:for19BranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommonBranches20PudendalnerveblockPudendalnerveblock21AutonomicplexusesofplevicHypogastricplexus

Superiorhypogastricplexus上腹下丛:liesinfrontofL5betweencommoniliacateriesInferiorhypogastricplexus下腹下丛(pelvicplexus):lieoneachsideofrectumSacralsympathetictrunkIscontinuosabovewiththeabdominalpartHas4or5ganglionAutonomicplexusesofplevicHy22RelationshipsofrectusAnteriorlyInmaleFundusofbladderSeminalvesicleProstateAmpullaductusdeferentisInfemaleneckofuterusVaginaRelationshipsofrectusAnterio23PosteriorlySacrumandcoccyxPiriformisMediansacralvesselsAnteriorbranchesofsacralandcoccygealnervesSacralsympathetictrunkLaterallyPelvicplexusSuperiorandinferiorrectalvesselsLevatoraniPosteriorly24VesselsandlymphaticsofrectumArteriesSuperiorrectala.Inferiorrectala.Mediansacrala.LymphaticdraingeLymphaticsfollowarterialbloodsupplytofollowingnodes:Superiorrectalln.Inferiormesentericln.Pararectalln.Internaliliacln.Sacralln.Vesselsandlymphaticsofrect25Perineum山东大学医学院解剖教研室李振华Perineum山东大学医学院解剖教研室26GeneralfeaturesRegionofbelowpelvicdiaphragmAdiamond-shapespacewhoseboundariesarethoseofthepelvicoutletLowerborderofsymphysispubisRamiofpubisandischiumIschialtuberositiesSacrotuberousligamentThecoccyxGeneralfeatures27TwotrianglesAnimaginarylinedrawnbetweenthetwoischialtuberositiesdividesperineumintoanteriorandposteriortrianglesUrogenitalregion尿生殖区(anterior)－differsinmaleandfemaleAnalregion肛区(posterior)－similarinbothsexesTwotriangles28Analregion肛区Analsphincters肛门括约肌InternalSmoothmuscle(thickenedcircularmusclecoat)Surroundsuppertwo-thirdsofanalcanalAutonomicnervesupplyExternalStriatedmuscleSurroundslowertwo-thirdsofanalcanalThreeparts－subcutaneous,superficialanddeepInnervationbyanalnervesofpudendalnerveandbranchesofS4Analregion肛区Analsphincters29

Ischioanalfossa坐骨肛门窝

BoundariesApex－conjunctiveareaofinferiorfasciaofpelvicdiaphragmandfasciacoveringtheobturatorinternusBase－skinofanalregionMedial－sphincteraniexternus,levatorani,coccygeus

andinferiorfasciaofpelvicdiaphragmLateral－ischialtuberosity,obturatorinternusandfasciaPaired,wedge-shaped,fat-filledspacesoneithersideofanalcanalIschioanalfossa坐骨肛门窝Bounda30AnteriorPosteriorborderofurogenitaldiaphragmForwardprojectionofanteriorrecessoffossabetweenpelvicdiaphragmaboveandurogenitaldiaphragmbelowPosteriorbackwardprojectionofposteriorrecessoffossabetweengluteusmaximus,sacrotuberousligamentandcoccyxAnterior31ContentsFatInternalpudendalarteryandveinandtheirrectalbranchesPudendalnerveanditsinferiorrectalbranchVesselsandnervesenterfromglutealregion,throughlessersciaticforamen,travelonafascialcanal－thepudentalcanal阴部管(Alcock’s)－onthelateralwalloffossa,andextendforwardintourogenitalregionContentsVesselsandnerves32BranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommonBranches33PudendalnerveblockPudendalnerveblock34Urogenitalregion尿生殖区SuperficialfasciahastwolayersThesuperficialorfattylayerThedeepormembranouslayer(superficialfasciaofperineum会阴浅筋膜orCollesfascia)Anteriorly－itiscontinuouswith:DartosofthescrotumFasciaofthepenisMembranouslayerofsuperficialfasciaoftheabdominalwallknownasthefasciaofScarpaDeepfasciahastwolayersSuperiorfasciaofurogenitaldiaphragm尿生殖隔上筋膜Inferiorfasciaofurogenitaldiaphragm尿生殖隔下筋膜Urogenitalregion尿生殖区Superfic35Camper’sfasciaPositionofpenisScarpa’sfasciaFascialaterLineoffusionPositionofscrotumCamper’sfasciaPositionofpen36SuperiorfasciaofurogenitaldiaphragmInferiorfasciaofurogenitaldiaphragmsuperficialfasciaofperineumDeepperinealspace

Superficialperinealspace

FasciaofthepenisFasciaofScarpaDartosofthescrotum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）Superiorfasciaofurogenital37Superficialperinealspace会阴浅隙BoundariesLiesbetweeninferiorfasciaofurogenitaldiaphragmandsuperficialfasciaofperineumSpaceopenanteriorly(Inruptureofcavernouspartofurethra,urinecanextravasatefromscrotumupwardinfrontofsymphysispubisintoanteriorabdominalwalldeeptomembranousfasciaofScarpa)Superficialperinealspace会阴浅38ContentsPosteriorpart－superficialtransverseperinealmuscleLateralpart－cruspenis(male),crusofclitoris(female)andischiocavernoususcoveringthemCentralpart－bulbofurethra(male),bulbofvestibule(female)andbulbocavernoususcoveringthemBranchesofpudendalnervesandinternalpudendalvesselsContents39盆部与会阴局部解剖学--课件40Deepperinealspace会阴深隙LiesbetweensuperiorandinferiorfasciaofurogenitaldiaphragmContentsDeeptransverseperinealmuscleBulbourethralgland(male)Sphincterofurethra尿道括约肌(male)，urethrovaginalsphincter尿道阴道括约肌Ateries,veinsandnervesDeepperinealspace会阴深隙Liesb41Urogenitaldiaphragm尿生殖隔

TriangularinshapeAtt