盆部與會陰局部解剖學(xué)-課件

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恥骨陰道肌)Puborectalis恥骨直腸肌Pubococcygeus恥尾肌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直腸膀胱隔Rectovaginalseptum直腸陰道隔Visceralpelvicfascia7Retropubicspace恥骨后隙LiesbetweenpubicsymphysisandurinarybladderPararectalspace

直腸周間隙LiesaroundtherectusRetrorectalspace直腸后隙Retropubicspace恥骨后隙8Commoniliacartery髂總動脈CommoniliacarteryContinuationofabdominalaortaatlevelofL4vertebraTerminatesinfrontofsacroiliacjointbydividingintointernalandexternaliliacarteriesCommoniliacartery髂總動脈Common9Internaliliacartery髂內(nèi)動脈ParietaliliacarteryObturatora.閉孔動脈Iliolumbera.髂腰動脈Lateralsacrala.骶外側(cè)動脈Superiorgluteala.臀上動脈Inferiorgluteala.臀下動脈Internaliliacartery髂內(nèi)動脈Pari10VisceralbranchesUmbilicala.臍動脈→superiorvesicala.

膀胱上動脈Inferiorvesicala.膀胱下動脈Uterinea.子宮動脈Inferiorrectala.直腸下動脈Internalpudendala.

陰部內(nèi)動脈Visceralbranches11盆部與會陰局部解剖學(xué)--課件12Uterinea.子宮動脈—about2cmfromneckofuterusitcrossesaboveandinfrontofureterUterinea.子宮動脈—about2cmfrom13Internalpudendalartery

陰部內(nèi)動脈

PerinealarteryAnalarteryDorsalarteryofpenis(clitoris)Internalpudendalartery陰部內(nèi)動脈14ExternaliliacarteryInferiorepigastricarteryDeepiliaccircumflexarteryExternaliliacartery15VeinsofpelvisInternaliliacvein髂內(nèi)靜脈Parietaltributaries:accompanywitharteriesVisceraltributaries

→superiorrectalvein→inferiormesentericv.①Rectalvenousplexus →inferiorrectalvein→internaliliacv.

直腸靜脈叢 →analvein→internalpudendalv.②Vesicalvenousplexus膀胱靜脈叢→vesicalv.③Uterinevenousplexus子宮靜脈叢→uterinev.VeinsofpelvisInternaliliac16

Externaliliacvein

髂外靜脈–accompanythearteryCommoniliacvein

髂總靜脈–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacavaExternaliliacvein髂17ThelymphaticdrainageofpelvisInternaliliaclymphnodeSurroundinternaliliacvesselsReceiveafferentsfrompelvicviscera,perineum,buttockandbackofthighExternaliliaclymphnodes

LiealongexternaliliacarteryReceiveafferentsfromlowerlimbandsomepartsofpelvicvisceraSacrallymphnodeCommoniliaclymphnode

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

Superiorhypogastricplexus上腹下叢:liesinfrontofL5betweencommoniliacateriesInferiorhypogastricplexus下腹下叢(pelvicplexus):lieoneachsideofrectumSacralsympathetictrunkIscontinuosabovewiththeabdominalpartHas4or5ganglionAutonomicplexusesofplevicHy22RelationshipsofrectusAnteriorlyInmaleFundusofbladderSeminalvesicleProstateAmpullaductusdeferentisInfemaleneckofuterusVaginaRelationshipsofrectusAnterio23PosteriorlySacrumandcoccyxPiriformisMediansacralvesselsAnteriorbranchesofsacralandcoccygealnervesSacralsympathetictrunkLaterallyPelvicplexusSuperiorandinferiorrectalvesselsLevatoraniPosteriorly24VesselsandlymphaticsofrectumArteriesSuperiorrectala.Inferiorrectala.Mediansacrala.LymphaticdraingeLymphaticsfollowarterialbloodsupplytofollowingnodes:Superiorrectalln.Inferiormesentericln.Pararectalln.Internaliliacln.Sacralln.Vesselsandlymphaticsofrect25Perineum山東大學(xué)醫(yī)學(xué)院解剖教研室李振華Perineum山東大學(xué)醫(yī)學(xué)院解剖教研室26GeneralfeaturesRegionofbelowpelvicdiaphragmAdiamond-shapespacewhoseboundariesarethoseofthepelvicoutletLowerborderofsymphysispubisRamiofpubisandischiumIschialtuberositiesSacrotuberousligamentThecoccyxGeneralfeatures27TwotrianglesAnimaginarylinedrawnbetweenthetwoischialtuberositiesdividesperineumintoanteriorandposteriortrianglesUrogenitalregion尿生殖區(qū)(anterior)－differsinmaleandfemaleAnalregion肛區(qū)(posterior)－similarinbothsexesTwotriangles28Analregion肛區(qū)Analsphincters肛門括約肌InternalSmoothmuscle(thickenedcircularmusclecoat)Surroundsuppertwo-thirdsofanalcanalAutonomicnervesupplyExternalStriatedmuscleSurroundslowertwo-thirdsofanalcanalThreeparts－subcutaneous,superficialanddeepInnervationbyanalnervesofpudendalnerveandbranchesofS4Analregion肛區(qū)Analsphincters29

Ischioanalfossa坐骨肛門窩

BoundariesApex－conjunctiveareaofinferiorfasciaofpelvicdiaphragmandfasciacoveringtheobturatorinternusBase－skinofanalregionMedial－sphincteraniexternus,levatorani,coccygeus

andinferiorfasciaofpelvicdiaphragmLateral－ischialtuberosity,obturatorinternusandfasciaPaired,wedge-shaped,fat-filledspacesoneithersideofanalcanalIschioanalfossa坐骨肛門窩Bounda30AnteriorPosteriorborderofurogenitaldiaphragmForwardprojectionofanteriorrecessoffossabetweenpelvicdiaphragmaboveandurogenitaldiaphragmbelowPosteriorbackwardprojectionofposteriorrecessoffossabetweengluteusmaximus,sacrotuberousligamentandcoccyxAnterior31ContentsFatInternalpudendalarteryandveinandtheirrectalbranchesPudendalnerveanditsinferiorrectalbranchVesselsandnervesenterfromglutealregion,throughlessersciaticforamen,travelonafascialcanal－thepudentalcanal陰部管(Alcock’s)－onthelateralwalloffossa,andextendforwardintourogenitalregionContentsVesselsandnerves32BranchesSuperiorglutealInferiorglutealPudendalPosteriorfemoralcutaneouSciaticCommonBranches33PudendalnerveblockPudendalnerveblock34Urogenitalregion尿生殖區(qū)SuperficialfasciahastwolayersThesuperficialorfattylayerThedeepormembranouslayer(superficialfasciaofperineum會陰淺筋膜orCollesfascia)Anteriorly－itiscontinuouswith:DartosofthescrotumFasciaofthepenisMembranouslayerofsuperficialfasciaoftheabdominalwallknownasthefasciaofScarpaDeepfasciahastwolayersSuperiorfasciaofurogenitaldiaphragm尿生殖隔上筋膜Inferiorfasciaofurogenitaldiaphragm尿生殖隔下筋膜Urogenitalregion尿生殖區(qū)Superfic35Camper’sfasciaPositionofpenisScarpa’sfasciaFascialaterLineoffusionPositionofscrotumCamper’sfasciaPositionofpen36SuperiorfasciaofurogenitaldiaphragmInferiorfasciaofurogenitaldiaphragmsuperficialfasciaofperineumDeepperinealspace

Superficialperinealspace

FasciaofthepenisFasciaofScarpaDartosofthescrotum會陰深隙：上、下兩層膜，中間夾著肉，四周均封閉，尿殖管穿過（如座墊）會陰淺隙：上、下兩層膜，中間東西多，三邊都封閉，前上方敞著（如口袋）Superiorfasciaofurogenital37Superficialperinealspace會陰淺隙BoundariesLiesbetweeninferiorfasciaofurogenitaldiaphragmandsuperficialfasciaofperineumSpaceopenanteriorly(Inruptureofcavernouspartofurethra,urinecanextravasatefromscrotumupwardinfrontofsymphysispubisintoanteriorabdominalwalldeeptomembranousfasciaofScarpa)Superficialperinealspace會陰淺38ContentsPosteriorpart－superficialtransverseperinealmuscleLateralpart－cruspenis(male),crusofclitoris(female)andischiocavernoususcoveringthemCentralpart－bulbofurethra(male),bulbofvestibule(female)andbulbocavernoususcoveringthemBranchesofpudendalnervesandinternalpudendalvesselsContents39盆部與會陰局部解剖學(xué)--課件40Deepperinealspace會陰深隙LiesbetweensuperiorandinferiorfasciaofurogenitaldiaphragmContentsDeeptransverseperinealmuscleBulbourethralgland(male)Sphincterofurethra尿道括約肌(male)，urethrovaginalsphincter尿道陰道括約肌Ateries,veinsandnervesDeepperinealspace會陰深隙Liesb41Urogenitaldiaphragm尿生殖隔

TriangularinshapeAtt