盆腔和会阴部解剖Pelvis_and_perineum.ppt
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1、Pelvic,Bony pelvis,Composition: formed by paired hip bones, sacrum, coccyx, and their articulations Two portions Greater pelvis Lesser pelvis Terminal line ( pelvic inlet): formed by promontory of sacrum, arcuate line, pectin of pubis, pubic tubercle, upper border of pubic symphysis Pelvic outlet: f
2、ormed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis,Anterior wall of the pelvis (posterior view),Posterior wall of the pelvis,Lateral wall of the pelvis,Inferior wall or floor of the pelvis,Muscles of pelvic wall,Piriform m. Obturat
3、or internus m.,Muscles of floor of pelvis and pelivic diaphragm,Muscles of floor of pelvis Levator ani 肛提肌 Levateo prostate 前列腺提肌(pubovaginalis 耻骨阴道肌) Puborectalis 耻骨直肠肌 Pubococcygeus 耻尾肌and iliococcygeus 髂尾肌 Coccygeus 尾骨肌,Pelivic diaphragm 盆膈 Superior fascia of pelvic diaphragm 盆膈上筋膜 Levator ani 肛提
4、肌 Coccygeus 尾骨肌 Inferior fascia of pelvic diaphragm盆膈下筋膜,Pelvic fascia,Parietal pelvic fascia A continuation of the transverse fascia into the pelvis. It covers the piriformis and obturator internus Attaches to the arcuate line of the pubis and ilium, thickens over the obturator internus to form the
5、 arcus tendineus, the origin of portions of the levator ani muscle At the tendinous arch of levator ani it splits to cover both superior and inferior surfaces of the levator ani as superior and inferior fascia of pelvic diaphragm,Visceral pelvic fascia Lies between the peritoneum and the pelvic visc
6、era It is a continuation of the extraperitoneal connective tissue Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs Rectovesical septum 直肠膀胱隔 Rectovaginal septum 直肠阴道隔,Retropubic space 耻骨后隙 Lies between pubic symphysis and urinary bladder Pararectal space 直肠周间隙 Lies a
7、round the rectus Retrorectal space 直肠后隙,Sagittal section of the male pelvis,Sagittal section of the female pelvis,Common iliac artery 髂总动脉,Common iliac artery Continuation of abdominal aorta at level of L4 vertebra Terminates in front of sacroiliac joint by dividing into internal and external iliac
8、arteries,Internal iliac artery 髂内动脉,Parietal iliac artery Obturator a. 闭孔动脉 Iliolumber a.髂腰动脉 Lateral sacral a. 骶外侧动脉 Superior gluteal a. 臀上动脉 Inferior gluteal a. 臀下动脉,Visceral branches Umbilical a.脐动脉 superior vesical a. 膀胱上动脉 Inferior vesical a.膀胱下动脉 Uterine a.子宫动脉 Inferior rectal a.直肠下动脉 Internal
9、 pudendal a. 阴部内动脉,Uterine a. 子宫动脉about 2cm from neck of uterus it crosses above and in front of ureter,Internal pudendal artery 阴部内动脉 Perineal artery Anal artery artery of penis (clitoris),External iliac artery,Inferior epigastric artery Deep iliac circumflex artery,Veins of pelvis,Internal iliac v
10、ein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries superior rectal veininferior mesenteric v. Rectal venous plexus inferior rectal veininternal iliac v. 直肠静脉丛 anal veininternal pudendal v. Vesical venous plexus 膀胱静脉丛vesical v. Uterine venous plexus 子宫静脉丛uterine v.,External i
11、liac vein 髂外静脉 accompany the artery Common iliac vein 髂总静脉 formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4L5 by uniting each other to form inferior vena cava,The lymphatic drainage of pelvis,Internal iliac lymph node Surround internal iliac vessels Rece
12、ive afferents from pelvic viscera, perineum, buttock and back of thigh External iliac lymph nodes Lie along external iliac artery Receive afferents from lower limb and some parts of pelvic viscera Sacral lymph node Common iliac lymph node Lie along common iliac artery Receive afferents from all the
13、above nodes Efferents pass to lumbar lymph node,Sacral plexus 骶丛,Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves Position: lies in pelvic cavity, anterior to sacrum and piriformis,Branches Superior gluteal Inferi
14、or gluteal Pudendal Posterior femoral cutaneou Sciatic Common,Pudendal nerve block,Autonomic plexuses of plevic,Hypogastric plexus Superior hypogastric plexus 上腹下丛: lies in front of L5 between common iliac ateries Inferior hypogastric plexus下腹下丛 (pelvic plexus): lie on each side of rectum Sacral sym
15、pathetic trunk Is continuos above with the abdominal part Has 4or 5 ganglion,Relationships of rectus,Anteriorly In male Fundus of bladder Seminal vesicle Prostate Ampulla ductus deferentis In female neck of uterus Vagina,Posteriorly Sacrum and coccyx Piriformis Median sacral vessels Anterior branche
16、s of sacral and coccygeal nerves Sacral sympathetic trunk Laterally Pelvic plexus Superior and inferior rectal vessels Levator ani,Vessels and lymphatics of rectum,Arteries Superior rectal a. Inferior rectal a. Median sacral a. Lymphatic drainge Lymphatics follow arterial blood supply to following n
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