12盆部、会阴部-20110523-蔡艳

nullPELVIS AND PERINEUMDept. of Anatomy, Xiangya School of Medicine, CNSPELVIS AND PERINEUMCai YannullOUTLINEnull盆部 ：位于躯干的下部，由骨盆、盆壁、盆膈及盆腔脏器等组成盆部(pelvis) 骨盆 盆膈 盆腔 Introductionnull会阴(perineum) 肛区 尿生殖区 尿生殖膈 会阴：盆膈以下封闭骨盆下口的全部软组织nullII. pelvis 1.Bony pelvis2.Muscles of pelvic3.Pelvic fascia5. The organs in the pelvic cavity4. the blood, lymph and nerves of pelvisnull1. Bony pelvisnullpelvic cavityFemale MaleThe difference of the pelvis between male and female 90~100070~750 null2. Muscles of pelvicPiriform m. Obturator internus m.(1) Muscles of pelvic wallnull(2) Muscles of floor of pelvis Levator ani Levateo prostate (pubovaginalis) Puborectalis Pubococcygeus and iliococcygeus Coccygeusnullnullpuborectal sling (skeletal muscle)Failure for the puborectal sling & external anal sphincter to relax during defection results in constipationnull3. Pelvic fasciaParietal pelvic fascia (盆壁筋膜） piriformis fascia obturator internus fascia•arcus tendineusnullThe fascia of pelivic diaphragm (盆膈筋膜)Superior fascia of pelvic diaphragm Inferior fascia of pelvic diaphragmnull Rectovesical septum Rectovaginal septum Visceral pelvic fascia（盆脏筋膜）nullMale and female pelvic viscera in situnullPelvic fascia spacesnull4. the blood, lymph and nerves of pelvisnullnull左右盆内脏神经骶交感干节后纤维上腹下丛左、右腹下神经左、右下腹下丛 (盆丛）腹主动脉丛nullGrowths in the pelvis can compress the sacral plexus producing sensory and motor symptoms in the lower limbnull5. The organs in the pelvic cavity nullprostatenullThe Prostate Has 5 LobesNote that urethra runs in the middle of the prostatenullObstruction results in the “up-stream” dilation of the urinary track and hydronephrosnullA digital rectal exam can determine if the prostate is:enlarged hard irregularnullThe prostatic & vertebral plexuses freely communicate through valve-less veinsincreases in intrapelvic pressure can cause blood to flow from the prostate to the vertebral columnnulluterusnullnullBlood of the pelvisUterine artery passes superior to ureternullBlood Supply to the UterusnullSupportsThe normal position of the uterus is maintained by various ligments and other supports such as the muscles of pelvic floor, neighbour organs and connective tissue.Broad ligament of uterus Round ligament of uterus Cardinal ligament of uterus Uterosacral ligament nullBirth canal & obstetric lacerations of pelvic diaphramnullProlapse of Uterus1st Degree2nd DegreeSinking (herniation) of the uterus into the vagina3rd DegreenullProlapsed Rectum (rectocele)Prolapse of the Bladder (cystocele)nullIII. perineum（会阴）anal canal（肛管）ischiorectal fossa（坐骨直肠窝 ）Urogenital regionsuperficial perineal space（会阴浅隙 ）deep perineal space（会阴深隙 ） Anal regionnullTwo triangles Urogenital region (anterior) Anal regionnull狭义 男性：阴囊根与肛门之间的软组织 女性：阴道前庭后端与肛门之间的软组织 ，即产科会阴 Urogenital region Urogenital region Superficial fascia The superficial or fatty layer The deep or membranous layer (superficial fascia of perineum or Colles fascia) Deep fascia Superior fascia of urogenital diaphragm Inferior fascia of urogenital diaphragmnullpeniscavernous body of peniscavernous body of urethrabulb of urethracrus penisurethrabulbourethral glandsnullperineal aanal a.dorsal a. of penis阴部管（Alcock管）null会阴浅隙1. 3块肌（坐骨海绵体肌、球海绵体肌、会阴浅横肌） 2.阴茎脚（阴茎海绵体）、尿道球（尿道海棉体） 3.会阴动脉、会阴神经定义:会阴浅筋膜与尿生殖膈下筋膜之间的间隙结构：会阴深隙定义：位于尿生殖膈上、下筋膜之间，此间隙封闭结构：1块扁肌（尿道括约肌和会阴深横肌） 2.尿道球腺、尿道膜部 3.阴部神经和阴部内血管男性尿生殖区null会阴深隙会阴浅隙女性尿生殖区1. 3块肌（坐骨海绵体肌、阴道括约肌、会阴浅横肌） 2.阴蒂脚、前庭球、前庭大腺 3.会阴动脉、会阴神经1.肌（尿道括约肌、尿道阴道括约肌和会阴深横肌） 2.尿道、阴道 3.阴部神经和阴部内血管nullPerineal spaces (frontal section)nullExtravasation of Fluid Following a Ruptured UrethraWHY?null4Rupture of the Penile UrethranullScarpa’s & Colles’ Fascias Are ContinuousScarpa’s fasciaColles’ fasciadeep fascianote Colles’ fascia fuses with the perineal body6note Scarpa’s fascia fuses with deep fascianull男性会阴浅隙 的交通nullnull THANKS nullnull坐骨直肠窝 (ischioanal fossa)nullnullnull向前 延伸到肛提肌与尿生殖膈会合处，形成前隐窝 向后 延伸至臀大肌。骶结节韧带与尾骨肌之间形成后隐窝