妇产科精品教学：女性盆底功能障碍性疾病和生殖道瘘.pptVIP

汕头大学医学院第二附属医院 * * * This illustration is of the bony pelvis in the dorsal lithotomy position. Again, the ischium is comprised of the ischial ramus, ischial spine, and ischial tuberosity. The junction between the inferior pubic ramus and the ischial ramus is the ischiopubic ramus. * This is a superior view of the pelvis. Be sure to orient yourself in terms of the sacrum, pubis, and left and right os coxae. Also notice the openings for the urethra, vagina, and anal canal. The vessel anterior to the urethra is the deep dorsal vein of the clitoris. The pelvis not only has an anterior, posterior, and lateral boundaries, it also has a floor. The floor of the pelvis is comprised of pelvic floor muscles. Looking down into the pelvis you can see the various pelvic floor muscles. The majority of the pelvic floor is comprised of the levator ani muscle. The levator ani muscle is divided into three areas: puborectalis, pubococcygeus, and iliococcygeus. These muscles are located between the pubis anteriorly, the coccyx posteriorly, and the left and right pelvic walls laterally. It functions to support and raise the pelvic floor. Now go back to the language of medicine and break these terms down into root words, prefixes, and suffixes. For example, pubo- means pubic bone and rect- means rectum. Therefore, the muscle fibers of the puborectalis travel from the pubic bone to the rectum. Apply this same concept to the words pubococcygeus and iliococcygeus. The muscle fibers of the pubococcygeus travel from the pubic bone to the coccyx. The muscle fibers of the iliococcygeus travel from the ilium to the coccyx. Levator = raises, Ani = anus, Pubo = pubis, Coccygeus = coccyx, Ilio = ilium * This is a dorsal lithotomy view of the pelvic floor muscles. * 汕头大学医学院第二附属医院 * 手术治疗：个体化（1） 曼氏手术（manchester手术）：适用于年龄较轻、宫颈延长的子宫脱垂患者。 诊断性刮宫 宫颈部分切除术 阴道前后壁修补 主韧带缩短 汕头大学医学院第二附属医院 * 手术治疗：个体化（2） 经阴道子宫全切除及阴道前后壁修补术：适用于年龄较大、无需考虑生育功能的患者，重度脱垂复发率高。 目前观点： 增加阴道顶端支持重建 骶棘韧带固定术