盆部（医学课件）.ppt

Uterus 子宫 分部 子宫壁 子宫腔 子宫底 子宫颈 子宫体 子宫峡 内层 中层 外层 子宫位置 90o 170o 前倾前屈位 子宫固定装置 子宫阔韧带：防止向两侧倾斜 子宫圆韧带：维持子宫前倾位 子宫主韧带：防止子宫脱垂 子宫骶韧带：维持子宫前屈位 子宫动脉uterin artery 阴道vagina 上端连接子宫颈 下部穿过尿生殖膈 阴道穹--直肠子宫陷窝--穿刺 位于小骨盆腔的后部、骶骨的前方； 上端与乙状结肠相接，向下穿过盆隔移行于肛管； 全长约10—14cm； 在矢状面上有骶曲和会阴曲两个弯曲； 上端与乙状结肠交接处管径较细 向下肠腔显著扩大成为直肠壶腹 直肠横襞：由粘膜及环行肌构成。 最上方的接近直肠乙状结肠交接处， 位于直肠左壁，距肛门约11cm。 中间的最大而明显，位置最恒定， 位于直肠右壁，距肛门约7cm。 最下方的一条多位于直肠左壁， 有时此横襞缺如。 直肠 Rectum 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梨状肌 Median sacral vessels Anterior branches of sacral and coccygeal nerves Sacral sympathetic trunk Laterally Pelvic plexus Superior and inferior rectal vessels Levator ani肛提肌 Vessels and lymphatics of rectum Arteries Superior rectal a. Inferior rectal a. Median sacral a. Lymphatic drainge Lymphatics follow arterial blood supply to following nodes: Superior rectal ln. Inferior mesenteric ln. Pararectal ln. Internal iliac ln. Sacral ln. Perineum General features Region of below pelvic diaphragm A diamond-shape space whose boundaries are those of the pelvic outlet Lower border of symphysis pubis Rami of pubis and ischium Ischial tuberosities Sacrotuberous ligament The coccyx Two triangles An imaginary line drawn between the two ischial tuberosities divides perineum into anterior and posterior triangles Urogenital region尿生殖区 (anterior)－differs in male and female Anal region 肛区 (posterior)－similar in both sexes 结构 盆膈：肛提肌、尾骨肌及盆膈上下筋膜 尿生殖膈：会阴深横肌、尿道括约肌及尿生殖膈上下筋膜 Anal region 肛区 又称肛门三角，包括肛管及坐骨直肠窝等结构。 肛管 anal canal 肛柱：动、静脉及纵行肌 肛瓣 肛窦 齿状线 白线 Anal sphincters 肛门括约肌 Internal Smooth muscle (thickened circular muscle coat) Surrounds upper two-thirds of anal canal Autonomic nerve supply External Striated muscle Surrounds lower two-thirds of anal canal Three parts－subcutaneous, superficial and deep Innervation by anal nerves of pudendal nerve and branches of S4 Ischioa