会阴解剖图示总结

Section3TheperineumUrogenitaltriangleAnaltriangleMaleSection3TheperineumFemaleUrogenitaltriangleAnaltriangleSection3TheperineumObstetricalperineumSection3TheperineumFemaleAppendixIIThePerineum(会阴)A.TheAnalRegion(triangle)[肛区(肛三角)]B.TheUrogenitalRegion(triangle)[尿生殖区(尿生殖三角)]A.TheAnalRegion(Triangle)1.Pelvicdiaphragm(盆膈)1)superiorfasciaofpelvicdiaphragm(盆膈上筋膜)2)levatorani(肛提肌)&coccygeus(尾骨肌)3)inferiorfasciaofpelvicdiaphragm(盆膈下筋膜)2Analcanal(肛管)1.Internalstructure1)analcolumns(肛柱)2)analvalves(肛瓣)[fissureinano肛裂]3)analsinuses(肛窦)[analfistula肛瘘]4)dentate(anocutaneous)line(齿状线)5)analpecten(肛梳)[pile(hemorrhoid)痔]6)whiteline(intersphinctersulcus)(白线)7)anus(肛门)[examinationperanus肛门检查]A.TheAnalRegion2.sphincteraniexternus(肛门外括约肌)皮下部浅部深部A.TheAnalRegion2.Muscles1)sphincteraniinternus(肛门内括约肌)2)sphincteraniexternus(肛门外括约肌)a.subcutaneouspart(皮下部)b.superficialpart(浅部)c.deeppart(深部)[fecalincontinence大便失禁]3.Ischioanal(ischiorectal)fossa(坐骨肛门窝)pudendalnerve(S2-4)→analnn.→perinealnn.→dorsaln.ofpenis(clitoris)Ischioanal(ischiorectal)fossa(坐骨肛门窝)pudendalcanal(阴部管)pudendalnerve&internalpudendalv.,a.,A.TheAnalRegion3.Ischioanal(ischiorectal)fossa(坐骨肛门窝)pudendalcanal(阴部管)pudendalnerve&internalpudendalv.,a.,[ischiorectalabscess坐骨肛门窝脓肿]B.TheUrogenitalRegion(triangle)1.Superficialfasciaofperineum(Colles)(会阴浅筋膜)2.Superficialperinealspace(会阴浅间隙)1)superficialtransversemuscleofperineum(会阴浅横肌)2)bulbocavernousmuscle(球海绵体肌)3)ischiocavernousmuscle(坐骨海绵体肌）TheUrogenitalRegionTheUrogenitalRegion4)urogenitaldiaphragm(尿生殖膈)a.inferiorfasciaofurogenitaldiaphragm(尿生殖膈下筋膜)b.superiorfasciaofurogenitaldiaphragm(尿生殖膈上筋膜)c.deepperinealspace(会阴深间隙)i.deeptransversemuscleofperineum(会阴深横肌)ii.sphincterofurethraM:(尿道括约肌)urethrovaginalsphincterF:(尿道阴道括约肌)TheUrogenitalRegionSection3TheperineumAccessorygland Thegreatervestibular(Bartholin’s)glands Oneithersideofvaginalorifice OpenintovestibuleatorificeofvaginaSection3TheperineumII.Theexternalreproductiveorgans Monspubis Greaterlipsofpudendum Lesserlipsofpudendum Vaginalvestibule Clitoris BulbofvestibuleHymenSection3TheperineumTheExternalGenitalOrgans(外生殖器)A.THESCROTUM(阴囊)B.THEPENIS(阴茎)Theexternalreproductiveorgans Pouchofthinskinlyingbelowtherootofthepenis Dividedintotwohavesbyseptumofscrotum,containstestesandtheirducts Deeptoskinisdartoscoat,aconnectivetissuelayerthatcontainsmanysmoothmusclefiberswhichcontractsinresponsetocold,pullingthetestesclosertothebodyandwrinklingtheskinⅠ)Thescrotumcavityoftunicavaginalis(鞘膜腔)[hydroceleoftunicavaginalis鞘膜积液][varicocele精索静脉曲张]TheScrotum(阴囊) Consistsoftheroot,bodyandglanspenis Contains Twocavernousbodyofpenis AcavernousbodyofurethraSkin－thinandloose Prepuceofpenis FrenulumofprepuceⅡ)ThepenisThemaleurethraThreeparts ProstaticpartLieswithintheprostateandisthewidestandmostdilatableportionofurethra. MembranouspartLieswithintheurogenitaldiaphragmsurroundbythesphincterofurethra. CavernouspartTransversethelengthofcavernousbodyofurethra.2.Compositions(组成)1)cavernousbodyofpenis(阴茎海绵体)crusofpenis(阴茎脚)2)cavernousbodyofurethra(尿道海绵体)glansfpenis(阴茎头)bulbofurethra(尿道球)ThePenis(阴茎)ThePenis(阴茎)[redundantprepuce包皮过长][phimosis包皮狭窄][paraphimosis包皮嵌顿][circumcision包皮环切术][smegma包皮垢][carcinomaofpenis阴茎癌]2)neckofpenis(阴茎颈)3)bodyofpenis(阴茎体)4)rootofpenis(阴茎根)TheBulbourethralGland(尿道球腺)Thebulbourethralgland(尿道球腺)Theurethralmucousglands(尿道粘膜腺)Function(功能):produceamucoussecretionsometime(uptoseveralminutes)beforeejaculation(射精前分泌)TheMaleUrethra(男尿道)A.Division(分部)1.Prostaticpart(前列腺部)1)urethralridge(尿道嵴)2)seminalcolliculus(精阜)3)prostaticutricle(前列腺小囊)2.Membranouspart(膜部)3.Cavernouspart(海绵体部)1)bulbofurethra(尿道球)2)navicularfossa(舟状窝)TheMaleUrethra(男尿道)B.Strictures(狭窄)1.Internalurethralorifice(尿道内口)2.Membranousportion(膜部)3.Externalorifice(尿道外口)TheMaleUrethra(男尿道)C.Curvatures(弯曲)1.Subpubiccurvature(耻骨下曲)2.Prepubiccurvature(耻骨前[urethrostenosis尿道狭窄]TheglutealregionandbackofthighandlegCutaneousnervesMedialclunealn.suprapiriformforameninfrapiriformforamenStructurespassingsuprapiriformforamen Superiorglutealn.,a.,v.fromlateraltomedialsideStructurespassinginfrapiriformforamen Sciaticn.,posteriorfemoralcutaneousn.,inferiorglutealn.,a.,v.,internalpudendalv.,a.,andpudendaln.fromlateraltomedialsidePudendalnerve,internalpudendalartery Thesestructuresentertheglutealregionthroughtheinfrapiriformforamen. Theythencurveforwardstoentertheperineumthroughthelessersciaticforamen.★Sciaticnerve Course:Itarisesfromthesacralplexusandpassesthroughinfrapiriformforamenintotheglutealregion,deeptogluteusmaximus,passingmidwaybetweenthegreatertrochanteroffemurandischialtuberositytobackofthigh,thenerveliesdeeptothelongheadofbicepsontheposteriorsurfaceofadductormagnus.Thesciaticnerveusuallyendshalf-waydownthebackofthethighbydividingintothecommonperonealandtibialnerves. Distribution:semitendinosus,semimembranosusandbicepsfemorisandhasarticularbranchestohipandkneejointsRelationshipofsciaticn.tothepiriformisBoundariesofthepoplitealfossa Diamond-shaped Upperlateralboundary:Bicepsfemoris Uppermedialboundary:semimembranosusandsemitendinosus Twolowerboundariesaretheheadsofgastrocnemius Posteriorwall:deepfascia Anteriorwall:poplitealsurfaceofthefemur,theposteriorcapsuleofthekneejoint,andthefasciacoveringpoplitellsContentsofthepoplitealfossa Tibialandcommonperonealnervesandtheirbranches Poplitealveinanditstributaries Poplitealarteryanditsbranches Popliteallympnnodes FattytissuePoplitealartery Itbeginsattheadductortendinousopeningin.Hereitiscontinuouswiththefemoralartery.Itendsatthelowerborderofthepopliteusmusclewhereitdividesintoanteriorandposteriortibialarteries. Branches:1.Superior,inferior,andmiddlegeniculararteries2.MuscularbranchesPoplitealvein Thisisformedbythejunctionoftheanteriorandposteriortibialveinsnearthelowerborderofthepopliteusmuscle.Popliteallymphnodes Theremaybeoneortwonodesjustunderthedeepfascia,closetothepoplitealfossavessels. Theydrainthedeeptissuesofthelegandfootandthekneejoint.Theyalsoreceivesuperficiallymphvesselsfromthelateralsideofthefoot,theheel,andthebackofthecalf.Thesedrainalongthelineofthesmallsaphenousvein.Thebackoftheleg Findthesmallsaphenousvein FindtheSuralnerveandPeronealcommunicatingnerveFindout Gastrocnemius Soleus Plantaris Tibialnerve Poplitealarteryandbranches(Peronealartery) Popliteus Flexorhallucislongus Flexordigitorumlongus Tibialisposterior