直肠和肛管.ppt

直直肠和肛管和肛管Rectum&Anal Canal1 1.盆部与会阴盆部与会阴概述概述一、境界与分区一、境界与分区 会阴会阴：1.尿生殖区尿生殖区 2.肛区肛区二、表面解剖二、表面解剖 耻骨耻骨联合，耻骨合，耻骨嵴，耻骨，耻骨结节，髂前上棘，前上棘，耻骨弓，坐骨耻骨弓，坐骨结节，尾骨尖尾骨尖 2 2.三、骨盆整体三、骨盆整体观 界线，大、小骨盆，骨盆上、下口，骨盆腔，闭孔，闭膜管四、盆壁肌四、盆壁肌 闭孔内肌，梨状肌 3 3.五、盆底肌与盆膈五、盆底肌与盆膈 肛提肌：肛提肌：前列腺提肌（耻骨阴道肌），耻骨直肠肌，耻尾肌和髂尾肌 尾骨肌尾骨肌 盆膈上、下筋膜盆膈上、下筋膜4 4.盆部的血管、淋巴和神盆部的血管、淋巴和神经动动脉脉脉脉 髂总动髂总动脉、脉、髂髂内内动动脉脉 壁支：壁支：髂髂腰腰动动脉，骶外脉，骶外侧动侧动脉，臀上脉，臀上动动脉，脉，臀下臀下动动脉，脉，闭闭孔孔动动脉脉 脏脏支：膀胱上、下支：膀胱上、下动动脉，子脉，子宫动宫动脉，脉，直直肠肠下下动动脉，阴部内脉，阴部内动动脉脉 髂髂外外动动脉脉 旋旋髂髂深深动动脉和腹壁下脉和腹壁下动动脉脉静脉静脉静脉静脉 与同名与同名动动脉伴行，直脉伴行，直肠肠的静脉的静脉丛丛分分为为内外两部分，二内外两部分，二 者之者之间间有广泛吻合，构成了有广泛吻合，构成了门门腔静脉系的交通腔静脉系的交通5 5.淋巴淋巴:髂外、内淋巴结，骶淋巴结髂总淋 巴结左、右腰淋巴结神神经：骶骶丛丛由腰骶干、第由腰骶干、第1414骶神骶神经经前支前支组组 成，位于梨成，位于梨状肌前面，其分支状肌前面，其分支经经梨状肌梨状肌 上、下孔出盆，分布于上、下孔出盆，分布于臀部、会阴及下肢。臀部、会阴及下肢。内内脏脏神神经经：骶交感干，上腹下骶交感干，上腹下丛丛，盆内，盆内脏脏神神经经6 6.直直肠 位置与形位置与形位置与形位置与形态态：骶曲和会阴曲骶曲和会阴曲 直直肠肠横襞（上：横襞（上：13cm13cm；中中:11cm:11cm；下下:8cm:8cm）毗毗毗毗邻邻：血管、淋巴和神血管、淋巴和神血管、淋巴和神血管、淋巴和神经经：直直肠肠上、下上、下动动脉脉 上份：直上份：直肠肠旁淋巴旁淋巴结结-直直肠肠上淋巴上淋巴结结-肠肠系膜下淋系膜下淋巴巴结结 下份：下份：髂髂内淋巴内淋巴结结 后：骶淋巴后：骶淋巴结结 其他：其他：髂髂内淋巴内淋巴结结 神神神神经经：交感：来自交感：来自肠肠系膜下系膜下丛丛和盆和盆丛丛 副交感：来自盆内副交感：来自盆内脏脏神神经经7 7.Rectum1.Position,shape and relations1.Position,shape and relationsl lThe The rectum rectum lies lies in in front front of of the the sacrum sacrum and and coccyx.coccyx.It It begins begins at at the the pelvic pelvic surface surface of of the the 3rd 3rd sacral sacral vertebra vertebra as as the the continuation continuation of of the the sigmoid sigmoid colon.colon.Running Running downwards,downwards,it it pierces pierces the the pelvic pelvic diaphragm diaphragm to to end end as as the the anus.anus.It It is is approximately approximately 1216cm 1216cm in in length.length.The The part part of of the the rectum rectum superior superior to to the the pelvic pelvic diaphragm diaphragm is is the the pelvic pelvic part part and and below below this this diaphragm diaphragm is is the the anal anal canal.canal.The The lower lower portion portion of of the the pelvic pelvic part part of of rectum rectum is is frequently frequently more more distended distended than than the the remainder,remainder,and and is is known known as as the the ampulla ampulla of of rectum.rectum.8 8.9 9.1010.1111.1212.1313.1414.1515.Structure of the rectum&anal canal1616.1717.1818.1919.2020.2121.2222.2323.2424.2525.Prineopelvic spaces2626.2727.2828.1.骨盆直骨盆直肠间隙（隙（2）2.坐骨直坐骨直肠间隙隙(2)3.直直肠后后间隙隙(1)(骶前骶前间隙隙)共五个共五个间隙隙2929.Blood vessels3030.3131.3232.Lymphatic drainage3333.3434.3535.3636.3737.Innervation3838.3939.4040.4141.4242.4343.4444.4545.4646.5/26/20245/26/20244747.