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1、第二章第二章第二章第二章 女性生殖系统解剖女性生殖系统解剖女性生殖系统解剖女性生殖系统解剖The Anatomy of the Female Reproductive SystemThe Anatomy of the Female Reproductive System中山二院妇产科中山二院妇产科 1;.Female Reproductive SystemFemale Reproductive Systeml内、外生殖器内、外生殖器l血管、淋巴和神经血管、淋巴和神经l骨盆和骨盆底、骨盆和骨盆底、l临近器官临近器官2;.1 1 外生殖器外生殖器外生殖器外生殖器 External genital
2、organsExternal genital organs 生殖器官的外露部分,位于两股内侧,前为耻骨联合生殖器官的外露部分,位于两股内侧,前为耻骨联合pubis,后为会阴,后为会阴perineum,统称外阴,统称外阴 pudenda or vulva.3;.1. 1.阴阜阴阜阴阜阴阜 Mons pubis(or mons veneris)Mons pubis(or mons veneris)l耻耻骨骨联联合合前前面面的的皮皮肤肤隆隆起起,皮皮下下脂脂肪肪组组织织丰丰富富,青青春春期期后后开开始始生生长长倒倒三三角角形形阴阴毛毛,第二性征存在个体差异。第二性征存在个体差异。4;.阴阜阴阜阴阜阴
3、阜 Mons pubisMons pubis5;.2. 2. 大阴唇大阴唇大阴唇大阴唇Labium majusLabium majus(labia majoralabia majora)l两两个个纵纵行行隆隆起起的的皮皮肤肤皱皱襞襞,自自阴阴阜阜到到会会阴阴后后联联合合posterior commissure ,上上端连接圆韧带。有色素沉着和阴毛。端连接圆韧带。有色素沉着和阴毛。l皮下有一层致密结缔组织,富含弹性纤维和脂肪组织,几乎不含肌肉组织皮下有一层致密结缔组织,富含弹性纤维和脂肪组织,几乎不含肌肉组织l富含血管、淋巴管和神经,外伤后血管丛(静脉)破裂易形成血肿。富含血管、淋巴管和神经,外
4、伤后血管丛(静脉)破裂易形成血肿。l未产妇自然合拢,产后分开,绝经后萎缩。未产妇自然合拢,产后分开,绝经后萎缩。 6;.2. 2. 大阴唇大阴唇大阴唇大阴唇 Labium majusLabium majus7;.3. 3. 小阴唇小阴唇小阴唇小阴唇 Labium minus Labium minus (labia minoralabia minora)l大大阴阴唇唇内内侧侧的的一一对对薄薄皮皮肤肤皱皱襞襞,表表面面湿湿润润,无无毛毛,富富含含神神经经末末梢梢,前前端端融融合合包包绕绕阴阴蒂蒂,形形成成阴阴蒂蒂包包皮皮frenulum 和和阴阴蒂蒂系系带带prepuce 。后后方方形形成成阴阴唇
5、唇系系带带fourchet和和舟状窝舟状窝navicular fossa 。8;.3. 3. 小阴唇小阴唇小阴唇小阴唇 Labium minusLabium minus9;.4. 4. 阴蒂阴蒂阴蒂阴蒂 ClitorisClitoris海绵体构成,可以勃起,富含神经纤维。海绵体构成,可以勃起,富含神经纤维。由由3部分组成部分组成: l阴蒂头阴蒂头glans, l阴蒂体阴蒂体body(corpus),l两个阴蒂脚两个阴蒂脚crura附着于耻骨支上。附着于耻骨支上。仅阴蒂头可见,约仅阴蒂头可见,约68mm长。长。10;.4. 4. 阴蒂阴蒂阴蒂阴蒂 Clitoris Clitoris 11;.5.
6、 5. 阴道前庭阴道前庭阴道前庭阴道前庭 Vaginal vestibuleVaginal vestibulel小阴唇内侧的菱形区,前为阴唇系带,后为阴唇系带和舟状窝小阴唇内侧的菱形区,前为阴唇系带,后为阴唇系带和舟状窝fossa navicularis(阴道前庭窝),产后消失。有阴道口和尿道口。(阴道前庭窝),产后消失。有阴道口和尿道口。12;.5. 5. 阴道前庭阴道前庭阴道前庭阴道前庭 Vaginal vestibuleVaginal vestibule13;.前庭球前庭球前庭球前庭球 Vestibule bulbVestibule bulbl又称球海绵体(又称球海绵体(bulbocav
7、ernosus body),为勃起组织,表明被球海绵体肌覆盖。),为勃起组织,表明被球海绵体肌覆盖。14;.前庭球前庭球前庭球前庭球 Vestibule bulbVestibule bulb15;.前庭大腺前庭大腺前庭大腺前庭大腺 Major vestibule glandsMajor vestibule glandsl又称巴多林腺或巴氏腺又称巴多林腺或巴氏腺(Bartholins gland),位于大阴唇后部,被球海绵体覆盖,位于大阴唇后部,被球海绵体覆盖,直径大约直径大约0.51cm 。腺导管长约。腺导管长约 12cm 开口于前庭后部。开口于前庭后部。l性交时可分泌粘液起润滑作用,平时不可
8、触及,导管闭塞可以形成前庭大腺囊肿或性交时可分泌粘液起润滑作用,平时不可触及,导管闭塞可以形成前庭大腺囊肿或脓肿脓肿Bartholins gland abscess or cyst 。16;.前庭大腺前庭大腺前庭大腺前庭大腺 Major vestibule glandsMajor vestibule glands17;.尿道外口尿道外口尿道外口尿道外口 External Urethral orifice or urethraExternal Urethral orifice or urethral位于阴蒂后下方位于阴蒂后下方 ,其有一对尿道旁腺,其有一对尿道旁腺para-urethral or
9、 skenes glands,容易潜伏细,容易潜伏细菌。菌。18;.阴道口阴道口阴道口阴道口Vaginal orifice Vaginal orifice 和处女膜和处女膜和处女膜和处女膜hymenhymenl阴道口位于尿道口后方的前庭下部。阴道口位于尿道口后方的前庭下部。 l处女膜是膜状结构处女膜是膜状结构, 含有结缔组织、血管和神经,覆盖鳞状上皮。含有结缔组织、血管和神经,覆盖鳞状上皮。l可于性交或剧烈运动后破裂,形成处女膜痕可于性交或剧烈运动后破裂,形成处女膜痕myrtiform caruncles 。19;.阴道口阴道口阴道口阴道口 Vaginal orifice Vaginal or
10、ifice 处女膜处女膜处女膜处女膜 hymenhymen20;.2 2 内生殖器内生殖器内生殖器内生殖器 Internal genital organsInternal genital organs21;. 2 2 内生殖器内生殖器内生殖器内生殖器 Internal genital organsInternal genital organs真骨盆内:阴道、子宫、输卵管和卵巢22;.阴道阴道阴道阴道 VaginaVaginal位于盆腔中部,性交器官,月经血排出和胎儿分娩的通道。位于盆腔中部,性交器官,月经血排出和胎儿分娩的通道。l邻邻近近器器官官: 子子宫宫颈颈cervix (形形成成前前、后
11、后和和侧侧穹穹窿窿fornix),前前庭庭vestibule,膀膀胱胱和和尿尿道口道口urinary bladder & urethra,and 直肠直肠rectum。l阴阴道道后后穹穹窿窿Posterior vaginal fornix位位于于道道格格拉拉斯斯窝窝Douglas pouch(recto-uterine pouch or cul-de-sac)下方。下方。23;.内生殖器内生殖器内生殖器内生殖器 Internal genital organsInternal genital organs24;.阴道阴道阴道阴道 VaginaVaginal阴道壁阴道壁: 粘膜、肌肉和纤维组织。粘
12、膜、肌肉和纤维组织。 l阴阴道道皱皱襞襞Transverse mucosal ridge:伸伸展展性性大大,富富含含静静脉脉丛丛,外外伤伤易易形形成成血血肿肿和和出血。出血。l阴道粘膜阴道粘膜Vaginal mucosa: 非角化复层鳞状上皮非角化复层鳞状上皮-阴道脱落细胞学阴道脱落细胞学 cytology25;.Internal genital organsInternal genital organs26;.子宫子宫子宫子宫 UterusUterusl梨梨形形中中空空器器官官,容容积积约约5ml,子子宫宫内内膜膜Endometrium受受卵卵巢巢性性激激素素调调控控产产生生周周期期性月经。
13、性月经。l功能功能: 1.内膜脱落产生月经内膜脱落产生月经menstruation;2.精子通道;精子通道; 3.孕育胚胎孕育胚胎fetus; 4.分娩胚胎和胎盘分娩胚胎和胎盘placenta。 27;.l大小大小 7-84-52-3cm,重量,重量 50 g。l上部子宫体上部子宫体Uterine body or corpus uteri,子宫底,子宫底fundus uteri;子宫角;子宫角cornua uteri 。 l下部为子宫颈下部为子宫颈 cervix with cylinder shape.年轻女性:年轻女性:the body of uterus is only half as l
14、ong as the cervix;成年妇女:成年妇女:the body of uterus is two times longer than the cervix. 子宫子宫子宫子宫 UterusUterus28;.子宫子宫子宫子宫 Uterus Uterus 29;.Uterus of different stagesUterus of different stages30;.子宫子宫子宫子宫 UterusUterusl子宫峡部子宫峡部Isthmus uterus: is a narrow segment between the corpus and cervix. 非非孕妇女长孕妇女长1
15、cm becomes the lower uterine segment子宫下段子宫下段 in 孕妇。孕妇。 l上部解剖学内口上部解剖学内口anatomical internal os ;下部为组织学内口;下部为组织学内口 histological os.31;.子宫子宫子宫子宫 Uterus Uterus 32;.子宫体组织机构子宫体组织机构子宫体组织机构子宫体组织机构 l内内层层Inner layer: mucosal layer, 子子宫宫内内膜膜endometrium. 性性激激素素调调控控, 基基底底层层 & 功功能能层层 ;l中中层层Middle layer: 子子宫宫肌肌层层my
16、ometrium. much of blood vessel, 宫宫缩缩压压迫迫止止血血(decreasing uterine bleeding);l外外层层Outer layer: 浆浆膜膜层层serosal layer, 子子宫宫直直肠肠窝窝recto-uterine pouch (or cul-de-sac or Douglas pouch)and broad ligament的腹膜延续。的腹膜延续。33;.子宫颈子宫颈子宫颈子宫颈 CervixCervixl阴道上部和阴道部阴道上部和阴道部 Supra-vaginal & vaginal portion: fusiform shape
17、cavity of cervix宫颈管宫颈管 3cm 长。长。l粘液栓粘液栓Mucous plug: protect uterine cavity from infection. l宫颈内口和外口宫颈内口和外口 internal & external os of cervix. 34;.子宫颈子宫颈子宫颈子宫颈 CervixCervixl外口外口 The external os: 分娩前为小圆口,分娩后撕裂为前后唇分娩前为小圆口,分娩后撕裂为前后唇anterior and posterior lips of cervix 。35;.子宫颈子宫颈子宫颈子宫颈 CervixCervix 平滑肌和胶
18、原组织;平滑肌和胶原组织;l宫颈管粘膜宫颈管粘膜Cervical mucosa: 单层柱状上皮;单层柱状上皮;lVaginal portion of cervix披覆鳞状上皮。披覆鳞状上皮。l多数宫颈癌好发于多数宫颈癌好发于junction of squamous-columnar epithelium鳞柱上皮交界区鳞柱上皮交界区36;.子宫颈子宫颈子宫颈子宫颈 CervixCervix 37;.子宫韧带子宫韧带子宫韧带子宫韧带l圆圆韧韧带带Round ligament: 10-12厘厘米米,平平滑滑肌肌和和结结缔缔组组织织,宫宫角角前前面面,maintains the uterus at a
19、nteversion position.l主主韧韧带带Cardinal ligament (宫宫颈颈横横韧韧带带transverse cervical ligament) : 宫宫颈颈到到盆盆侧侧壁壁,fastens the uterus.l宫宫骶骶韧韧带带Uterosacral ligament:from the back of cervix to the 2nd and 3rd sacral fascia, maintaining the uterus at antevertion position.l阔韧带阔韧带 Broad ligament38;.子宫韧带子宫韧带子宫韧带子宫韧带39;
20、.阔韧带阔韧带阔韧带阔韧带 Broad ligamentBroad ligamentl宫旁到盆壁的翼状双层腹膜皱襞。宫旁到盆壁的翼状双层腹膜皱襞。lIts inner two-third enclosed oviduct, outer one-third is 骨盆漏斗韧带骨盆漏斗韧带infundibulo-pelvic ligament (or 卵巢悬韧带卵巢悬韧带suspensory ligament of ovary), ovarian artery & vein pass through this ligament. l输卵管系膜输卵管系膜Mesosalpinx, 卵巢韧带卵巢韧带ov
21、arian ligament, 宫旁组织宫旁组织parametrium. l子宫血管和输尿管子宫血管和输尿管pass under the broad ligament.40;.子宫韧带子宫韧带子宫韧带子宫韧带41;.输卵管输卵管输卵管输卵管 Fallopian tubeFallopian tube(oviductoviduct)长长8-14厘米,输卵管的四部分厘米,输卵管的四部分:1. 间质部间质部Interstitial or 宫角部宫角部intramural portion, short and narrow.2. 峡部峡部Isthmic portion(isthmus), narrow
22、and short.3. 壶腹部壶腹部Ampulla, wide lumen.4. 伞端伞端Fimbrae or 漏斗部漏斗部infundibulum, opens into abdominal cavity. 42;.输卵管输卵管输卵管输卵管 Fallopian tubeFallopian tube(oviductoviduct)43;.输卵管输卵管输卵管输卵管 Fallopian tube (oviduct)Fallopian tube (oviduct)Infundibulum,fimbrem,1-1.5cmAmpulla,5-8cmIsthmus,2-3cmInterstitial,1
23、cm44;. 三层组织三层组织三层组织三层组织 l外层外层Outer layer:peritoneum, serosal layer.l中中层层Middle layer:muscular layer. Ova can be moved toward uterine cavity by the muscle contracting.l内内层层 Inner layer:mucosa composed of a single layer of columnar cells with cilia, secretory function. 受性激素影响。受性激素影响。45;.卵巢卵巢卵巢卵巢 Ovary
24、OvarylAlmond-shaped. 大小大小431cm, 重量重量5-6g, 绝经后萎缩绝经后萎缩. l功能功能: 卵泡发育和排卵(生育),性激素合成和分泌(内分泌)。卵泡发育和排卵(生育),性激素合成和分泌(内分泌)。 l表面为表面为tunica albuginea(whitish)无腹膜;无腹膜;lOvarian blood vessels and nerves in the 卵巢门卵巢门hilum.Infundibulo-pelvic ligament. 46;.卵巢卵巢卵巢卵巢 OvaryOvary47;.卵巢卵巢卵巢卵巢 OvaryOvary48;.卵巢皮质卵巢皮质卵巢皮质卵巢
25、皮质 Cortex of ovaryCortex of ovaryl格格拉拉夫夫卵卵泡泡 graafian follicles 和和不不同同阶阶段段的的卵卵泡泡:始始基基卵卵泡泡primordial follicles, 初初级级卵卵泡泡primary follicles, 窦窦卵卵泡泡antral follicles, 成成熟熟卵卵泡泡mature follicles发育卵泡。发育卵泡。 l血血体体Hemorrhage cavity (blood filled cavity) and 黄黄体体corpus luteam (yellow body). 若未妊娠萎缩为白体若未妊娠萎缩为白体cor
26、pus albicantis (white body) 。 49;. 卵巢髓质卵巢髓质卵巢髓质卵巢髓质 Medulla of ovaryMedulla of ovary l疏疏松松结结缔缔组组织织富富含含血血管管、淋淋巴巴管管、神神经经和和平平滑滑肌肌纤纤维维(与与悬悬韧韧带带相相连连续续),没没有有卵卵泡泡,肌肉组织与卵巢运动有关。肌肉组织与卵巢运动有关。50;.3 3 3 3 血管、神经和淋巴血管、神经和淋巴血管、神经和淋巴血管、神经和淋巴Blood vessels, nerves and lymphBlood vessels, nerves and lymph 血管血管:l1. Righ
27、t ovarian artery卵卵巢巢动动脉脉 is from the 主主动动脉脉aorta( left ovarian artery may come from 肾动脉肾动脉renal artery).l2. Uterine artery子子宫宫动动脉脉, it crosses over 输输尿尿管管ureter宫宫旁旁2cm。upward and downward branch上行支和下行支上行支和下行支.51;.子宫动脉和输尿管子宫动脉和输尿管子宫动脉和输尿管子宫动脉和输尿管Uterine artery and ureterUterine artery and ureter52;.血
28、管血管血管血管 Blood vessels:Blood vessels:l3.Vaginal artery阴道动脉阴道动脉, 来自髂内动脉,供应阴道和膀胱。来自髂内动脉,供应阴道和膀胱。l4.Internal pudendal artery阴部内动脉阴部内动脉,来自髂内动脉终末支来自髂内动脉终末支, 分出分出4支支: perineal artery会阴动脉会阴动脉 labia artery阴唇动脉阴唇动脉 clitoris artery阴蒂动脉阴蒂动脉 inferior haemorroidal artery痔下动脉痔下动脉.53;.盆腔血管盆腔血管盆腔血管盆腔血管 Blood vessels
29、 of pelvisBlood vessels of pelvis internal iliac artery54;.盆腔血管盆腔血管盆腔血管盆腔血管 Blood vessels of pelvisBlood vessels of pelvisinternal iliac artery55;.外阴血管和神经外阴血管和神经外阴血管和神经外阴血管和神经 Blood vessels and nerves of the vulva and perineumBlood vessels and nerves of the vulva and perineum56;.淋巴淋巴淋巴淋巴 LymphLymphl
30、沿大动脉分布沿大动脉分布 ( internal iliac artery, external iliac a. , common iliac a. ,and aorta ) lleading to lumbar nodes腰淋巴结腰淋巴结(around aorta) and lfinally into thoracic duct胸导管。胸导管。 57;.内生殖器淋巴内生殖器淋巴内生殖器淋巴内生殖器淋巴 Lymph of the internal genital organsLymph of the internal genital organslIliac group髂淋巴组髂淋巴组: com
31、mon iliac nodes, external Iliac nodes and internal iliac nodeslLumbar group腰淋巴组腰淋巴组: around aortalSacral group骶前淋巴组骶前淋巴组: in front of sacrum lLower vagina-inguinal腹股沟组腹股沟组58;.淋巴淋巴淋巴淋巴 LymphLymph59;.lUpper vagina and cervix internal iliac nodes髂淋巴组髂淋巴组 sacral group骶前淋巴骶前淋巴组组lUterine body, fundus, ovi
32、duct, and ovary lumbar group腰淋巴组腰淋巴组lLateral uterine body round ligament superficial inguinal lymphatic node腹股沟浅淋巴腹股沟浅淋巴.内生殖器淋巴内生殖器淋巴内生殖器淋巴内生殖器淋巴 Lymph of the internal genital organsLymph of the internal genital organs60;.淋巴淋巴淋巴淋巴 LymphLymph61;.外生殖器神经外生殖器神经外生殖器神经外生殖器神经The nerve of external genital o
33、rgansThe nerve of external genital organs阴部神经阴部神经pudendal nerve最重要,来自最重要,来自 2nd, 3rd and 4th 骶神经,伴随阴部动脉。穿过骶神经,伴随阴部动脉。穿过 坐骨坐骨棘棘ischial spines后后-Obstetric local anesthesia产科局麻。产科局麻。在坐骨结节在坐骨结节tuberosity内侧内侧 分出分出3支支: linferior hemorrhoid nerve痔下神经痔下神经ldorsal nerve阴蒂背神经阴蒂背神经lperineal nerve会阴神经。会阴神经。62;.外
34、阴血管和神经外阴血管和神经外阴血管和神经外阴血管和神经 Blood vessels and nerves of the vulva and perineumBlood vessels and nerves of the vulva and perineum63;.Obstetric local anesthesiaObstetric local anesthesia64;.内生殖器神经内生殖器神经内生殖器神经内生殖器神经The nerve of the internal genital organsThe nerve of the internal genital organslSympath
35、etic and parasympathetic nerves from lumbar and sacral spinal cord.l神经丛神经丛: 主动脉丛主动脉丛 aortic plexus 骶前神经丛骶前神经丛 sacral plexus 腹下神经丛腹下神经丛 hypogastric plexus 卵巢神经丛卵巢神经丛 ovarian plexus65;.NervesNerves 66;.NervesNerves 67;.4 4 骨盆骨盆骨盆骨盆 Bony pelvisBony pelvis 胎儿阴道的娩出通道,包括胎儿阴道的娩出通道,包括:lOne sacrum骶骨:骶骨: 5 fu
36、sed vertebrae at the back of the pelvis.lOne coccyx尾骨:尾骨: 5 small pieces of cartilaginous bones.lTwo innominate bones 无名骨无名骨(coxae)68;.骨盆骨盆骨盆骨盆 Bony pelvisBony pelvis69;.骨盆骨盆骨盆骨盆 Bony pelvisBony pelvis无名骨无名骨: lone ileum髂骨髂骨,lone ischium坐骨坐骨, lone pubis耻骨耻骨.70;.骨盆关节骨盆关节骨盆关节骨盆关节 Pelvic jointsPelvic jo
37、intspubic symphysis耻骨联合(耻骨联合(a cartilage)、)、sacro-iliac joint骶髂关节、骶髂关节、sacro-coccygeal joint骶尾关节、骶尾关节、lumbo-sacral joint腰骶关节。腰骶关节。71;.骨盆韧带骨盆韧带骨盆韧带骨盆韧带 Pelvic ligamentsPelvic ligaments骶棘韧带骶棘韧带sacro-spinous ligament, 骶结节韧带骶结节韧带sacro-tuberous ligament72;.骨盆骨盆骨盆骨盆 pelvispelvis髂耻线髂耻线 Ilio-pectineal line(
38、terminal line)将骨盆分为上下两部分:)将骨盆分为上下两部分:假骨盆假骨盆False pelvis(大骨盆(大骨盆pelvis major)真骨盆真骨盆True pelvis(小骨盆(小骨盆pelvis minor):骨产道:骨产道bony birth canal 骨盆入口骨盆入口 pelvic inlet 骨盆出口骨盆出口pelvic outlet. 73;.骨盆骨盆骨盆骨盆 pelvispelvis74;. 真骨盆真骨盆真骨盆真骨盆 true true pelvispelvis前壁前壁4.2cm ,后壁,后壁9.8cm high. 女性骨盆浅而宽,胎儿易娩出。女性骨盆浅而宽,胎
39、儿易娩出。75;.骨盆骨盆骨盆骨盆 pelvispelvisbony marks骨性标志骨性标志:耻骨弓耻骨弓pubic arch, 骶骨岬骶骨岬sacral promontory,坐骨棘坐骨棘ischial spines.76;.骨盆四平面骨盆四平面骨盆四平面骨盆四平面Four planes of the pelvisFour planes of the pelvisl骨盆人口骨盆人口 Pelvic inlet (obstetric conjugate, anatomic conjugate or true conjugate)。)。 卵圆形,卵圆形, 真假骨盆分界线。真假骨盆分界线。77;
40、.骨盆人口骨盆人口骨盆人口骨盆人口 Pelvic inletPelvic inlet界限界限l后后: sacral promontory l前前: pubic symphysis l侧侧: ilio-pectineal line78;.骨盆最大平面骨盆最大平面 The plane of greatest pelvic dimension,圆形,界限:,圆形,界限:l前前: mid-point of the pubic symphysis l后后: junction of the 2nd and 3rd sacral vertebrae l侧侧: center of the acetabulum
41、(髋臼髋臼)骨盆四平面骨盆四平面骨盆四平面骨盆四平面Four planes of the pelvisFour planes of the pelvis79;.骨盆最小平面骨盆最小平面 The plane of least pelvic dimensions(中骨盆(中骨盆 midpelvis):): 卵圆形,胎头衔接后的梗阻性难产卵圆形,胎头衔接后的梗阻性难产obstructed labor 。 骨盆四平面骨盆四平面骨盆四平面骨盆四平面Four planes of the pelvisFour planes of the pelvis80;.中骨盆中骨盆中骨盆中骨盆 midpelvismid
42、pelvis界限界限l前前: inferior border of the pubic symphysis l后后: sacrum l侧侧: ischial spine,Inter spinous diameter should be 10cm or more.81;.骨盆出口骨盆出口骨盆出口骨盆出口 The outletThe outlet包括两个三角形平面:包括两个三角形平面: lThe apex of the 后三角后三角posterior triangle is at the tip of sacrum.l侧:骶结节韧带侧:骶结节韧带sacro-sciatic ligaments(sa
43、cro-tuberous lig.)and 坐骨结节坐骨结节ischial tuberosities. 82;.骨盆出口骨盆出口骨盆出口骨盆出口 The outletThe outletl前三角前三角anterior triangle is formed by the area under 耻骨弓耻骨弓pubic arch. lThe apex is at the inferior border of the 耻骨联合耻骨联合pubic symphysisl侧:侧: pubic rami. The inter tuberositys diameter 坐骨结节间经坐骨结节间经should be
44、 8cm or more. 83;.骨盆倾斜骨盆倾斜骨盆倾斜骨盆倾斜 Pelvic inclinationPelvic inclinationThe angle between horizon and the plane of pelvic inlet is about 60in an upright woman. If it is too big, the fetal head is difficult to engage the pelvis. 84;.骨盆轴骨盆轴骨盆轴骨盆轴 Pelvic axisPelvic axisPelvic axis, for an upright women,
45、 在盆腔上部在盆腔上部 指向后下指向后下,在盆腔下部弯向前下。在盆腔下部弯向前下。85;.骨盆形状骨盆形状骨盆形状骨盆形状 Pelvic shapesPelvic shapes骨盆骨盆4类型类型according to Callwell-Molog classification:l女性型女性型Gynaecoid type 5258.9%l扁平型扁平型Platypelloid type 23.229%l类人猿型类人猿型Anthropoid type 14.218%l男性型男性型Android type 13.7% 86;.4 types of the pelvis4 types of the p
46、elvis87;.5 5 骨盆底骨盆底骨盆底骨盆底 Pelvic floorPelvic floorl几层肌肉和筋膜,封闭骨盆出口,承托骨盆脏器,尿道、阴道和直肠经过,几层肌肉和筋膜,封闭骨盆出口,承托骨盆脏器,尿道、阴道和直肠经过,If the structure and function is damaged, there may happen prolapse脱垂脱垂of uterus, bladder and rectum. 88;.5 5 骨盆底骨盆底骨盆底骨盆底 Pelvic floorPelvic floorl前前Anterior: 耻骨联合耻骨联合pubic symphysis
47、 l后后Posterior: 尾骨尖尾骨尖coccyx tip l侧侧Lateral: 坐骨结节和耻骨降支坐骨结节和耻骨降支ischial tuberosity and pubic rami.lIncluding 3 layers:89;.内层内层内层内层Inner layerInner layer(盆膈(盆膈(盆膈(盆膈pelvic diaphragmpelvic diaphragm)肛提肌及其筋膜肛提肌及其筋膜:l耻尾肌耻尾肌Pubo-coccygeal muscle l髂尾肌髂尾肌Ilio-coccygeal musclel坐尾肌坐尾肌Ischio-coccygeal muscle 90
48、;.内层内层内层内层Inner layerInner layer(盆膈(盆膈(盆膈(盆膈pelvic diaphragmpelvic diaphragm)91;.内层内层内层内层Inner layerInner layer(盆膈(盆膈(盆膈(盆膈pelvic diaphragmpelvic diaphragm)内层筋膜内层筋膜 ( 盆底筋膜盆底筋膜pelvic fascia) 融合几条韧带融合几条韧带: 主韧带主韧带cardinal ligament宫底韧带宫底韧带utero-sacral ligament 耻骨耻骨-膀胱膀胱-宫颈韧带宫颈韧带pubo-vesico-cervical liga
49、ment. pelvic connective tissue, extra-peritoneal tissue,-宫旁组织宫旁组织parametrium.92;.中层中层中层中层 Middle layerMiddle layer(泌尿生殖膈(泌尿生殖膈(泌尿生殖膈(泌尿生殖膈urogenital diaphragm or urogenital diaphragm or 三角韧带三角韧带三角韧带三角韧带triangular ligamenttriangular ligament)l会阴深横肌会阴深横肌 deep transverse perineal muscle 及其筋膜及其筋膜 betwee
50、n pubic arch and tuberosities l尿道和阴道尿道和阴道urethra and vagina pass through it. lconstrictor around urethra尿道括约肌尿道括约肌.93;.中层中层中层中层 Middle layerMiddle layer(泌尿生殖膈(泌尿生殖膈(泌尿生殖膈(泌尿生殖膈urogenital diaphragm or urogenital diaphragm or 三角韧带三角韧带三角韧带三角韧带triangular ligamenttriangular ligament)94;.外层外层外层外层 Outer la
51、yerOuter layerSuperficial fascia and muscles:1. 会阴浅筋膜会阴浅筋膜Superficial perineal facia(Colles fascia)2. 球海绵体肌球海绵体肌Bulbocavernosus muscle3. 坐骨海绵体肌坐骨海绵体肌Ischiocavernosus muscle 4. 会阴浅横肌会阴浅横肌Superficial transverse perineal muscle 5. 肛门外括约肌肛门外括约肌External sphincter muscle of anus95;.外层外层外层外层 Outer layerOut
52、er layer96;.会阴会阴会阴会阴 PerineumPerineum The central tendon of perineum.l会阴体会阴体 Perineal body includes skin, adipose tissue and the 中心腱中心腱central tendon. 孕期变软易伸展。孕期变软易伸展。 l会阴是阴道和肛门之间的软组织,分娩时阻碍胎头可能撕裂。会阴是阴道和肛门之间的软组织,分娩时阻碍胎头可能撕裂。97;.6 6 邻近器官邻近器官邻近器官邻近器官 Adjacent organsAdjacent organsl尿道尿道 Urethra 约约4cm长长,
53、 短于男性尿道。短于男性尿道。 l内口位于膀胱颈。内口位于膀胱颈。 l外口开口于前庭外口开口于前庭 。 l在耻骨联合后阴道前。在耻骨联合后阴道前。98;.尿道尿道尿道尿道 UrethraUrethra99;.邻近器官邻近器官邻近器官邻近器官 Adjacent organsAdjacent organsl膀胱膀胱Urinary bladder: 三角形囊状中空器官,位于子宫和耻骨联合之间三角形囊状中空器官,位于子宫和耻骨联合之间 。 l三层三层: serosal, muscular and mucosal layer. l膀胱三角膀胱三角Trigone , Ureteric openings.l
54、容容积积约约400ml, can be greatly distended.过过度度充充盈盈Over-distention导导致致尿尿潴潴留留retention of urine。 100;.膀胱膀胱膀胱膀胱 bladderbladder101;.bladderbladdercervixureterUterine arteryrectum102;.输尿管输尿管输尿管输尿管 UreterUreterl30cm长长, 腹腹膜膜后后,在在骶骶髂髂关关节节前前穿穿过过髂髂外外动动脉脉external iliac artery 进进入入pelvic cavity。 l宫宫颈颈旁旁2cm 穿穿过过子子宫宫
55、动动脉脉后后方方 uterine artery away。输输尿尿管管损损伤伤Ureter injury when performing hysterectomy !l三三层层: mucosa, muscle and outer membrane. Its blood supplying is from renal, ovarian, iliac, uterine and bladder artery. 103;.邻近器官邻近器官邻近器官邻近器官 Adjacent organsAdjacent organs104;.直肠直肠直肠直肠 RectumRectuml约约15-20cm长长, conn
56、ecting with 乙状结肠乙状结肠sigmoid colon and anus. l肛管肛管Anal canal 2-3cm 长长. l肛肛门门内内外外括括约约肌肌internal & external sphincters和和肛肛提提肌肌ani levater muscle around anus.105;.阑尾阑尾阑尾阑尾 Appendix vermiformisAppendix vermiformisl7-9cm长长, 位于右髂窝位于右髂窝right iliac fossa. lIt may be lifted higher during pregnancy. l阑尾炎阑尾炎Appendicitis可能误诊为盆腔炎可能误诊为盆腔炎pelvic inflammation in some cases. 106;.中山二院妇产科国内先进妇产科广东省重点学科硕导13名、博导5名欢迎报考我科研究生!电话:电话:020-81332233,13602797433E-mail:107;.