section 3 the perineum

Section 3 The perineum

Urogenital triangle Urogenital triangle

Anal triangle Anal triangle

Male


Female

Urogenital triangle Urogenital triangle

Anal triangle Anal triangle


Obstetrical perineum


Female

Appendix II The Perineum (会阴 )

A. The Anal Region (triangle)

[ 肛区 ( 肛三角 )]B. The Urogenital Regi

on (triangle) [ 尿生殖区 ( 尿生殖三角 )]

A. The Anal Region (Triangle) 1. Pelvic diaphragm ( 盆膈 ) 1) superior fascia of pelvic diaphragm ( 盆膈上筋膜 ) 2) levator ani ( 肛提肌 ) & coccygeus ( 尾骨肌 ) 3) inferior fascia of pelvic diaphragm ( 盆膈下筋膜 )

2 Anal canal ( 肛管 ) 1. Internal structure 1) anal columns ( 肛柱 ) 2) anal valves ( 肛瓣 ) [fissure in ano 肛裂 ] 3) anal sinuses ( 肛窦 ) [anal fistula 肛瘘 ] 4) dentate (anocutaneous) line ( 齿状线 ) 5) anal pecten ( 肛梳 ) [pile (hemorrhoid) 痔 ] 6) white line (intersphincter sulcus) ( 白线 ) 7) anus ( 肛门 ) [examination per anus 肛门检查 ]

A. The Anal Region

2. sphincter ani externus ( 肛门外括约肌 ) 皮下部浅部深部A. The Anal Region

2. Muscles 1) sphincter ani internus ( 肛门内括约肌 ) 2) sphincter ani externus ( 肛门外括约肌 ) a. subcutaneous part ( 皮下部 ) b. superficial part ( 浅部 ) c. deep part ( 深部 ) [fecal incontinence 大便失禁 ]

3. Ischioanal (ischiorectal) fossa ( 坐骨肛门窝 )

pudendal nerve (S2-4) → anal nn. → perineal nn. → dorsal n. of penis (clitoris)

Ischioanal (ischiorectal) fossa ( 坐骨肛门窝 ) pudendal canal ( 阴部管 ) pudendal nerve & internal pudendal v., a.,

A. The Anal Region3. Ischioanal (ischiorectal) fossa ( 坐骨肛门窝 ) pudendal canal ( 阴部管 ) pudendal nerve & internal pudendal v., a.,

[ischiorectal abscess 坐骨肛门窝脓肿 ]

B. The Urogenital Region (triangle) 1. Superficial fascia of perineum (Colles) (会阴浅筋膜 )

2. Superficial perineal space ( 会阴浅间隙 ) 1) superficial transverse muscle of perineum ( 会阴浅横肌 ) 2) bulbocavernous muscle ( 球海绵体肌 ) 3) ischiocavernous muscle ( 坐骨海绵体肌）

The Urogenital Region

The Urogenital Region4) urogenital diaphragm ( 尿生殖膈 ) a. inferior fascia of urogenital diaphragm ( 尿生殖膈下筋膜 ) b. superior fascia of urogenital diaphragm ( 尿生殖膈上筋膜 )

c. deep perineal space ( 会阴深间隙 ) i. deep transverse muscle

of perineum ( 会阴深横肌 ) ii. sphincter of urethra M:

( 尿道括约肌 ) urethrovaginal sphincter F: ( 尿道阴道括约肌 )

The Urogenital Region

Urogenital diaphragmUrogenital diaphragm

pelvic diaphragm pelvic diaphragm


Accessory gland

• The greater vestibular (Bartholin’s) glands – On either side of vaginal orif

ice– Open into vestibule at orifice

of vagina


II. The external reproductive organs

• Mons pubis • Greater lips of pudendum • Lesser lips of pudendum • Vaginal vestibule • Clitoris • Bulb of vestibule

The External Genital Organs (外生殖器 )

A. THE SCROTUM ( 阴囊 ) B. THE PENIS ( 阴茎 )

The external reproductive organsⅠ) The scrotum

• Pouch of thin skin lying below the root of the penis

• Divided into two haves by septum of scrotum, contains testes and their ducts

• Deep to skin is dartos coat , a connective tissue layer that contains many smooth muscle fibers which contracts in response to cold, pulling the testes closer to the body and wrinkling the skin

cavity of tunica vaginalis ( 鞘膜腔 )

[hydrocele of tunica vaginalis 鞘膜积液 ]

[varicocele 精索静脉曲张 ]

The Scrotum (阴囊 )

Aponeurosis of obliquus externus abdominis

Obliquus internus abdominis

Trasversus abdominisTransvers fascia

Parietal peritoneum

External spermatic fascia

CremastterInternal spermatic fascia

Tunica vaginalis of testis

• Consists of the root, body and glans penis

• Contains– Two cavernous body of penis– A cavernous body of urethra

Skin － thin and loose – Prepuce of penis – Frenulum of prepuce

Ⅱ) The penis

The male urethra

Three parts• Prostatic part Li

es within the prostate and is the widest and most dilatable portion of urethra.

• Membranous part Lies within the urogenital

diaphragm surround by the sphincter of urethra.

• Cavernous part Transverse the length of cavernous body of urethra.

2. Compositions ( 组成 ) 1) cavernous body of penis

( 阴茎海绵体 ) crus of penis ( 阴茎脚 ) 2) cavernous body of urethra ( 尿道海绵体 ) glans f penis ( 阴茎头 ) bulb of urethra ( 尿道球 )

The Penis (阴茎 )

The Penis (阴茎 )

[redundant prepuce 包皮过长 ] [phimosis 包皮狭窄 ] [paraphimosis 包皮嵌顿 ] [circumcision 包皮环切术 ] [smegma 包皮垢 ] [carcinoma of penis 阴茎癌 ] 2) neck of penis ( 阴茎颈 ) 3) body of penis ( 阴茎体 ) 4) root of penis ( 阴茎根 )

The Bulbourethral Gland (尿道球腺 )

The bulbourethral gland ( 尿道球腺 ) The urethral mucous glands ( 尿道粘膜腺 ) Function ( 功能 ): produce a m

ucous secretion sometime (up to several minutes) before ejaculation

( 射精前分泌 )

The Male Urethra(男尿道 )A. Division ( 分部 )1. Prostatic part ( 前列腺部 ) 1) urethral ridge ( 尿道嵴 ) 2) seminal colliculus ( 精阜 ) 3) prostatic utricle ( 前列腺小囊 )2. Membranous part ( 膜部 )3. Cavernous part ( 海绵体部 ) 1) bulb of urethra ( 尿道球 ) 2) navicular fossa ( 舟状窝 )

The MaleMale Urethra( 男尿道 )B. Strictures ( 狭窄 ) 1. Internal urethral orifice

( 尿道内口 ) 2. Membranous portion ( 膜部 ) 3. External orifice ( 尿道外口 )

The Male Urethra(男尿道 )C. Curvatures ( 弯曲 ) 1. Subpubic curvature

( 耻骨下曲 ) 2. Prepubic curvature

( 耻骨前 [urethrostenosis

尿道狭窄 ]

The gluteal region and back of thigh and leg

Cutaneous nervesSuperior cluneal n.

Medial cluneal n.

Inferior cluneal n.

suprapiriform foramen

infrapiriform foramen

Structures passing suprapiriform foramen

• Superior gluteal n., a., v. from lateral to medial side

Structures passing infrapiriform foramen

• Sciatic n., posterior femoral cutaneous n., inferior gluteal n., a.,v., internal pudendal v., a., and pudendal n. from lateral to medial side

Pudendal nerve, internal pudendal artery • These structures enter the gluteal region through the infrapiriform f

oramen. • They then curve forwards to enter the perineum through the lesser

sciatic foramen.

★Sciatic nerve • Course: It arises from the sacral plexus and

passes through infrapiriform foramen into the gluteal region, deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, the nerve lies deep to the long head of biceps on the posterior surface of adductor magnus. The sciatic nerve usually ends half-way down the back of the thigh by dividing into the common peroneal and tibial nerves.

• Distribution: semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

Relationship of sciatic n. to the piriformis

Boundaries of the popliteal fossa• Diamond-shaped • Upper lateral boundary: Bic

eps femoris • Upper medial boundary: semimembranosus and se

mitendinosus • Two lower boundaries are t

he heads of gastrocnemius • Posterior wall: deep fascia • Anterior wall: popliteal surf

ace of the femur, the posterior capsule of the knee joint, and the fascia covering poplitells

Contents of the popliteal fossa • Tibial and common

peroneal nerves and their branches

• Popliteal vein and its tributaries

• Popliteal artery and its branches

• Popliteal lympn nodes

• Fatty tissue

Popliteal artery• It begins at the adductor

tendinous opening in. Here it is continuous with the femoral artery. It ends at the lower border of the popliteus muscle where it divides into anterior and posterior tibial arteries.

• Branches: 1. Superior, inferior, and mi

ddle genicular arteries 2. Muscular branches

Popliteal vein• This is formed by the junction of the ante

rior and posterior tibial veins near the lower border of the popliteus muscle.

Popliteal lymph nodes • There may be one or two nodes just und

er the deep fascia, close to the popliteal fossa vessels.

• They drain the deep tissues of the leg and foot and the knee joint. They also receive superficial lymph vessels from the lateral side of the foot, the heel, and the back of the calf. These drain along the line of the small saphenous vein.

The back of the leg• Find the small saphenou

s vein• Find the Sural nerve and

Peroneal communicating nerve

Find out• Gastrocnemius • Soleus • Plantaris • Tibial nerve • Popliteal artery and bran

ches (Peroneal artery )• Popliteus • Flexor hallucis longus • Flexor digitorum longus • Tibialis posterior

section 3 the perineum

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