Pelvic 盆部

1. Pelvic 盆部 山东大学医学院 解剖教研室 李振华

2. Bony pelvis Composition: formed by paired hip bones, sacrum, coccyx, and their articulations Two portions • Greater pelvis • Lesser pelvis • Terminal line ( pelvic inlet): formed by promontory of sacrum, arcuate line, pectin of pubis, pubic tubercle, upper border of pubic symphysis • Pelvic outlet: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis

3. Muscles of pelvic wall • Piriform m. • Obturator internus m.

4. Muscles of floor of pelvis • Levator ani 肛提肌 • Levator prostate 前列腺提肌(pubovaginalis 耻骨阴道肌) • Puborectalis 耻骨直肠肌 • Pubococcygeus 耻尾肌 • Iliococcygeus 髂尾肌 • Coccygeus 尾骨肌

5. Pelivic diaphragm 盆膈 • Formed by • Superior fascia of pelvic diaphragm 盆膈上筋膜 • Levator ani 肛提肌and coccygeus 尾骨肌 • Inferior fascia of pelvic diaphragm 盆膈下筋膜 • Hiatus of pelvic diaphragm盆膈裂孔

6. Pelvic fascia Parietal pelvic fascia 盆壁筋膜 • Lines the pelvic walls and is regionally named according to the muscle it overlies. • Above the pelvic inlet, it is continuous with the fascia lining the abdominal walls. • Superior fascia of pelvic diaphragm 盆膈上筋膜 • Inferior fascia of pelvic diaphragm 盆膈下筋膜

7. Pelvic fascia Visceral pelvic fascia盆脏筋膜 • A layer of loose connective tissue that covers and supports all the pelvic viscera. • Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs • Rectovesical septum 直肠膀胱隔 • Rectovaginal septum 直肠阴道 • Vesicovaginal septum 膀胱阴道隔

8. Spaces of pelvic fascia • Retropubic space耻骨后隙 • Lies between pubic symphysis and urinary bladder • Pararectal space直肠周间隙 • Lies around the rectum • Retrorectal space直肠后隙

9. Common iliac artery 髂总动脉 • Continuation of abdominal aorta at level of L4 vertebra • Run downward and laterally to end opposite the sacroiliac joint by dividing into internal and external iliac arteries.

10. Internal iliac artery 髂内动脉 Parietal branches • Obturator a. 闭孔动脉 • Iliolumber a. 髂腰动脉 • Lateral sacral a. 骶外侧动脉 • Superior gluteal a. 臀上动脉 • Inferior gluteal a. 臀下动脉

11. Internal iliac artery 髂内动脉 Visceral branches • Umbilical a. 脐动脉→ superior vesical a.膀胱上动脉 • Inferior vesical a. 膀胱下动脉 • Uterine a.子宫动脉 • Inferior rectal a. 直肠下动脉 • Internal pudendal a. 阴部内动脉

12. Internal iliac artery 髂内动脉 • Uterine a.子宫动脉－about 2cm from neck of uterus it crosses above and in front of ureter 小桥流水

13. Internal iliac artery 髂内动脉 • Uterine a.子宫动脉－about 2cm from neck of uterus it crosses above and in front of ureter 小桥流水

14. Internal iliac artery 髂内动脉 Internal pudendal artery阴部内动脉 • Course: leaves the pelvis through the infrapiriform foramen and enters the gluteal region. It enters the perineum through the lesser sciatic foramen and then passes forward in the pudendal canal with the pudendal nerve. • Branches • Anal artery • Perineal artery • Dorsal artery of penis (clitoris)

15. Veins of pelvis • Internal iliac vein 髂内静脉 • Parietal tributaries: accompany with arteries • Visceral tributaries • External iliac vein髂外静脉 – accompany the artery • Common iliac vein髂总静脉 • Formed by union of internal and external iliac veins in front of sacroiliac joint • End upon L4~L5 by uniting each other to form inferior vena cava

16. Veins of pelvis Internal iliac vein髂内静脉 • Parietal tributaries: accompany with arteries • Visceral tributaries ① Rectal venous plexus →superior rectal vein→inferior mesenteric v. 直肠静脉丛→inferior rectal vein→internal iliac v. →anal vein→internal pudendal v. ② Vesical venous plexus 膀胱静脉丛→vesical v. ③ Uterine venous plexus 子宫静脉丛→uterine v.

17. Venogram showing the veins of the pelvis and groin. Contrast medium has been injected into the bodies of the pubic bones.

18. The lymphatic drainage of pelvis • Internal iliac lymph node • Surround internal iliac vessels • Receive afferents from pelvic viscera, perineum, buttock and back of thigh • External iliac lymph nodes • Lie along external iliac artery • Receive afferents from lower limb and some parts of pelvic viscera • Sacral lymph node • Common iliac lymph node • Lie along common iliac artery • Receive afferents from all the above nodes • Efferent pass to lumbar lymph node

19. Sacral plexus 骶丛 L4 • Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves • Position: lies in pelvic cavity, anterior to sacrum and piriformis L5 S1 S2 S3 S4 S5 Co

20. Sacral plexus 骶丛 Branches • Superior gluteal n. • Inferior gluteal n. • Posterior femoral cutaneous n. • Pudendal n. • Sciatic n.

21. Autonomic plexuses of plevic • Hypogastric plexus腹下丛 • Superior hypogastric plexus 上腹下丛lies in front of L5 between common iliac ateries • Inferior hypogastric plexus 下腹下丛(pelvic plexus): lie on each side of rectum • Sacral sympathetic trunk 骶交感干 • Is continuous above with the abdominal part • Has 4 or 5 ganglion

22. Relations of rectum Anteriorly in male • Fundus of bladder • Seminal vesicle • Prostate • Ampulla ductus deferentis • Pelvic part of ureter Anteriorly in female • Neck of uterus • Vagina

23. Relations of rectum Posteriorly • Sacrum and coccyx • Piriformis • Median and lateral sacral vessels • Anterior branches of sacral and coccygeal nerves • Sacral sympathetic trunk and ganglion impar Laterally • Pelvic plexus • Superior and inferior rectal vessels • Levator ani

24. Vessels and lymphatics of rectum • Arteries • Superior rectal a. • Inferior rectal a. • Median sacral a. • Lymphatic drainge • Pararectal ln. • Superior → superior rectal ln. • Inferior → internal iliac ln. • Posterior → sacral ln.

25. Relations of urinary bladder • Superior surface (covered by peritoneum) • Small intestine • Sigmoid colon • Body of uterus, when bladder if empty • Posterior surface • In males • Seminal vesicle • Ampulla of ductus deferens • Rectum • In females • Vagina • Neck of uterus

26. Relations of urinary bladder • Inferolateral surfaces (devoid of peritoneum) • Anteriorly－retropubic pad of fat and pubic bone • Posteriorly －fascia overlying obturator internus and levator ani muscles • Apex－pubic symphysis • Neck(below and least mobile) • In the male, rests of prostate and urogenital diaphragm • In the female,rests directly on pelvic fascia surrounding the short urethra

27. Relations of uterus • Anteriorly－ separated by vesicouterine pouch from superior surface of urinary bladder • Posteriorly－ separated by rectouterine pouch and rectovaginal septum from rectum

28. Male Genital Organs Testis Epididymis Head, body and tail of epididymis Ductus deferens Spermatic cord Seminal vesicle Prostate Male urethra Prostatic part Membranous part Cavernous part Subpubic curvature Prepubic curvature Female Genital Organs Ovary Suspensory ligament of ovary Proper ligament of ovary Uterine tubes Infundibulum of uterine tube Ampulla of uterine tube Isthmus of uterine tube Uterus Fundus of uterus Body of uterus Neck of uterus Broad ligament of uterus Round ligament of uterus Fornix of vagina ★You must identify follow structures！

29. Common iliac artery Internal iliac artery Umbilical a. Superior vesical a. Inferior vesical a. Uterine a. External iliac artery Sacral plexus Obturator n. Obturator a. ★You must identify follow structures！