Section 3 The perineum
Section 3 The perineum
Urogenital triangle
Anal triangle
Male
Section 3 The perineum
Urogenital triangle
Anal triangle
Female
Section 3 The perineum
Female
Obstetrical perineum
Appendix II
The Perineum (会阴)
A. The Anal Region
(triangle)
[肛区 (肛三角)]
B. The Urogenital
Region (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
A. The Anal Region
2. sphincter ani externus (肛门外括约肌)
皮下部
浅部
深部
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)
Ischioanal (ischiorectal) fossa (坐骨肛门窝)
pudendal canal (阴部管) pudendal nerve &
internal pudendal v., a.,
pudendal nerve (S2-4)
→ anal nn.
→ perineal nn.
→ dorsal n. of penis (clitoris)
A. The Anal Region
3. 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)
The Urogenital Region
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
4) 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)
The Urogenital Region
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)
Section 3 The perineum
pelvic diaphragm
Urogenital diaphragm
Section 3 The perineum
Accessory gland
• The greater vestibular
(Bartholin’s) glands
– On either side of vaginal
orifice
– 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
Hymen
Section 3 The perineum
The External Genital Organs (外
生殖器)
A. THE
SCROTUM
(阴囊)
B. THE PENIS (阴茎)
The external reproductive organs
Ⅰ) 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
The Scrotum (阴囊)
cavity of tunica vaginalis
(鞘膜腔)
[hydrocele of tunica
vaginalis 鞘膜积液]
[varicocele
精索静脉曲张]
Parietal peritoneum
Transvers fascia
Trasversus abdominis
Obliquus internus
abdominis
Aponeurosis of obliquus
externus abdominis
External spermatic fascia
Cremastter
Internal spermatic fascia
Tunica vaginalis of testis
Ⅱ) The penis
• 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
The male urethra
Three parts
• Prostatic part
Lies 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.
The Penis (阴茎)
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)
[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
mucous 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 Male 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 nerves
Superior 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 foramen.
• 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:
Biceps femoris
• Upper medial boundary:
semimembranosus and
semitendinosus
• Two lower boundaries are
the heads of
gastrocnemius
• Posterior wall: deep
fascia
• Anterior wall: popliteal
surface 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
middle genicular arteries
2. Muscular branches
Popliteal vein
• This is formed by the junction of the
anterior and posterior tibial veins near
the lower border of the popliteus muscle.
Popliteal lymph nodes
• There may be one or two nodes just
under 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
saphenous vein
• Find the Sural nerve and
Peroneal communicating
nerve
Find out
• Gastrocnemius
• Soleus
• Plantaris
• Tibial nerve
• Popliteal artery and
branches (Peroneal
artery )
• Popliteus
• Flexor hallucis longus
• Flexor digitorum longus
• Tibialis posterior