摘要
目的 通过对肛管周围解剖关系的观察 ,分析肛管直肠角形成和维持的解剖机制 ,为临床提供形态学参考依据。方法 从盆部侧方对 5 9例小儿肛直肠周围相关结构进行了层次解剖观察和测量。结果 会阴体是由会阴深、浅横肌、球海绵体肌、前列腺提肌 (或耻骨阴道肌 )和肛门外括约肌前部纤维交织而成的腱质结构 ,肛管前壁上部的直肠纵肌和肛门内括约肌也向前呈角状突起 ,融合于会阴体。耻骨直肠肌与前列腺提肌 (或耻骨阴道肌 )共同起于耻骨支后面和肛提肌腱弓前部 ,位于耻骨尾骨肌外下方同一层次上 ,两者间无明显分界。前列腺提肌 (或耻骨阴道肌 )止于会阴体 ;耻骨直肠肌在肛直曲后方与对侧同名肌的肌束接续形成袢。结论 由于肛管前壁上部牢固地固定于会阴体 ,会阴体及与之相连的前列腺提肌 (或耻骨阴道肌 )是除耻骨直肠肌以外另一个对肛管直肠角形成和维持的结构因素。耻骨直肠肌和前列腺提肌 (或耻骨阴道肌 )无论在形态上还是在功能上都应视为一个整体 ,两者分别牵拉肛直前、后角向前上方 ,在上提肛管的同时加曲肛直角。由于会阴体在盆底中央位置相对固定 ,肛直前、后角在排便与排便控制过程中变动的幅度有较大的差别。
Objective To demonstrate the structures which deal with the formation and maintenance of the anorectal angle and provide an anatomic reference for clinical practice. Methods 59 well embalmed children cadavers aged from 1-5 years were dissected under a magnifier, the structures surounding the ano rectum were observed and measured. Results The perineal body was composed of the external anal sphincter, deep and superficial transverse perineal muscles, bulbocavernosus muscle and puboprostatic muscle in male or pubovaginal muscle in female. The longitudinal muscle and the internal anal sphincter in front of the upper part of anal canal were found to be blended with the perineal body. The anterior portion of the levator ani can be divided into two layers, the upper layer belonged to the pubococcygeus muscle; the lower layer consisted of the anterior portion of the puborectalis sling and puboprostatic muscle or pubovaginal muscle. At the level of the pelvic floor, the longitudinal muscle fused with the inner fibers of the levator ani to form a conjoined longitudinal coat. Conclusions Apart from the puborectalis sling, the perineal body and the puboprostatic muscle or pubovaginal muscle are main components that deal with the formation and maintenance of anorectal flexure. The rectum ends where it passes through the pelvic floor at which it angles sharply backward and downward so as to retain normal bowel control.
出处
《中华小儿外科杂志》
CSCD
2000年第5期298-301,共4页
Chinese Journal of Pediatric Surgery
