中国医科大学：直肠肛管疾病（PPT课件讲稿）Rectal Anal Disease（主讲：苏 琪）

结直肠肛管 苏琪N0.2 HOSPITAL CHIINA MEDICAL UNIVERSITY

结直肠肛管 苏 琪 No.2 HOSPITAL CHINA MEDICAL UNIVERSITY

结肠特点 A ,如 图40-36 Dixon手术

结肠特点

直肠范围分段 要的几个同 壁腹膜 间,与州 直同 直肠 肛提肌 一直肠横襞 坐骨直肠窝 肛柱 肛管内括约肌 一直肠上静脉丛 缸管外括约肌深部 齿状线 性曾 缸管外括约肌浅部 肛管外括约肌皮下部 直肠下静脉丛

直肠范围分段

直肠的弯曲及直肠壶腹 Rectum and Anal canal Rectosigmoid junction Supenor rectal valve iddle rectal valve Inferior rectal valre 11-13 Anal columns (of Morgagni) Muscularis mucosae Circular muscle layer ret Longitudinal muscle layer Rectal fascia Levator ani muscle Anal sinus Anorectal (pectinate, or dentate) line Intemal rect plexus in submucous space Intemal sphincter muscle Surgica Deep extemal sphincter muscle anal canal Conjoined longitudinal muscle Anat 一2:53 atomical Superficial extemal sphincter muscle Anal valve I canal Anal crypt Anal verge ≈ al glands Sweat glands -Transverse fibrous septum and hairs in Intermuscular groove (white line of Hilton) Musculus submucosa ani perianal skin Extemal rectal venous plexus in perianal sPace Penanal space Corrugator cutis ani muscle Subcutaneous extemal sphincter muscl O CIBA-GEIGY

直肠的弯曲及直肠壶腹

直肠的粘膜面 Anorectal musculature Frontal section Superior fascia of pelvic diaphragm Inferior fascia of Circular muscle of rectum Muscularis mucosae of rectum Levator ani muscle Rectal fascia Deep extemal anal sphincter muscle Longitudinal muscle of rectum Intemal rectal venous plexus Conjoined longitudinal muscle Superficial extemal Intemal anal sphincter muscle anal sphincter muscle Musculus submucosa ani Transverse fibrous septum of ischiorectal Intermuscular groove (white line of Hiiton) Subcutaneous extemal anal sphincter muscle Ectemal rectal venous plexus Corrugator cutis ani muscle OCIEA-GEIGY

直肠的粘膜面

内外括约肌肛管直肠环 E04园) 其误 途昔自 直肠纵肌 肛管内括约用 肛提肌耻 骨直肠部 肛管外括约肌深部 管外括纳肌浅部 舡臂外括约肌皮下部 图402肛管外括约肌

内外括约肌肛管直肠环

外括约肌三环 直肠低曲 覆膜反折处 耻骨联合 肛提肌 方肯坐 是内营 耻骨直肠肌及肛 肛管外括 管外括约肌深部 约肌浅部 暴真,下部扩大成直压,是管 「肛管外括约 解到学说点直图403肛管括约肌环是。4肌皮下部

外括约肌三环

直肠肛管周围间隙 肛提肌 骨盆直肠间隙 坐骨肛管间隙 耻骨直肠肌 和肛管外括 约肌深部 坐骨肛管横隔 缸管外括约 肛门周围间隙 肌皮下部 直,与来 一图405直肠肛管周围间隙

直肠肛管周围间隙

直肠肛管血供 Arteries of Rectum and Anal Canal Abdominal aorta Inferior mesenteric artery Inferior vena cava Ascending branch of lett colic artery Middle sacral artery Descending branch of left colic artery ommon iliac artery Extemal iliac artery arenas ntemal iliac arten Rectosigmoid arteries Obturator artery Lateral sacral artery Inferior epigastne-auery Superior gluteal artery Mddle rectal artery Umbilical artery Ischial spine Artery of duct Coccygeus muscle Intemal Inferior gluteal arten pudendal artery Inferior vesical artery Pudendal (Acocks) canal Intemal pudendal arter Ischial tuberosi Inferior rectal artery Posterior Mddle rectal arten ator ani muscle View Inferior rectal arten Ectemal anal sphincter muscle Anus O CIBA-GEIGY

直肠肛管血供

Veins of rectum and Anal canal Anterior view Inferior vena cava Inferior mesenteric vein (to portal vein via splenic Common iliac veins Rectosigmoid vein Mddle sacral vein Intemal iliac vein Extemal iliac vein Superior rectal vein(bifurcation)- Obturator vein Communication between Superior vesical and uterine veins intemal and perimuscular rectal plexuses Mddle rectal vein Intemal pudendal Perimuscular rectal plexus Vaginal vein Intemal rectal plexu Inferor vesical vein Communication between Intemal pudendal vein in intemal and extemal udendal ( Alcock's) canal venous plexuses Etemal rectal plexus Inferior rectal vein