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目的以直肠中下段为中心解剖观察其毗邻结构,为临床经肛门切除直肠提供解剖学导向。方法结合28例成人盆部CT扫描资料,对14具成人盆部标本进行解剖观察,用游标卡尺测量直肠阴道(尿道)隔的厚度和肛门括约肌及肛提肌的宽度和厚度,结果进行统计学分析。结果直肠中下段及肛管毗邻的诸多肌性部分均分别有自己的筋膜包绕,结构易于辨认;在盆部标本和盆部CT扫描片上,测得直肠尿道隔的厚度分别为(1.65±0.19)cm和(1.26±0.05)cm、直肠阴道隔的厚度分别为(0.89±0.11)cm和(0.75±0.04)cm,在不同材料间的测得值差异有统计学意义(P<0.05),而该结构的厚度在性别间差异有显著性(P<0.01),直肠尿道隔的厚度大于直肠阴道隔的厚度。结论直肠下段毗邻结构复杂,特别是直肠阴道隔菲薄,应避免手术操作中引起的损伤。
Objective To anatomize the adjacent structures in the middle and lower rectum of the rectum to provide anatomic guidance for the clinical resection of the rectum. Methods According to CT data of 28 cases of adult pelvis, 14 adult pelvic specimens were dissected and the rectovaginal (urethral) septum thickness and anal sphincter and levator muscle were measured by vernier caliper. The results were analyzed statistically . Results The medial and inferior segments of the rectum and many muscular parts adjacent to the anal canal had their own fascia wraps and the structures were easy to identify. The thickness of the rectal urethral septum measured on the pelvic and pelvic CT scans were (1.65 ± 0.19 cm and 1.26 ± 0.05 cm respectively. The thickness of rectovaginal septum was (0.89 ± 0.11) cm and (0.75 ± 0.04) cm, respectively. There were significant differences in the measured values between different materials (P <0.05) , While the thickness of the structure in the sex difference was significant (P <0.01), the thickness of the rectal urethra is greater than the thickness of the rectovaginal septum. Conclusion Adjacent to the lower rectum is complex structure, especially the rectovaginal fenetration, should avoid the injury caused by the operation.