肛提肌的形态学及其功能意义和临床应用

目的：探讨肛提肌表态及其与肛直肠的解剖关系和功能，为腊肠手术预防和治疗肛门失禁提供解剖学参考资料，方法：采用经福尔马林固0定的59具小儿尸体，3例成人盆部标本在3倍放大镜下解剖对照观察，结果：肛提肌是由许多细小的带状肌束分层叠连，自然铺展而成的一整块片状肌，按肌束的层次和肌纤维方向可分上，下两层和三块肌，耻骨尾骨肌和髂骨尾骨肌较薄，位在上层，耻骨直肠肌位在下层，耻骨直肠肌根据基肌纤维方向可分为五部，即会阴体部，肌袢部，联合中纵肌部，肛门外括约肌部和会阴浅横肌部，耻骨直肠肌肌袢部和耻骨尾骨肌肌袢在肛直曲两侧和后方呈内，外重叠关系，结论：肛提肌肌束的排列形式是认识，区别肛周肌群及其相互关系的关键，耻骨直肠肌并非单一肌袢，其会阴体部，肌袢部及联合纵肌部共同牵拉作用于肛管，分别与肛管直肠前，后角的形成和维持有关，临床应用应将前列腺提取及会阴体也纳入重点保护范围内。

Morphology, Functions and Clinical Application of Levator Ani Muscle

OBJECTIVE To investigate into the morphology of levator ani muscle and its anatomical relationship to anorectum so as to provide reference data for the prevention of anus incontinence with surgery. METHOD Observations were made with 59 children corpses and 3 adult pelvis specimens treated with formaldehyde solution under a 3-time magnifier. RESULT Levator ani muscle is composed by layers of many tiny bandlike muscle bundles, which spread naturally into a whole piece of muscle. It can be divided into upper and lower 2 layers and 3 pieces of muscles: the pubococcygal muscle and the iliococcygeal muscle are thin and lie in the upper layer, and puborectal muscle lies in the lower layer. The puborectal muscle can be divided into five parts: perineal body, muscle ansa, conjoined longitudinal muscle, anal external sphincter, and superficial transverse muscle of perineum. The muscle ansa of the puborectal muscle and that of the pubococcygal muscle assume an overlapping relationship at the lateral and posterior aspects of the anal flexure. CONCLUSION The arrangement of the levator ani muscle is the key link for the recognition of and distinction between the muscle groups around the anus. The puborectal muscle is not a single muscle ansa, and the tractive functions of different parts of the muscle act on the anal canal, which is related to the formation and maintenance of anterior and posterior horns of the anal canal. In clinical practice, the levator muscle of prostate and the perineal body should be specially protected.