Kleeman Steven D, Westermann Cynthia, Karram Mickey M
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA.
Am J Obstet Gynecol. 2005 Dec;193(6):2050-5. doi: 10.1016/j.ajog.2005.07.096.
The purpose of this study was to histologically evaluate the posterior aspect of the pelvis, specifically, the relationship between the perineum, posterior vagina, anterior rectum, and all other intervening tissue.
The perineum, posterior vaginal wall, and upper part of the rectum were removed en bloc from 4 fresh cadavers without pelvic prolapse. Length of the specimens ranged from 6 to 7.9 cm and width 3 to 4 cm. Seven to 26 serial sections were taken from each cadaver. Sections were stained with hematoxylin and eosin (H&E), Masson trichrome, and Verhoeff Von Gieson elastic stain.
All 4 specimens showed dense connective tissue and no plane of cleavage for 3 to 3.5 cm proximally from the posterior forchette. Proximal to this, all 4 specimens showed space between the muscular wall of the vagina and the muscular wall of the rectum, which was composed of adipose tissue with discontinuous bands of fibrous tissue or loose areolar tissue. This appears to be a natural line of cleavage. Histologically, no evidence of fascia or a rectovaginal septum was identified.
Histologically, there is no evidence of a distinct fascial layer between the posterior vaginal wall and anterior wall of the rectum. Clinically, it is the splitting of the adventitia and fibromuscular layers of the vagina that are used in defect-specific rectocele repairs to support the anterior rectal wall.
本研究旨在从组织学角度评估骨盆后部，特别是会阴、阴道后壁、直肠前部以及所有其他中间组织之间的关系。
从4具无盆腔脏器脱垂的新鲜尸体上整块切除会阴、阴道后壁和直肠上部。标本长度为6至7.9厘米，宽度为3至4厘米。每具尸体取7至26个连续切片。切片用苏木精和伊红（H&E）染色、马松三色染色以及韦尔霍夫·冯·吉森弹性染色。
所有4个标本在距后阴唇系带近端3至3.5厘米处均显示为致密结缔组织，无分裂平面。在此近端，所有4个标本在阴道肌壁和直肠肌壁之间均显示有间隙，该间隙由含有不连续纤维组织带或疏松蜂窝组织的脂肪组织构成。这似乎是一个自然的分裂线。组织学检查未发现筋膜或直肠阴道隔的证据。
组织学检查未发现阴道后壁与直肠前壁之间存在明显筋膜层的证据。临床上，在针对特定缺损的直肠膨出修补术中，利用的是阴道外膜和纤维肌层的劈开，以支撑直肠前壁。
