Stein Tamara A, DeLancey John O L
Division of Anatomical Sciences, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0608, USA.
Obstet Gynecol. 2008 Mar;111(3):686-93. doi: 10.1097/AOG.0b013e318163a9a5.
To re-examine the anatomy of the perineal membrane and its anatomical relationships in whole-pelvis and histologic serial section as well as gross anatomical dissection.
Serial trichrome-stained histologic sections of five female pelvic specimens (0-37 years old) were examined. Specimens included the urethra, perineal membrane, vagina, and surrounding structures. Macroscopic whole-pelvis sections of three adults, 28-56 years of age, in axial, sagittal, and coronal sections were also studied. Dissections of six female cadavers, 48-90 years of age, were also performed.
The perineal membrane is composed of two regions, one dorsal and one ventral. The dorsal portion consists of bilateral transverse fibrous sheets that attach the lateral wall of the vagina and perineal body to the ischiopubic ramus. This portion is devoid of striated muscle. The ventral portion is part of a solid three-dimensional tissue mass in which several structures are embedded. It is intimately associated with the compressor urethrae and the urethrovaginal sphincter muscle of the distal urethra with the urethra and its surrounding connective. In this region the perineal membrane is continuous with the insertion of the arcus tendineus fascia pelvis. The levator ani muscles are connected with the cranial surface of the perineal membrane. The vestibular bulb and clitoral crus are fused with the membrane's caudal surface.
The structure of the perineal membrane is a complex three-dimensional structure with two distinctly different dorsal and ventral regions; not a simple trilaminar sheet with perforating viscera.
通过全盆腔和组织学连续切片以及大体解剖，重新审视会阴膜的解剖结构及其解剖关系。
检查了5个女性盆腔标本（0 - 37岁）的三色染色组织学连续切片。标本包括尿道、会阴膜、阴道及周围结构。还研究了3名28 - 56岁成年人的全盆腔宏观轴向、矢状和冠状切片。对6名48 - 90岁女性尸体进行了解剖。
会阴膜由两个区域组成，一个背侧区域和一个腹侧区域。背侧部分由双侧横向纤维片组成，将阴道侧壁与会阴体附着于耻骨坐骨支。该部分没有横纹肌。腹侧部分是一个实体三维组织块的一部分，其中嵌入了几个结构。它与尿道压肌和尿道远端的尿道阴道括约肌以及尿道及其周围结缔组织密切相关。在该区域，会阴膜与盆筋膜腱弓的附着处连续。肛提肌与会阴膜的颅面相连。前庭球和阴蒂脚与会阴膜的尾面融合。
会阴膜的结构是一个复杂的三维结构，有两个明显不同的背侧和腹侧区域；不是一个简单的有穿经脏器的三层薄片。
