Joguet E, Robert R, Labat J J, Riant T, Guérineau M, Hamel O, Louppe J M
Faculty of Médecine, Laboratory of Anatomy, Nantes, France.
Surg Radiol Anat. 2012 Jan;34(1):73-9. doi: 10.1007/s00276-011-0832-8. Epub 2011 Jun 4.
Rectal examination is difficult to carry out by students because of their lack of knowledge and fear. It is therefore necessary to search for methods in order to facilitate its practice. This work mainly focuses on the palpation of the posterior lateral area of the rectum.
This work bases itself on the study of the average length of indexes and on the anatomical study of the dissection and prints of two pelvises. In the lithotomy position, we can identify three successive levels of exploration of the posterior and lateral area of the rectum. These three levels are defined by the extremity of the index, and the distal and proximal interphalangeal articulations placed successively on the tip of the coccyx. A 180° rotation of the hand enables at each level to identify the parietal structures that the pad of the index comes across, but excludes the palpation of genital organs and rectum.
The first level corresponds to the higher part of the anal canal, the ischioanal fossa and the ischium. The second level corresponds to the levator ani muscle, the ischioanal fossa and the pudendal canal. The third level corresponds to the sacrospinous ligament, the ischiatic spine and the internal obturator muscle.
In spite of the significant differences between the lengths of the indexes, the use of these landmarks will facilitate the identification of parietal anatomical structures. The internal organs' palpation will depend on the patient's position, his efforts in pushing, the length of the index, and the way the examiner presses on the perineum.
由于缺乏知识和恐惧，学生很难进行直肠检查。因此，有必要寻找便于实践的方法。这项工作主要聚焦于直肠后外侧区域的触诊。
这项工作基于对食指平均长度的研究以及对两个骨盆的解剖和印记的解剖学研究。在截石位，我们可以确定直肠后外侧区域的三个连续探查水平。这三个水平由食指末端以及依次置于尾骨尖端的远侧和近侧指间关节来界定。手部旋转180°能在每个水平识别食指指腹所碰到的壁层结构，但不包括对生殖器官和直肠的触诊。
第一水平对应肛管上部、坐骨肛门窝和坐骨。第二水平对应肛提肌、坐骨肛门窝和阴部管。第三水平对应骶棘韧带、坐骨棘和闭孔内肌。
尽管食指长度存在显著差异，但使用这些标志将有助于识别壁层解剖结构。对内部器官的触诊将取决于患者的体位、用力情况、食指长度以及检查者按压会阴的方式。
