Kamina P, Chansigaud J P
Laboratoire d'Anatomie, Faculté de Médecine, C.H.U., Hôpital Jean-Bernard, Poitiers.
J Gynecol Obstet Biol Reprod (Paris). 1988;17(7):835-48.
This work is an attempt to settle the semantics of the pelvic connective tissues based on the international nomenclature (Nomina Anatomica) on the one hand on the other following a study of the macroscopic anatomy together with the microscopic appearances and a functional study together with a radiological study which includes in particular tomodensitometry. The Pelvic viscera are held in position by visceral fasciae which are continuous with the parietal pelvic fascia and the retro peritoneal connective tissue. This connective tissue, which is moderately loose, is arranged around the blood vessels as visceral ligaments. These are more obvious when traction is exerted during surgical operations and it resembles the way strands of a net come together when they are being stretched. It is essential to ligate and cut these ligaments if the viscera are to be freed. The surfaces which join the viscera together (the septum and the retro-pubic and retro-rectal spaces) are very important and from the biomechanical point of view resemble bonds that are stuck together. In fact, their resistance has the effect of interlocking neighbouring surfaces, and so effects a better distribution of pressures that are exerted and of their absorption. The changes that take place at rest and at movement of the pelvic organs during the menopause and during pregnancy and the puerperium have been studied. The role of episiotomy in particular as a step towards preventing urinary incontinence is emphasized. In fact, it lessens the pull on the external fibres of the sphincter muscle of the urethra which are bound up with the tissues of the vaginal wall. We have found in 140 women who have been operated on for stress incontinence that 62% had a tear or an episiotomy that was carried out late and that was insufficiently large; 13.9% had a tear: and 11.4%, on the other hand, had an episiotomy without a tear. On the other hand, in another group of similar women over the age of 45 who had had an episiotomy, 16.17% had stress incontinence.
这项工作一方面试图依据国际命名法（《解剖学名词》）来确定盆腔结缔组织的语义，另一方面在对宏观解剖结构、微观外观进行研究以及对包括断层密度测定在内的功能和放射学研究之后进行。盆腔脏器由脏筋膜固定在位，脏筋膜与盆壁筋膜和腹膜后结缔组织相连。这种结缔组织较为疏松，像内脏韧带一样围绕血管排列。在外科手术中施加牵引力时，这些韧带会更明显，就如同拉伸时网的线股汇聚在一起的样子。如果要游离脏器，结扎并切断这些韧带至关重要。连接脏器的表面（隔膜以及耻骨后和直肠后间隙）非常重要，从生物力学角度看类似于粘连在一起的结合部。事实上，它们的阻力起到使相邻表面相互连锁的作用，从而能更好地分布施加的压力并吸收压力。已经研究了绝经期间、妊娠期间及产褥期盆腔器官在静止和运动时发生的变化。特别强调了会阴切开术作为预防尿失禁的一个步骤的作用。实际上，它减少了与阴道壁组织相连的尿道括约肌外部纤维所受的拉力。我们发现，在140名因压力性尿失禁接受手术的女性中，62%有撕裂伤或会阴切开术实施过晚且切口不够大；13.9%有撕裂伤；另一方面，11.4%进行了会阴切开术但没有撕裂伤。另一方面，在另一组年龄超过45岁且做过会阴切开术的类似女性中，16.17%有压力性尿失禁。
