Читать книгу Ridley's The Vulva - Группа авторов - Страница 80
The inguinofemoral region
ОглавлениеThe femoral triangle is a gutter‐shaped depression below the groin. The base is formed by the inguinal ligament, and its apex is situated medially and inferiorly. The inguinal ligament is the lower free margin of the external oblique muscle of the anterior abdominal wall and extends from the anterior superior spine of the iliac bone laterally to the tubercle on the body of the pubic bone medially. Midway between these two points, the external iliac artery becomes the femoral artery and enters the femoral triangle deep to the inguinal ligament and the deep fascia of the thigh (fascia lata). A short downward extension of the abdominal fascia (femoral sheath) is created when the external iliac vessels enter the triangle, and this sheath encloses the femoral artery laterally, the femoral vein centrally, and the femoral canal medially. The long saphenous vein passes through the saphenous opening in the fascia lata to enter the femoral vein at the medial end of the inguinal ligament.
Table 2.2 Blood supply, innervation, and lymphatic drainage of the vulva.
| Arterial supply | Venous drainage | Innervation | Lymphatic drainage | |
|---|---|---|---|---|
| Mons pubis | Superficial external pudendal artery which is a branch of the femoral artery. | Pudendal veins to the long saphenous vein | Branches of the perineal nerve | To superficial inguinal nodes and then to deep femoral nodes and pelvic nodes |
| Labia majora | Labial branches of the internal pudendal artery | Tributaries to the superficial external pudendal vein which then drain to the great saphenous vein | Labial branches of the perineal nerve | Superficial inguinal nodes and the inferior aspect to the rectal lymphatic plexus |
| Labia minora | Labial branches of the internal pudendal artery | Tributaries to the superficial external pudendal vein which then drain to the great saphenous vein | Labial branches of the perineal nerve | Superficial inguinal nodes |
| Clitoris | Superficial and deep terminal branches of the internal pudendal artery | Deep dorsal vein to vesicle plexus, deep external pudendal veins to femoral vein and internal pudendal veins to internal iliac vein | Dorsal nerve of the clitoris, a branch of the pudendal nerve | To deep inguinal and internal iliac nodes |
| Vestibule | Branches of the internal pudendal artery | Tributaries to the external pudendal vein | Perineal branch of the pudendal nerve | To superficial inguinal nodes |
| External urethral meatus and urethra | Vesical and vaginal arteries which are branches of the anterior internal iliac artery | Via plexus around the urethra to vesicle plexus around the bladder neck and into the pudendal veins | Pudendal nerve | Urethral lymphatics drain into the internal and external iliac nodes |
| Vagina | The vaginal artery may arise from the internal iliac artery or one of its branches, most commonly the internal pudendal artery. The uterine artery supplies a descending branch to the upper vagina, and there is frequently a vaginal branch from the middle rectal artery. The lower vagina is supplied by branches of the internal pudendal artery. These vessels anastomose with each other in or on the vaginal walls. Vessels from the right and left sides anastomose to form unpaired, midline, anterior, and posterior azygos arteries | The veins of the vagina drain to the uterovaginal plexus, which itself communicates with the uterine, vesical, and rectal venous plexuses, all of which drain mainly to the internal iliac veins | Nerve fibres accompany the vessels as they penetrate the walls of the body of the uterus, cervix, and vagina. There is general agreement that almost all of the motor fibres to uterine muscle are sympathetic, while afferent innervation of the body is sympathetic and that of the cervix is parasympathetic | The upper two‐thirds is with the cervix to the internal and external iliac nodes. The lower vessel third drains with the rest of the perineum to the superficial inguinal nodes |
| Perineum | Perineal artery | Internal pudendal vein | Pudendal nerve | Superficial inguinal nodes |
| Pelvic floor | Lumbosacral plexus (S2–S4) |
