腹膜后隙解剖课件.ppt

1、January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹膜后隙腹膜后隙内容：内容：一、肾一、肾二、输尿管二、输尿管三、血管、神经三、血管、神经January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 概概 述述 腹膜后隙位置腹膜

2、后隙位置：腹后：腹后壁腹膜后方。壁腹膜后方。范围：范围：上自膈，下至上自膈，下至骶岬，两侧续腹膜外骶岬，两侧续腹膜外筋膜。向下续盆部的筋膜。向下续盆部的腹膜后间隙。腹膜后间隙。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （一）肾（一）肾 kidney 内容：内容： （一）（一）肾的位置和肾的位置和毗邻毗邻（二）肾蒂（二）肾蒂（三）（三）肾的血管肾的血管（四）肾的被膜（四）肾的被膜 January,

3、2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 一、肾的位置及一、肾的位置及毗邻毗邻 肾位于脊柱肾位于脊柱两侧，腹膜后方，两侧，腹膜后方，紧贴腹后壁的上紧贴腹后壁的上部。部。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 左肾位置

4、：左肾位置： 上端上端平第平第1111胸椎下缘胸椎下缘下端下端平第平第2 2腰椎下缘腰椎下缘 January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 上端上端平第平第1212胸椎上缘胸椎上缘 下端下端平第平第3 3腰椎上缘腰椎上缘 第第1212肋跨过左肾的中肋跨过左肾的中部，右肾的上部。部，右肾的上部。：January, 2007Copyright Depart. Anatomy, School of Medi

5、cine, Lanzhou University. All right reserved by YP HOU and YF SONG 肾门位置肾门位置： 肾门平第一腰肾门平第一腰椎平面，距正中线椎平面，距正中线约约5cm5cm。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肾区：肾区： 竖脊肌外侧缘与第竖脊肌外侧缘与第1212肋之间的部位称肋之间的部位称肾区肾区（肋脊角肋脊角）。在某些肾。在某些肾疾病

6、患者，叩击或触压疾病患者，叩击或触压该区可引起疼痛。该区可引起疼痛。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肾的毗邻：肾的毗邻： 两肾后面：两肾后面：膈膈 腰大肌腰大肌 腰方肌腰方肌 腹横肌腹横肌两肾上端两肾上端: 肾上腺肾上腺January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All r

7、ight reserved by YP HOU and YF SONG 右肾前面邻：右肾前面邻：肝右叶肝右叶 结肠右曲结肠右曲 十二指肠降部十二指肠降部January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 左肾前面邻：左肾前面邻：胃胃 胰胰 空肠空肠 结肠左曲结肠左曲January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou Univ

8、ersity. All right reserved by YP HOU and YF SONG 二、二、肾门、肾门、肾蒂肾蒂 肾门：肾门： 肾的内侧肾的内侧缘中部凹陷，是肾缘中部凹陷，是肾的血管、神经、淋的血管、神经、淋巴管和肾盂出入肾巴管和肾盂出入肾的部位，称的部位，称肾门肾门。 January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肾蒂肾蒂 renal pedicle：出入肾门的结构合称出入肾门的结构合

9、称肾蒂肾蒂，主要结构，主要结构肾动肾动脉、肾静脉、肾盂。脉、肾静脉、肾盂。右侧肾蒂较左侧短。右侧肾蒂较左侧短。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 由前向后依次为：由前向后依次为：肾静脉、肾动脉、肾盂肾静脉、肾动脉、肾盂 从上向下依次为：从上向下依次为：肾动脉、肾静脉、肾盂肾动脉、肾静脉、肾盂January, 2007Copyright Depart. Anatomy, School of M

10、edicine, Lanzhou University. All right reserved by YP HOU and YF SONG 三、肾的被膜三、肾的被膜 肾表面包有三层被膜，由内向外为：肾表面包有三层被膜，由内向外为：纤维囊纤维囊脂肪囊脂肪囊肾筋膜肾筋膜January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （二）输尿管（二）输尿管 ureter 输尿管起于肾盂，输尿管起于肾盂，终于膀胱，长约终于膀

11、胱，长约252530cm30cm。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 输尿管行程分部输尿管行程分部: : 分三部分三部: : 腹腹部部盆盆部部壁壁内内部部January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG

12、 位于腹膜后方，位于腹膜后方，沿腰大肌前面下降至沿腰大肌前面下降至小骨盆上口处，左右小骨盆上口处，左右输尿管分别跨过髂血输尿管分别跨过髂血管的前面，进入盆腔管的前面，进入盆腔移行于盆段。移行于盆段。输尿管腹部：输尿管腹部：January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 输尿管腹部在输尿管腹部在腰大肌前面中点处腰大肌前面中点处与睾丸血管（男）与睾丸血管（男）或卵巢血管（女）或卵巢血管（女）相交叉（血管位于

13、相交叉（血管位于输尿管前面）。输尿管前面）。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹部的血管、神经腹部的血管、神经January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹主动脉从膈的腹主动脉从膈的主动脉裂孔沿

14、脊柱左主动脉裂孔沿脊柱左前方下降，至第四腰前方下降，至第四腰椎平面分为左、右髂椎平面分为左、右髂总动脉。其右侧邻下总动脉。其右侧邻下腔静脉。腔静脉。动脉：动脉：腹主动脉腹主动脉January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹主动脉的腹主动脉的分支分支有有： 壁壁 支支脏脏 支支January, 2007Copyright Depart. Anatomy, School of Medicine, Lan

15、zhou University. All right reserved by YP HOU and YF SONG 1.壁支壁支主要有：主要有： 膈下动脉膈下动脉 4对腰动脉对腰动脉 骶正中动脉骶正中动脉January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 2.脏支脏支主要有：主要有： 成对的脏支成对的脏支 不成对的脏支不成对的脏支January, 2007Copyright Depart. Anatomy,

16、 School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （1）成对的脏支）成对的脏支 有有3对对: 肾上腺中动脉肾上腺中动脉 肾动脉肾动脉 睾丸动脉睾丸动脉(精索内动脉精索内动脉) (在在女性则称女性则称卵巢动脉卵巢动脉)January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （2）不成对的脏支）不成对的

17、脏支 有有3支：支： 腹腔干腹腔干 肠系膜上动脉肠系膜上动脉 肠系膜下动脉肠系膜下动脉January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 膈下动脉膈下动脉发出发出: 肾上腺上动脉肾上腺上动脉 腹主动脉腹主动脉发出发出: 肾上腺中动脉肾上腺中动脉 肾动脉肾动脉发出发出: 肾上腺下动脉肾上腺下动脉肾上腺的动脉肾上腺的动脉 （3对）对）January, 2007Copyright Depart. Anatomy,

18、 School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 静脉：静脉：下腔静脉下腔静脉inferior vena cava 下腔静脉由下腔静脉由左、右髂总静脉左、右髂总静脉在第在第5腰椎右侧汇腰椎右侧汇合而成。下腔静合而成。下腔静脉收集下肢、盆脉收集下肢、盆部和腹部的静脉。部和腹部的静脉。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by

19、YP HOU and YF SONG 壁支壁支脏支脏支下腔静脉的属支有下腔静脉的属支有：January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 1. 壁支：壁支：膈下静脉膈下静脉 对腰静脉对腰静脉 January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU

20、 and YF SONG 2. 脏支：脏支： 成对脏器成对脏器和和肝肝的静的静脉注入下腔静脉脉注入下腔静脉, 不成不成对脏器的静脉先汇合成对脏器的静脉先汇合成肝门静脉肝门静脉, 入肝后再经入肝后再经肝静脉入下腔静脉。肝静脉入下腔静脉。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 3对：对：(1)肾静脉肾静脉 (2)肾上腺静脉肾上腺静脉 生殖腺静脉生殖腺静脉成对脏器的静脉：成对脏器的静脉：January

21、, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG (1)肾静脉肾静脉 renal V 左侧长于右侧。左侧长于右侧。(2)肾上腺静脉肾上腺静脉 右侧注入下腔静脉右侧注入下腔静脉, , 左侧注入肾静脉左侧注入肾静脉。生殖腺静脉生殖腺静脉右侧注入下腔静脉右侧注入下腔静脉, ,左侧注入肾静脉。左侧注入肾静脉。January, 2007Copyright Depart. Anatomy, School of Medicine,

22、Lanzhou University. All right reserved by YP HOU and YF SONG 肝静脉肝静脉hepatic V.一般有左、中、一般有左、中、右右3条条, 包埋在肝实质内包埋在肝实质内, 在腔静脉沟在腔静脉沟上份（裸区）注入下腔静脉。上份（裸区）注入下腔静脉。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 思考题思考题 肾的位置、毗邻；肾角、肾门、肾窦肾的位置、毗邻；肾角、肾门、肾窦和肾蒂概念，肾血管和被膜和肾蒂概念，肾血管和被膜。 肾蒂结构的排列。肾蒂结构的排列。 输尿管分部和狭窄，左、右输尿管毗输尿管分部和狭窄，左、右输尿管毗邻异同邻异同。