局部解剖学课件合辑英文版（共380页）.ppt

1、Anterolateral Abdominal Wall Regional anatomy The Anterolateral Abdominal Wall Superficial structures 浅层结构浅层结构 Deep structures 深层结构深层结构 皮肤皮肤 浅筋膜浅筋膜 腹膜下筋膜腹膜下筋膜 深筋膜和肌肉深筋膜和肌肉 The layers of the anterolateral abdominal wall 1.Skin 2.Superficial fascia 3.Deep fascia and muscles 4.Transverse fascia 5.Extra

2、peritoneal fascia 6.Parietal fascia 腹横筋膜腹横筋膜 壁腹膜壁腹膜 .The superficial structures 浅层结构浅层结构 Surface Features of Skin Superficial fascia 浅筋膜浅筋膜 Surface Features of the Abdomen Divisions below umbilicus（脐以下） Superficial fatty layer (Campers) Membranous layer (Scarpas) Superficial fascia Superficial vesse

3、ls and cutaneous nerves Arteries Superficial epigastric a. Superficial iliac circumflex a. Veins Thoracoepigastric v. Superficial epigastric v. Cutaneous nerves Anterior and lateral cutaneous n. of lower six thoracic Iliohypogastric n. (first lumb nerves) 浅动脉、浅静脉、皮神经浅动脉、浅静脉、皮神经 The ilioinguinal and

4、the lower abdominal flaps 髂腹股沟区和下腹部的皮瓣髂腹股沟区和下腹部的皮瓣 .The Deep Structures 深层结构深层结构 Muscular layer 肌层肌层 Vessels, lymph and nerve 血管、淋巴及神经血管、淋巴及神经 Transversalis fascia 腹横筋膜腹横筋膜 Extraperitoneal fascia 腹膜下筋膜腹膜下筋膜 Parietal peritoneum 壁腹膜壁腹膜 Muscles of abdomen Anterolateral group obliquus externus abdominis

5、 腹外斜肌腹外斜肌 oblequus enternus abdominis 腹内斜肌腹内斜肌 transversus abdominis 腹横肌腹横肌 rectus abdominis 腹直肌腹直肌 Posterior group Quadiatus lumborum 腰方肌腰方肌 Psoas major 腰大肌腰大肌 Obliquus externus absominis 腹外斜肌腹外斜肌 General direction of fibers: downward, forward and medially (run down and inward) Structures Inguinal

6、ligament 腹股沟韧带腹股沟韧带 Lacunar ligament 腔隙韧带腔隙韧带 pectineal ligament 耻骨梳韧带耻骨梳韧带 Superficial inguinal ring 腹股沟浅环腹股沟浅环 triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle Inguinal ligament Lacunar ligament Superficial inguinal ring pectineal ligament Superficial ing

7、uinal ring Obliquus internus abdominis 腹内斜肌腹内斜肌 Deep to obliquus externus abdominis General direction of fibres: upwards, forwards and medially Transversels abdominis 腹横肌腹横肌 Deep to obliquus internus inguinal ligament腹股沟韧带、腹股沟韧带、lacunar ligament腔隙韧带、腔隙韧带、 pectineal ligament耻骨梳韧带耻骨梳韧带 Inguinal falx 腹

8、股沟镰腹股沟镰: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睾肌提睾肌: around the spermatic cord and testis Inguinal falx Rectus abdominis 腹直肌腹直肌 Position: lie on to either of midline Origin: pubic crest and symphysis Insertion: xiphoid and

9、 5th- 7th costal cartilages Has 3-4 tendinous intersections 腱划腱划 linea semiluaris 半月线半月线 arcuate line Linea alba 白线白线 tendinous raphe between right and left recti from xiphoid to pubic symphysis. Linea alba Deep vessels and nerves Arteres Superior and inferior epigastric arteris Lower posterior inte

10、rcostal a. Subcostal a. Four lumbar a. Nerves Intercostal n.(6-11) Subcostal n. Nerves Iliohypogastric n. 髂腹下神经髂腹下神经 Ilioinguinal n. 髂腹股沟神经髂腹股沟神经 Genitofemoral n. 生殖股神经生殖股神经 Regional anatomy Sheath of rectus abdominis 腹直肌鞘腹直肌鞘 Ant layerformed by fusion of aponeurosis of obliquus externus abdominis a

11、nd anterior leaf of aponeurosis of obliquus internus abdominis Post layer Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominis Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer th

12、e lower free border named arcuate line Below this line rectus abdominis in contact with transverse fascia arcuate line The Inguinal Region 腹股沟区腹股沟区 Boundary 境界境界 Layers and characteristics 层次与特点层次与特点 Inguinal canal 腹股沟管腹股沟管 Inguinal triangle 腹股沟三角腹股沟三角 Hernias 疝疝 ： Direct inguinal hernias 腹股沟直疝腹股沟直疝

13、 Indirect inguinal hernias 腹股沟斜疝腹股沟斜疝 Femoralhernias 股疝股疝 Inguinal region 腹股沟区腹股沟区 Boundaries Inguinal ligament Lateral margin of rectus abdominis A horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominis Inguinal canal 腹股沟管腹股沟管 Position: oblique passage, 4cm long,

14、located 1.5cm above medial half of inguinal lig. Boundaries Ant wall Aponeurosis of obliquus externus abdominis Obliquus internus abdominis (lateral third of wall) Posterior wall Transverse fascia Inguinal flax medially Roofarched lower fibers of obliquus internus and transversua abdominis Flooringu

15、inal lig Two openings Superficial inguinal ring 腹股沟浅环腹股沟浅环 Deep inguinal ring 腹股沟深环腹股沟深环 defect in transverse fascia 1.5cm above midpoint of inguinal ligament Structures passing through the inguinal canal Spermatic cord 精索精索 and ilioinguinal nerve髂腹股沟神经髂腹股沟神经 in males Round ligament of uterus 子宫圆韧带子

16、宫圆韧带and ilioinguinal nerve 髂腹股沟神经髂腹股沟神经 in females Descent of testes Seven-week embryo showing the testis before its descent from the dorsal abdominal wall Fetus at 28 week the testis passing through the inguinal canal Newborn Inguinal Triangle (of Hesselbach) 腹股沟三角腹股沟三角 Boundaries Inguinal ligament

17、 inferiorly Lateral border of rectus abdominis medially Inferior epigastric artery laterally Inguinal Triangle 腹股沟三角腹股沟三角 （Hesselbachs triangle 海氏三角海氏三角 ） 构成：构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。 临床意义：临床意义：由腹股沟三角突出的疝，称腹股沟直疝。由腹股沟三角突出的疝，称腹股沟直疝。 腹腹 股股 沟沟 三三 角角 腹腹 股股 沟沟 直直 疝、

18、疝、 腹腹 股股 沟沟 斜斜 疝、疝、 股股 疝疝 Indirect inguinal heinia and direcet inguinal heinia 斜疝斜疝 Indirect inguinal ehinia 直疝直疝 Direcet heinia Hernias Hernias Hernias Subcostal incision Muscle-splitting incision Transverse incision Median or midline incision Left paramedian incision Layer ? Suprapubic incision Th

19、e peritoneum Ling Shucai Regional anatomy The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities Parietal peritoneum 壁腹膜壁腹膜 lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹膜脏腹膜 covers the

20、 organs Peritoneal cavity 腹膜腔腹膜腔the potential space between the parietal and visceral layer of peritoneum, in the mail, is a closed sac, but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina .General features Function Secretes a lubricati

21、ng serous fluid that continuously moistens the associated organs Absorb Support viscera Intraperitoneal viscera 腹膜内位器官腹膜内位器官 Interperitoneal viscera 腹膜间位器官腹膜间位器官 Retroperitoneal viscera 腹膜外位器官腹膜外位器官 Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera .The relationship between vis

22、cera and peritoneum Interperitoneal viscera 腹膜间位器官腹膜间位器官 The omentum 网膜网膜 The mesenteries and mesocolons 系膜系膜 The ligaments 韧带韧带 The peritoneal recesses, pouches, fossae and folds 隐窝和陷凹隐窝和陷凹 . Formative formation by peritoneum two-layered fold of peritoneum that extends from stomach to adjacent orga

23、ns Lessor omentum 小网膜小网膜 Greater omentum 大网膜大网膜 Omentum 网膜网膜 Lessor omentum 小网膜小网膜 Hepatogastric ligament 肝胃韧带肝胃韧带extends from porta hepatis to lesser curvature of stomach Hepatoduodenal ligament 肝十二指肠韧带肝十二指肠韧带 Extends from porta hepatis to superior part of duodenum Contains common bile duct, proper

24、 hepatic a. and hepatic portal v. Omental foramen 网膜孔网膜孔 Behind the right border of hepatoduodenal ligament Superiorcaudate lobe of liver Inferiorsuperior part of duodenum Anteriorhepatodudenal ligament Posteriorperitoneum covering the inferior vena cava Greater omentum 大网膜大网膜 four-layered fold of p

25、eritoneum, the anterior two layers descend from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. If an infection occurs in the intestine, plasma cells formed i

26、n the lymph nodes combat the infection and help prevent it from spreading to the peritoneum. Lessor omentum Greater omentum Omental bursa 网膜囊网膜囊 Positionsituated behind the lesser omentum and stomach Walls Superiorperitoneum which covers the caudate lobe of liver and diaphragm Anteriorformed by less

27、er omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum Inferiorconjunctive area of anterior and posterior two layers of greater omentum Posteriorformed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering

28、pancreas, left kidney and suprarenal gland Leftformed by the spleen, gastrosplenic ligament胃脾韧带胃脾韧带 and splenorenal ligament 脾肾韧带脾肾韧带 Rightformed by omental foramen The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen. Mesenteries or mesocolons two-layered fol

29、d of peritoneum that attach part of the intestines to the posterior abdominal wall Mesentery 肠系膜肠系膜 suspends the small intestine from the posterior abdominal wall Broad and a fan-shaped Consists of two peritoneal layers Intestinal borderfolded, 7 m long Radix of mesentery 15 cm long Directed oblique

30、ly from left side of L2 to in front of right sacroiliac joint The mesenteries and mesocolons 系膜系膜 Mesoappendix 阑尾系膜阑尾系膜 Triangular mesentery extends from terminal part of ileum to appendix Appendicular artery runs in free margin of the mesoappendix Transverse mesocolon 横结肠系膜横结肠系膜 a double fold of pe

31、ritoneum which connects the transverse colon to the posterior abdominal wall Sigmoid mesocolon 乙状结肠系膜乙状结肠系膜 inverted V-shaped, with apex located in front of left ureter and division of common iliac artery two-layered folds of peritoneum that attached the lesser mobile solid visera to the abdominal w

32、all Ligaments of liver Falciform ligament of liver 镰状韧带镰状韧带 Coronary ligament 冠状韧带冠状韧带 Left and right triangular ligaments 左、右三角韧带左、右三角韧带 Ligaments 韧带韧带 Hepatogastric ligament 肝胃韧带肝胃韧带 Hepatoduodenal ligament 肝十二指肠韧带肝十二指肠韧带 Ligamentum teres hepatis 肝圆韧带肝圆韧带 Ligaments of spleen Gastrosplenic ligament

33、 胃脾韧带胃脾韧带 Splenorenal ligament 脾肾韧带脾肾韧带 Phrenicosplenic ligament 膈脾韧带膈脾韧带 Splenocolic ligament 脾结肠韧带脾结肠韧带 Ligaments of stomach Hepatogastric ligament 肝胃韧带肝胃韧带 Gastrosplenic ligament 胃脾韧带胃脾韧带 Gastrophrenic ligament 胃膈韧带胃膈韧带 Gastrocolic ligament 胃结肠韧带胃结肠韧带 Gastropancrestic ligament 胃胰韧带胃胰韧带 Superior d

34、uodenal fold and recess 十二指肠上襞和上隐窝十二指肠上襞和上隐窝 Inferior duodenal fold and recess 十二指肠下襞和下隐窝十二指肠下襞和下隐窝 Intersigmoid recess 乙状结肠乙状结肠 间隐窝间隐窝formed by the inverted V attachment of sigmoid mesocolon The peritoneal recesses, pouches, fossae and folds Superior duodenal fold and recess 十二指肠上襞和上隐窝十二指肠上襞和上隐窝 In

35、ferior duodenal fold and recess 十二指肠下襞和下隐窝十二指肠下襞和下隐窝 Intersigmoid recess 乙状结肠乙状结肠 间隐窝间隐窝formed by the inverted V attachment of sigmoid mesocolon The peritoneal recesses, pouches, fossae and folds Retrocecal recess 盲肠后隐窝盲肠后隐窝 in which the appendix frequenty lies Hepatorenal recess 肝肾隐窝肝肾隐窝 lies betwe

36、en the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the subject is supine Folds and fossas of anterior abdominal wall Median umbilical fold 脐正中襞脐正中襞contain the remnant of urachus (median umbilical ligaments) Medial umbilical fold 脐

37、内侧襞脐内侧襞contains remnants of the umbilical arteries (medial umbilical ligaments) Lateral umbilical fold 脐外侧襞脐外侧襞contains the inferior epigastric vessels Supravesical fossa 膀胱上窝膀胱上窝 Medial inguinal fossa 腹股沟内侧窝腹股沟内侧窝 Lateral inguinal fossa 腹股沟外侧窝腹股沟外侧窝 Pouches In male - rectovesical pouch 直肠膀胱陷窝直肠膀胱陷窝

38、 In female Rectouterine pouch 直肠子宫陷窝直肠子宫陷窝between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝膀胱子宫陷窝between bladder and uterus .Peritoneal subdivisions The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic compartments. Supracolic compartments 结肠上区结肠上区(

39、subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Infracolic compartments. 结肠下区结肠下区lies below the transverse colon and transverse mesocolon Subphrenic Space 结肠上区结肠上区 Suprahepatic recess 肝上间隙肝上间隙 Left suprahepatic recesses 左肝上间隙左肝上间隙 left anterior suprahepatic spac

40、es 左肝上前间隙 left posterior suprahepatic spaces 左肝上后间隙 Right suprahepatic recesses 右肝上间隙右肝上间隙 right anterior suprahepatic spaces 右肝上前间隙 right posterior suprahepatic spaces 右肝上后间隙 bare area of live (extraperitoneal space) 肝裸区 Infrahepatic recess 肝下间隙肝下间隙 Right infrahepatic recesses 右肝下间隙右肝下间隙 (hepatoren

41、al recess) Left infrahepatic recesses 左肝下间隙左肝下间隙 left anterior infrahepatic space 左肝下前间隙 left posterior infrahepatic space 左肝下后间隙(网膜囊） Suprahepatic recess 肝上间隙肝上间隙 lies between the diaphragm and live the falciform ligament divides it into right and left suprahepatic recesses Left suprahepatic recess

42、es 左肝上间隙左肝上间隙 left anterior suprahepatic spaces left posterior suprahepatic spaces Right suprahepatic recesses 右肝上间隙右肝上间隙 right anterior suprahepatic spaces right posterior suprahepatic spaces bare area of live (extraperitoneal space) Infrahepatic recess 肝下间隙肝下间隙 lies between the live and transverse

43、 colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic recesses Right infrahepatic recesses 右肝下间隙右肝下间隙 (hepatorenal recess 肝肾隐窝肝肾隐窝) Left infrahepatic recesses 左肝下间隙左肝下间隙 left anterior infrahepatic space 左肝下前间隙左肝下前间隙 left posterior infrahepatic space

44、左肝下后间隙（网膜囊）左肝下后间隙（网膜囊） Infracolic compartments 结肠下区结肠下区 lies below the transverse colon and transverse mesocolon Right paracolic sulcus 右结肠旁沟右结肠旁沟 lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection b

45、etween the pelvic and the upper abdominal region. Left paracolic sulcus 左结肠旁沟左结肠旁沟 lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm. Right mesenteric sinus 右肠系

46、膜窦右肠系膜窦 triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon Left mesenteric sinus 左肠系膜窦左肠系膜窦 lies between root of mesentery, descending colon, right 1/3 of transverse colon and transverse mesocolon, its widens below where it is co

47、ntinuous with the cavity of the pelvis 上下流通，左沟不畅，右窦封闭，左窦入盆。上下流通，左沟不畅，右窦封闭，左窦入盆。 Infracolic Compartments Ling Shucai Regional anatomy Jejunum and ileum 空肠和回肠空肠和回肠 Jejunum and ileum Characteristic Jejunum 空肠 Ileum 回肠 Position Upper 2/5 Lower 3/5 Diameter Greater Less Wall Thicker Thin Circular folds 环状襞 Larger, numerous Fewer，smaller Vascularity Greater Less Colour Deeper red Paler pink Lymphatic follicles 淋巴滤泡 Solitary Aggregated Vermiform