上腹部臟器解剖腹膜和胃new

上腹部臟器解剖腹膜和胃new第一頁，共七十一頁。腹腔、腹膜和腹膜腔(Abdominalcavity,PeritoneumandPeritonealcavity)

基本概念：腹腔

腹膜（壁腹膜和臟腹膜）腹膜腔第二頁，共七十一頁。TheintroductionoftheperitoneumDefinition

Theperitoneumisathinserousmembranethatlinesthewallsoftheabdominalandpelviccavitiesandcovertheorganswithinthetwocavities第三頁，共七十一頁。SubdivisionsandperitonealcavityParietalperitoneum壁腹膜－linesthewallsoftheabdominalandpelviccavitiesVisceralperitoneum臟腹膜－coverstheorgansPeritonealcavity腹膜腔－thepotentialspacebetweentheparietalandviscerallayerofperitoneum.Isthereanyorgansintheperitonealcavity?Theperitonitisisverycommonforfemale!Formale,itisaclosedsac.Butforfemale,thereisacommunicationwiththeexteriorthroughtheuterinetubes,theuterus,andthevagina.第四頁，共七十一頁。FunctionSecretesalubricatingserousfluidthatcontinuouslymoistenstheassociatedorgansSupportandprotectviscusSemipermeablemembrane(Peritonealdialysis)Absorption第五頁，共七十一頁。TherelationshipbetweenvisceraandperitoneumIntraperitonealvisceraInterperitonealvisceraRetroperitonealviscera第六頁，共七十一頁。Intraperitonealviscera腹膜內(nèi)位器官－visceracompletelysurroundedbyperitoneum,example,stomach,superiorpartofduodenum,jejunum,ileum,cecum,vermiformappendix,transverseandsigmoidcolons,spleenandovaryInterperitonealviscera腹膜間位器官－mostpartofviscerasurroundedbyperitoneum,example,liver,gallbladder,ascendinganddescendingcolons,upperpartofrectum,urinarybladderanduterusRetroperitonealviscera腹膜外位器官－someorganslieontheposteriorabdominalwallandarecoveredbyperitoneumontheiranteriorsurfacesonly,example,kidney,suprarenalgland,pancreas,descendingandhorizontalpartsofduodenum,middleandlowerpartsofrectum,andureter第七頁，共七十一頁。第八頁，共七十一頁。StructuresformedbyperitoneumOmentum網(wǎng)膜

Thefoldofperitoneumthatextendsfromtwocurvaturesofstomachtoadjacentorgans第九頁，共七十一頁。Lesseromentum

小網(wǎng)膜

two-layeredfoldofperitoneumwhichextendsfromportahepatistolessercurvatureofstomachandsuperiorpartofduodenum.第十頁，共七十一頁。Greateromentum

大網(wǎng)膜－four-layeredfoldofperitoneum,theanteriortwolayersdescendfromthegreatercurvatureofstomachandinferiorpartofduodenumandhangsdownlikeanaproninfrontofcoilsofsmallintestine,andthenturnsupwardandattachestothetransversecolon.第十一頁，共七十一頁。LesseromentumGreateromentum第十二頁，共七十一頁。Mesenterium系膜－two-layeredfoldofperitoneumthatattachtheabdominalorpelvicorganstotheposteriorabdominalwall.mesenterium第十三頁，共七十一頁。Mesentery

腸系膜－suspendsthesmallintestinefromtheposteriorabdominalwallBroadandafan-shapedIntestinalborder－folded,5-7mlongRadixofmesentery15cmlongDirectedobliquelyfromleftsideofL2toinfrontofrightsacroiliacjoint第十四頁，共七十一頁。第十五頁，共七十一頁。第十六頁，共七十一頁。第十七頁，共七十一頁。第十八頁，共七十一頁。Mesoappendix闌尾系膜Triangularmesenterium－extendsfromterminalpartofileumtoappendixAppendiculararteryrunsinfreemarginofthemesoappendix第十九頁，共七十一頁。Transversemesocolon

橫結(jié)腸系膜－adoublefoldofperitoneumwhichconnectsthetransversecolontotheposteriorabdominalwallSigmoidmesocolon

乙狀結(jié)腸系膜－invertedV-shaped,withapexlocatedinfrontofleftureteranddivisionofcommoniliacartery第二十頁，共七十一頁。Ligaments韌帶

Ligamentsofliver

Falciformligamentofliver鐮狀韌帶ConsistsofdoubleperitoneallayerExtendsfromanteriorabdominalwall(umbilicus)toliveFreeborderofligamenthasligamentumteres第二十一頁，共七十一頁。Coronaryligament冠狀韌帶－itisformedbytheperitoneumbetweenthediaphragmandtheliver.ThereareleftandrightcoronaryligamentLeftandrighttriangularligaments左、右三角韌帶－formedbytheleftandrightextremityofcoronaryligamentligament,respectively第二十二頁，共七十一頁。Hepatogastricligament肝胃韌帶Hepatoduodenalligament肝十二指腸韌帶ExtendsfromportahepatistosuperiorpartofduodenumContainscommonbileduct,properhepatica.andhepaticportalv.第二十三頁，共七十一頁。LigamentsofspleenGastrosplenicligament胃脾韌帶－adoublelayerofperitoneumthatconnectsthefundusofstomachtohilumofspleen.Inthisdoublelayerofperitoneum,therearetheshortgastricandleftgastroepiploicvesselsSplenorenalligament脾腎韌帶－extendsbetweenthehilumofspleenandanterioraspectofleftkidney.Thesplenicvesselslieswithinthisligament,aswellasthetailofpancreasPhrenicosplenicligament膈脾韌帶第二十四頁，共七十一頁。Ligamentsofstomach

Hepatogastricligament肝胃韌帶Gastrosplenicligament胃脾韌帶Gastrophrenicligament胃膈韌帶Gastrocolicligament胃結(jié)腸韌帶Gastropancresticligament

胃胰韌帶第二十五頁，共七十一頁。Folds,recessesandfossa

皺襞、隱窩和窩Superiorduodenalfoldandrecess十二指腸上襞和上隱窩Inferiorduodenalfoldandrecess十二指腸下襞和下隱窩Intersigmoidrecess

乙狀結(jié)腸間隱窩－formedbytheinvertedVattachmentofsigmoidmesocolon第二十六頁，共七十一頁。Hepatorenalrecess肝腎隱窩－liesbetweentherightlobeofliver,rightkidney,andrightcolicflexure,andisthelowestpartsoftheperitonealcavitywhenthesubjectissupine第二十七頁，共七十一頁。Medianumbilicalfold臍正中襞－containtheremnantofurachus(medianumbilicalligaments)Medialumbilicalfold

臍內(nèi)側(cè)襞－containsremnantsoftheumbilicalarteries(medialumbilicalligaments)Lateralumbilicalfold臍外側(cè)襞－containstheinferiorepigastricvesselsSupravesicalfossa膀胱上窩Medialinguinalfossa腹股溝內(nèi)側(cè)窩Lateralinguinalfossa腹股溝外側(cè)窩第二十八頁，共七十一頁。Pouches

陷窩Inmale－rectovesicalpouch直腸膀胱陷窩InfemaleRectouterinepouch(Douglas,cavity)

直腸子宮陷窩－betweenrectumanduterusVesicouterinepouch膀胱子宮陷窩－betweenbladderanduterus第二十九頁，共七十一頁。Omental

bursa

網(wǎng)膜囊Position－situatedbehindthelesseromentumandstomachWallsSuperior－peritoneumwhichcoversthecaudatelobeofliveranddiaphragmAnterior－formedbylesseromentum,peritoneumofposteriorwallofstomach,andanteriortwolayersofgreateromentumInferior－conjunctiveareaofanteriorandposteriortwolayersofgreateromentumPosterior－formedbyposteriortwolayersofgreateromentum,transversecolonandtransversemesocolon,peritoneumcoveringpancreas,leftkidneyandsuprarenalgland腹膜腔的分部Thesubdivisionoftheperitonealcavity(twosacs)第三十頁，共七十一頁。Left－formedbythespleen,gastrosplenicligament胃脾韌帶

andsplenorenalligament脾腎韌帶Right－formedbyomentalforamen第三十一頁，共七十一頁。Omentalforamen網(wǎng)膜孔BehindtherightborderofhepatoduodenalligamentSuperior－caudatelobeofliverInferior－superiorpartofduodenumAnterior－h(huán)epatoduodenalligamentPosterior－peritoneumcoveringtheinferiorvenacavaTheOmentalbursa(lessersac)communicateswiththegreatersacthroughtheomentalforamen.

第三十二頁，共七十一頁。第三十三頁，共七十一頁。第三十四頁，共七十一頁。ThesubregionsoftheperitonealcavityThetransversecolonandtransversemesocolondividestheperitonealcavityintosupracolicandinfracoliccompartments.結(jié)腸上區(qū)和結(jié)腸下區(qū)第三十五頁，共七十一頁。Supracoliccompartment

結(jié)腸上區(qū)(subphrenicspace)－liesbetweendiaphragmandtransversecolonandtransversemesocolonSuprahepaticrecess肝上間隙

liesbetweenthediaphragmandlive－thefalciformligamentdividesitintorightandleftsuprahepaticrecesses第三十六頁，共七十一頁。Leftsuprahepaticspace

左肝上間隙leftanteriorsuprahepaticspaceleftposteriorsuprahepaticspaceRightsuprahepaticspace

右肝上間隙Subphrenicextraperitonealspace膈下腹膜外間隙

(correspondingtothebareareaofliver)第三十七頁，共七十一頁。Infrahepaticspace肝下間隙

liesbetweentheliveandtransversecolonandtransversemesocolon－theligamentumtereshepaticdividesitintorightandleftinfrahepaticspacesRightinfrahepaticspace右肝下間隙(hepatorenalrecess)Leftinfrahepaticspaces左肝下間隙

leftanteriorinfrahepaticspaceleftposteriorinfrahepaticspace第三十八頁，共七十一頁。Infracoliccompartment

結(jié)腸下區(qū)

－liesbelowthetransversecolonandtransversemesocolonRightparacolicsulcus(gutter)右結(jié)腸旁溝－lieslateraltotheascendingcolon.Itcommunicateswiththehepatorenalrecessandthepelviccavity.Itprovidesarouteforthespreadofinfectionbetweenthepelvicandtheupperabdominalregion.Leftparacolicsulcus(gutter)左結(jié)腸旁溝－lieslateraltothedescendingcolon.Itisseparatedfromtheareaaroundthespleenbythephrenicocolicligament,afoldofperitoneumthatpassesfromthecolicflexuretothediaphragm.第三十九頁，共七十一頁。Rightmesentericsinus

右腸系膜竇－triangularspace,liesbetweenrootof

mesentery,ascendingcolon,right2/3oftransversecolonandtransversemesocolonLeftmesentericsinus

左腸系膜竇－liesbetweenrootof

mesentery,descendingcolon,left1/3oftransversecolonandtransversemesocolon,itswidensbelowwhereitiscontinuouswiththecavityofthepelvis第四十頁，共七十一頁。Theorgansoftheabdominalcavity

腹腔臟器：Supracoliccompartment

結(jié)腸上區(qū)

Infracoliccompartment

結(jié)腸下區(qū)

Extraperitonealspace腹膜后間隙第四十一頁，共七十一頁。第四十二頁，共七十一頁。結(jié)腸上區(qū)臟器解剖胃的局解肝臟的局解肝外膽道的局解第四十三頁，共七十一頁。胃的局解（Anatomyof

stomach）形態(tài)和分部Featuresanddivisions位置和毗鄰Positionandrelationship胃的網(wǎng)膜和韌帶OmentumandLigaments血供和淋巴Bloodvesselsandlymphatics神經(jīng)支配Nerve第四十四頁，共七十一頁。Featuresanddivisions第四十五頁，共七十一頁。

Positionand

Relationshipofstomach１．位置中度充盈時，大部分位于左季肋區(qū)，小部分位于腹上區(qū)。

賁門在第11胸椎左側(cè)，幽門在第1腰椎右側(cè)。2.毗鄰?：第四十六頁，共七十一頁。

Positionand

Relationshipofstomach第四十七頁，共七十一頁。

Positionand

Relationshipofstomach第四十八頁，共七十一頁。１．位置中度充盈時，大部分位于左季肋區(qū)（3/4)，小部分位于腹上區(qū)(1/4)。

賁門在第11胸椎左側(cè)，幽門在第1腰椎右側(cè)。2.

毗鄰：胃前壁右側(cè)份鄰接肝左葉,左側(cè)份