腹部解剖經(jīng)典圖演示文稿

腹部解剖經(jīng)典圖演示文稿當(dāng)前1頁，總共83頁。優(yōu)選腹部解剖經(jīng)典圖當(dāng)前2頁，總共83頁。主要內(nèi)容MainContent境界與分區(qū)Theboundaryandregion表面解剖Thesurfaceanatomy腹前外側(cè)壁TheAnterolateralAbdominalWall當(dāng)前3頁，總共83頁。一、境界與分區(qū)

BoundaryandRegion當(dāng)前4頁，總共83頁。1.腹部的境界上界：為胸廓下口，即劍突、肋弓、第11肋前端、第12肋下緣和第12胸椎圍成；下界：為恥骨聯(lián)合上緣、恥骨嵴、恥骨結(jié)節(jié)、腹股溝韌帶、髂嵴至第5腰椎下緣的連線。當(dāng)前5頁，總共83頁。2.(固有)腹腔的境界上界：膈下界：骨盆上口當(dāng)前6頁，總共83頁。3A.腹部的分區(qū)(九分法)當(dāng)前7頁，總共83頁。3B.腹部的分區(qū)(四分法)當(dāng)前8頁，總共83頁。二、表面解剖

TheSurfaceAnatomy體表標(biāo)志Surfacelandmark表面投影Surfaceprojection當(dāng)前9頁，總共83頁。Xiphoidprocess劍突Costalarch肋弓Iliaccrest髂嵴Anteriorsuperioriliacspine髂前上棘Pubictubercle恥骨結(jié)節(jié)Superioredgeofpubicsymphysis恥骨聯(lián)合上緣Pubiccrest恥骨嵴1.骨性標(biāo)志當(dāng)前10頁，總共83頁。2.軟組織標(biāo)志Locationofinguinalligament當(dāng)前11頁，總共83頁。3.體表投影當(dāng)前12頁，總共83頁。三、腹前外側(cè)壁

TheAnterolateralAbdominalWall淺層結(jié)構(gòu)Superficialstructures深層結(jié)構(gòu)Deepstructures當(dāng)前13頁，總共83頁。皮膚淺筋膜腹膜下筋膜深筋膜和肌肉Thelayersoftheanterolateralabdominalwall1.Skin2.Superficialfascia3.Deepfasciaandmuscles4.Transversefascia5.Extraperitonealfascia6.Parietalfascia腹橫筋膜壁腹膜當(dāng)前14頁，總共83頁。（一）淺層結(jié)構(gòu)

Thesuperficialstructures皮膚Skin淺筋膜Superficialfascia當(dāng)前15頁，總共83頁。1.Skin:thinnerandmoreelastic薄而富有彈性當(dāng)前16頁，總共83頁。2.Superficialfascia：主要由脂肪和疏松結(jié)締組織組成。Camper筋膜在腹壁下部（約在臍平面以下），淺筋膜分為兩層：淺層稱為Camper`sfascia,含有豐富的脂肪組織，又稱脂肪層，向下與股部的淺筋膜相互延續(xù)；當(dāng)前17頁，總共83頁。深層稱為Scarpa`fascia，是富有彈性纖維的膜性層，在中線附于白線，向下在腹股溝下方約一橫指處，緊附于股部的深筋膜，在恥骨結(jié)節(jié)之間，越過恥骨聯(lián)合向下至?xí)?，與會陰淺筋膜（Colles筋膜）相延續(xù)。Scarpa筋膜當(dāng)前18頁，總共83頁。淺

筋

膜SkinSuperficialfasica

Scarpa’sfasciaMusclesofanteriorabdominalCamper’sfasciaTransversalisfasciawall當(dāng)前19頁，總共83頁。2.Superficial

fasciaSuperficial

fasciaconsistsofalayerofconnectivetissuethatcontainsavariableamountoffat.Abovethelevelofumbilicus,itisafattylayer.Intheinferiorpartoftheanterolateralwall,thesubcutaneoustissueiscomposedoftwolayers,thefattyouterlayer,knownasCamper`sfascia,andthemembranousinnerlayer,theScarpa`fascia.TheScarpa`fascia:1)isattachedtolineaalbamedially.2)continusedownwardscrosstheinguinalligamenttoblendwiththefascialataofthethighabout1.5cmbelowtheinguinalligament.3)iscontinuouswiththesuperficialfasciaoftheperineum(Colles’fascia).當(dāng)前20頁，總共83頁。淺動脈、淺靜脈、皮神經(jīng)當(dāng)前21頁，總共83頁。髂腹股溝區(qū)和下腹部的皮瓣Theilioinguinalandthelowerabdominalflaps當(dāng)前22頁，總共83頁。（二）深層結(jié)構(gòu)

TheDeepStructures肌肉層次Muscularlayer血管、淋巴及神經(jīng)Vessels,lymphandnerve腹橫筋膜Transversalisfascia腹膜下筋膜Extraperitonealfascia壁腹膜Parietalperitoneum當(dāng)前23頁，總共83頁。1.肌層

TheMuscularlayer前外側(cè)群TheAnterolateralGroupThethreeflatmusclesarethe:腹外斜肌externalobliquemuscle腹內(nèi)斜肌internalobliquemuscle腹橫肌transversusabdominis：腹直肌rectusabdominis錐狀肌pyramidalis當(dāng)前24頁，總共83頁。（1）腹外斜肌externalobliquemuscle

腹股溝管皮下環(huán)superficialinguinalring:內(nèi)側(cè)腳medialcrus、外側(cè)腳lateralcrus、腳間纖維intercruralfibers.腹外斜肌Externaloblique腹外斜肌腱膜Externaloblique，aponeurosisIntercruralfibersMedialcrus當(dāng)前25頁，總共83頁。腹股溝管皮下環(huán)superficialinguinalring:內(nèi)側(cè)腳medialcrus、外側(cè)腳lateralcrus、腳間纖維intercruralfibers.返轉(zhuǎn)韌帶reflectedligament、腹股溝韌帶inguinalligament、腔隙韌帶lacunarligament、恥骨梳韌帶pectinealligament當(dāng)前26頁，總共83頁。腹股溝韌帶inguinalligament、腔隙韌帶lacunarligament、恥骨梳韌帶pectinealligament當(dāng)前27頁，總共83頁。（2）腹內(nèi)斜肌及其腱膜internalobliquemuscle&aponeurosis

：參與構(gòu)成腹直肌鞘前、后層，結(jié)合腱和提睪肌。InternalobliquemuscleInternalobliquem.aponeurosis當(dāng)前28頁，總共83頁。Transversusabdominis,aponeurosisTransversusabdominis（3）腹橫肌及其腱膜transversusmuscle&aponeurosis：參與構(gòu)成腹直肌鞘前層（弓狀線以下）、后層（弓狀線以上），結(jié)合腱和提睪肌。當(dāng)前29頁，總共83頁?！钐岵G肌Cremastermuscle☆腹股溝鐮Inquinalfalx聯(lián)合腱Conjoinedtendon☆腹橫肌下緣

腹內(nèi)斜肌及其腱膜和腹橫肌及其腱膜形成的結(jié)構(gòu)

當(dāng)前30頁，總共83頁。Rectussheath,posteriorlayer腱劃tendinousintersectionsRectusabdominis弓狀線ArcuatelinePyramidalm.（4）腹直肌rectusabdominis（5）錐狀肌pyramidalmuscletendinousintersectionsRectussheath,anteriorlayer當(dāng)前31頁，總共83頁。腹直肌鞘

當(dāng)前32頁，總共83頁。☆腹直肌鞘rectussheath當(dāng)前33頁，總共83頁?！罡怪奔∏蔙ectussheath腹直肌鞘包繞腹直肌，由腹外側(cè)壁三個扁肌的腱膜構(gòu)成，分為前、后兩層。在弓狀線以上：腹直肌鞘前層anteriorlayeroftherectussheath由腹外斜肌腱膜和腹內(nèi)斜肌腱膜前層構(gòu)成；腹直肌鞘后層posteriorlayeroftherectussheath由腹內(nèi)斜肌腱膜的后層和腹橫肌腱膜構(gòu)成。在弓狀線以下：腹直肌鞘前層由三個扁肌的腱膜構(gòu)成；腹直肌鞘后層缺如。當(dāng)前34頁，總共83頁。2.血管、淋巴及神經(jīng)

Vessels,LymphandNerve當(dāng)前35頁，總共83頁。(1)動脈當(dāng)前36頁，總共83頁。當(dāng)前37頁，總共83頁。(2)靜脈當(dāng)前38頁，總共83頁。(3)神經(jīng)當(dāng)前39頁，總共83頁。3.腹橫筋膜Transversalis

Fascia當(dāng)前40頁，總共83頁。腹橫筋膜Transversefascia精索內(nèi)筋膜internalspermaticfascia當(dāng)前41頁，總共83頁。腹股溝深環(huán)deepinguinalring窩間韌帶interfoveolarligament腹橫筋膜Transversefascia當(dāng)前42頁，總共83頁。腹前壁內(nèi)面的皺襞及凹窩4.壁腹膜Parietalperitoneum當(dāng)前43頁，總共83頁。5.腹前壁手術(shù)常用切口ThoracoabdominalincisionSuperiormedianincisionTransrectusincisionPararectusincisionParamedianincision當(dāng)前44頁，總共83頁。SubcostalincisionSuperiortransverseincisionMcBurney’sincisionInferiormedianincisionInferiortransverseincision當(dāng)前45頁，總共83頁。AbovethearcuatelineBelowthearcuateline當(dāng)前46頁，總共83頁。四、腹股溝區(qū)

TheInguinalRegion境界Theboundary層次與特點(diǎn)Thelayersandcharacteristics腹股溝管Theinguinalcanal腹股溝三角Theinguinaltriangle疝hernias：腹股溝直疝D(zhuǎn)irectinguinalhernias、腹股溝斜疝indirectinguinalhernias、股疝femoralhernias當(dāng)前47頁，總共83頁。（一）境界Boundary1.皮膚skin2.淺筋膜superficialfascia3.腹外斜肌aponeurosisofexternalobliquusabdominis（二）腹股溝區(qū)層次結(jié)構(gòu)TheLayersoftheInguinalRegion當(dāng)前48頁，總共83頁。4.髂腹下神經(jīng)Iliohypogastricn.和髂腹股溝神經(jīng)ilioinguinaln.5.腹內(nèi)斜肌Obliquusinternusabdominis6.腹橫肌Transversusabdominis（二）腹股溝區(qū)層次結(jié)構(gòu)

TheLayersoftheInguinalRegion當(dāng)前49頁，總共83頁。7.腹橫筋膜Transversefascia8.腹膜外筋膜Extraperitonealfascia9.腹璧下動脈Inferiorepigastrica.and旋髂深動脈deepcircumflexiliaca.10.璧腹膜Parietalperitoneum特點(diǎn)：①腹外斜肌在此區(qū)移行為腱膜，并在下部形成一裂口(淺環(huán))；②腹內(nèi)斜肌與腹橫肌的下緣未達(dá)腹股溝韌帶的內(nèi)側(cè)部，兩者間無肌層覆蓋；③有精索或子宮圓韌帶通過，形成了一潛在性裂隙；④在人體站立時，該區(qū)所承受的腹內(nèi)壓力比平臥時高3倍。因此，腹股溝區(qū)為腹壁的薄弱區(qū)，是腹壁疝的多發(fā)部位。當(dāng)前50頁，總共83頁。（三）腹股溝管

Theinguinalcanal位置Position通過的結(jié)構(gòu)Structurespassingthroughit兩口、四璧Twoopeningandfourwalls精索Formingofthespermaticcord腹股溝斜疝Indirectinguinalhernia當(dāng)前51頁，總共83頁。（三）腹股溝管InguinalCanal1.位置2.內(nèi)容3.構(gòu)成4.臨床意義當(dāng)前52頁，總共83頁。

Theinguinalcanalisanoblique,inferomediallypassage(betweenthesuperficialanddeepinguinialrings)throughtheinferiorpartoftheanteriorabdominalwall),3~5cmlong.

Theinguinalcanalliesparallelandjustsuperiortothemedialhalfoftheinguinalligament.Themainoccupantoftheinguinalcanalisthespermaticcordinmalesandtheroundligamentoftheuterusinfemales.Italsocontainsbloodandlymphaticvesselsandtheilioinguinalnerveinbothsexes.當(dāng)前53頁，總共83頁。當(dāng)前54頁，總共83頁。Thedeep(internal)inguinalring,entrancetoinguinalcanal,isanoutpouchingofthetransversalisfasciaapproximately1.25cmsuperiortothemiddleoftheinguinalligamentandlateraltotheinferiorepigastricvessels.Theanteriorwalloftheinguinalcanalisformedbytheexternalobliqueaponeurosisthroughoutthelengthofthecanal,withtheanteriorwallofthelateralpartofthecanalbeingreinforcedbyfibersofinternusoblique.

Theposteriorwall

oftheinguinalcanalisformedbythetransversalisfasciawiththeposteriorwallofthemedialpartofthecanalbeingreinforcedtheconjointtendon.Roof(superiorwall)isformedbythearchingfibersoftheinternalobliqueandtransverseabdominalmuscles.Floor(inferiorwall)isformedbytheinguinalligament.Thesuperficial(external)inguinalring-exitfrominguinalcanal-isaslitlikeopeningbetweenthediagonalfibersoftheaponeurosisfotheexternaloblique,superolateraltothepubictubercle.當(dāng)前55頁，總共83頁。腹股溝三角InguinalTriangle（海氏三角Hesselbach’striangle）①構(gòu)成：腹壁下動脈、腹直肌外側(cè)緣和腹股溝韌帶內(nèi)側(cè)半所圍成的三角形區(qū)域。②臨床意義：由腹股溝三角突出的疝，稱腹股溝直疝。當(dāng)前56頁，總共83頁。腹股溝三角腹股溝直疝、腹股溝斜疝、股疝當(dāng)前57頁，總共83頁。IndirectHerniaDirectHernia股疝femoralhernia當(dāng)前58頁，總共83頁。睪丸下降過程當(dāng)前59頁，總共83頁。卵巢下降過程當(dāng)前60頁，總共83頁。睪丸下降過程descendingprocessofthetestis當(dāng)前61頁，總共83頁。

先天性腹股溝斜疝Acongenitalindirectinguinalhernia后天性腹股溝斜疝

Aacquiredindirectinguinalhernia當(dāng)前62頁，總共83頁。

先天性腹股溝斜疝Acongenitalindirectinguinalhernia后天性腹股溝斜疝

Aacquiredindirectinguinalhernia當(dāng)前63頁，總共83頁。精索的被膜與腹前外側(cè)壁層次的關(guān)系當(dāng)前64頁，總共83頁。精索或睪丸被膜與腹前外側(cè)壁層次的關(guān)系當(dāng)前65頁，總共83頁。解剖與觀察

DissectionandObservation淺層結(jié)構(gòu)superficialstructures三層闊肌、血管和神經(jīng)Threeflatmuscles,vesselsandnerves腹直肌rectusabdominis腹直肌rectussheath腹股溝區(qū)inguinalregion腹股溝管inguinalcanal腹股溝三角inguinaltriangle當(dāng)前66頁，總共83頁。1.切口Incision當(dāng)前67頁，總共83頁。2.將皮瓣翻向外側(cè)reflectskinflapslaterally.

當(dāng)前68頁，總共83頁。3.

Identifythefattylayerofthesuperificialfascia.當(dāng)前69頁，總共83頁。4.Identifythesuperficialepigastricvessels.當(dāng)前70頁，總共83頁。5.Removethesuperficialfascia.當(dāng)前71頁，總共83頁。6.Identifythemembranouslayerofthesuperficialfascia.當(dāng)前72頁，總共83頁。7.Identifyseveralanteriorcutaneousbranchesofthelowestfiveintercostalnerves(T7~T11)andthesubcostalnerve(T12).當(dāng)前73頁，總共83頁。8.Identifytheterminalbranchesoftheiliohypogastricnerve(L1)andtheilioinguinalnerve(L1).當(dāng)前74頁，總共83頁。9.Removedeepinvestingcoveringtheexternalabdominalobliquemuscle.10.Identifythedirectionofthefibersandtheaponeurosisoftheexternalabdominalobliquemuscle.當(dāng)前75頁，總共83頁。11.Identifytheinguinalligament,thesuperficialinguinalring,themedialcrus,thelateralcrusandtheintercruralfibers.當(dāng)前76頁，總共83頁。12.Reflecttheexternalabdominalobliqueandexposeth