腹部的局部解剖與操作1-人體局解剖學(xué)-課件-14

局部解剖學(xué)（十四）腹部的局部解剖與操作（1）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一、境界與分區(qū)

BoundaryandRegion1.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。2.(固有)腹腔的境界上界：膈下界：骨盆上口3A.腹部的分區(qū)(九分法)3B.腹部的分區(qū)(四分法)二、表面解剖

TheSurfaceAnatomy體表標(biāo)志Surfacelandmark表面投影SurfaceprojectionXiphoidprocess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2.軟組織標(biāo)志Locationofinguinalligament3.體表投影三、腹前外側(cè)壁

TheAnterolateralAbdominalWall淺層結(jié)構(gòu)Superficialstructures深層結(jié)構(gòu)Deepstructures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（一）淺層結(jié)構(gòu)

Thesuperficialstructures皮膚Skin淺筋膜Superficialfascia1.Skin:thinnerandmoreelastic薄而富有彈性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)；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筋膜淺

筋

膜SkinSuperficialfasica

Scarpa’sfasciaMusclesofanteriorabdominalCamper’sfasciaTransversalisfasciawall2.Superficial

fasciaSuperficial

fasciaconsistsofalayerofconnectivetissuethatcontainsavariableamountoffat.Abovethelevelofumbilicus,itisafattylayer.Intheinferiorpartoftheanterolateralwall,thesubcutaneoustissueiscomposedoftwolayers,thefattyouterlayer,knownasCamper`sfascia,andthemembranousinnerlayer,theScarpa`fascia.TheScarpa`fascia:1)isattachedtolineaalbamedially.2)continusedownwardscrosstheinguinalligamenttoblendwiththefascialataofthethighabout1.5cmbelowtheinguinalligament.3)iscontinuouswiththesuperficialfasciaoftheperineum(Colles’fascia).淺動脈、淺靜脈、皮神經(jīng)髂腹股溝區(qū)和下腹部的皮瓣Theilioinguinalandthelowerabdominalflaps（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Parietalperitoneum1.肌層

TheMuscularlayer前外側(cè)群TheAnterolateralGroupThethreeflatmusclesarethe:腹外斜肌externalobliquemuscle腹內(nèi)斜肌

internalobliquemuscle腹橫肌

transversus

abdominis：腹直肌rectus

abdominis錐狀肌pyramidalis（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腹股溝韌帶inguinalligament、腔隙韌帶lacunarligament、恥骨梳韌帶pectinealligament（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.aponeurosisTransversusabdominis,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?！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)

Rectussheath,posteriorlayer腱劃tendinousintersectionsRectusabdominis弓狀線ArcuatelinePyramidalm.（4）腹直肌rectusabdominis（5）錐狀肌pyramidalmuscletendinousintersectionsRectussheath,anteriorlayer腹直肌鞘

☆腹直肌鞘rectussheath☆腹直肌鞘Rectussheath腹直肌鞘包繞腹直肌，由腹外側(cè)壁三個(gè)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(gè)扁肌的腱膜構(gòu)成；腹直肌鞘后層缺如。2.血管、淋巴及神經(jīng)

Vessels,LymphandNerve(1)動脈(2)靜脈(3)神經(jīng)3.腹橫筋膜Transversalis

Fascia腹橫筋膜Transversefascia精索內(nèi)筋膜internalspermaticfascia腹股溝深環(huán)deepinguinalring窩間韌帶interfoveolarligament腹橫筋膜Transversefascia腹前壁內(nèi)面的皺襞及凹窩4.壁腹膜Parietalperitoneum5.腹前壁手術(shù)常用切口ThoracoabdominalincisionSuperiormedianincisionTransrectusincisionPararectusincisionParamedianincisionSubcostalincisionSuperiortransverseincisionMcBurney’sincisionInferiormedianincisionInferiortransverseincisionAbovethearcuatelineBelowthearcuateline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（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)TheLayersoftheInguinalRegion4.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)

TheLayersoftheInguinalRegion7.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(shí)，該區(qū)所承受的腹內(nèi)壓力比平臥時(shí)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。（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（三）腹股溝管InguinalCanal1.位置2.內(nèi)容3.構(gòu)成4.臨床意義

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

Theinguinalcanalliesparallelandjustsuperiortothemedialhalfoftheinguinalligament.

Themainoccupantoftheinguinalcanalisthespermaticcordinmalesandtheroundligamentoftheuterusinfemales.Italsocontainsbloodandlymphaticvesselsandtheilioinguinalnerveinbothsexes.Thedeep(internal)inguinalring,entrancetoinguinalcanal,isanoutpouchingofthetransversalisfasciaapproximately1.25cmsuperiortothemiddleoftheinguinalligamentandlateraltotheinferiorepigastricvessels.

Theanteriorwalloftheinguinalcanalisformedbytheexternalobliqueaponeurosisthroughoutthelengthofthecanal,withtheanteriorwallofthelateralpartofthecanalbeingreinforcedbyfibersofinternusoblique.

Theposteriorwall

oftheinguinalcanalisformedbythetransversalisfasciawiththeposteriorwallofthemedialpartofthecanalbeingreinforcedtheconjointtendon.Roof(superiorwall)isformedbythearchingfibersoftheinternalobliqueandtransverseab