课件：腹部概述、腹前外侧壁解剖.ppt

January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹 部,ABDOMEN,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,境界 分区 内容,概述,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,境界,上界：剑突、肋弓、第11肋前端、第12肋下缘和第12胸椎,下界:耻骨联合上缘、耻骨嵴、耻骨结节、腹股沟韧带、髂嵴至第5腰椎下缘的连线。,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,分区,九分法,四分法,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,内容,腹壁 结肠上区 结肠下区、腹膜后隙,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹前外侧壁,层次 局部结构 睾丸下降与腹股沟疝的关系,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,层次,1、皮肤 2、浅筋膜 3、肌层 4、腹横筋膜 5、腹膜外组织 6、壁腹膜,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1、皮肤,腹前外侧壁的皮肤 薄而富有弹性, 临床常选择为游离皮瓣的供皮区。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹前外侧壁浅筋膜较厚，在脐平面以下分浅、深两层。 浅层：为含大量脂肪组织的Camper筋膜(脂肪层)，向下与股部的浅筋膜相续 。 深层：为富含弹性纤维的Scarpa筋膜(膜性层)，中线处附于白线，向下在腹股沟韧带下方约一横指处附于阔筋膜，向内下与阴囊肉膜及会阴浅筋膜相续 。,2、浅筋膜,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,浅筋膜内含有丰富的浅血管、淋巴管和皮神经。,浅动脉：有三组 腹侧壁浅动脉：来自肋间后动脉、肋下动脉及腰动脉。 正中线附近浅动脉：来自腹壁上、下动脉的分支。 腹前壁下半部浅动脉：腹壁浅动脉、旋髂浅动脉，为股动脉分支。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脐以下的浅静脉汇入股静脉。,浅静脉：丰富, 吻合成脐周静脉网。,脐以上的浅静脉汇入腋静脉。,在脐区，浅静脉与深部的附脐静脉吻合，并借此静脉沟通肝门静脉，从而构成肝门静脉系统与上、下腔静脉系统的沟通。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,浅淋巴管：与浅血管伴行。脐以上入腋淋巴结；脐以下入腹股沟浅淋巴结；脐部淋巴管可经肝圆韧带与肝的淋巴管交通。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,皮神经：呈节段性分布 第7肋间神经剑突平面 第10肋间神经脐平面 第12肋间神经髂前上棘平面 第1腰神经腹股沟平面,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,3、肌层,腹直肌,腹外斜肌,腹内斜肌,腹横肌,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹直肌鞘,腱划,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹外斜肌腱膜形成的主要结构：,腹直肌鞘前层,皮下环(浅环),腹股沟韧带,腔隙韧带,耻骨梳韧带,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹内斜肌：肌纤维起自腹股沟韧带外侧1/2-1/3、髂棘及胸腰筋膜，呈扇形斜向内上，后部纤维止于下3对肋，余纤维在腹直肌外侧移行为腱膜，并分两层包裹腹直肌，止于腹白线。,腹内斜肌,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹横肌：肌纤维起自下6对肋骨内面、髂棘、胸腰筋膜及腹股沟韧带外侧1/3，自后向前内侧横行，在腹直肌外侧移行为腱膜。,腹横肌,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹横肌与腹内斜肌共同形成的结构：,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4、腹横筋膜,腹横筋膜为腹内筋膜的一部分，位于腹横肌深面，形成的结构有：,凹间韧带,腹股沟管深环,精索内筋膜,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,5、腹膜外组织,腹膜外组织又称腹膜外脂肪，是位于腹横筋膜与壁腹膜之间的疏松结缔组织，向后与腹膜后隙的疏松结缔组织相续。在腹股沟区此层含脂肪较多。输精管、腹壁下动脉等均行于此层内，临床行泌尿外科和妇产科手术，尽量避免进入腹膜腔，经腹膜外组织入路进行。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,6、壁腹膜,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹前外侧壁的血管、神经,1.血管 腹壁上、下动脉 下5对肋间后动脉 肋下动脉 4对腰动脉 旋髂深动脉,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹壁下动脉是髂外动脉经过腹股沟韧带深面时发出的分支，其体表投影为腹股沟韧带中内1/3交点与脐的连线。故腹膜腔穿刺应在此线的外上方，以免损伤腹壁下动脉。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,旋髂深动脉：与腹壁下动脉同一水平发自髂外动脉，经髂前上棘内侧，行向髂棘前部的上缘，在此分支入髂棘内唇，临床上常取其为营养动脉的带血管蒂髂骨移植。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2. 神经 第7-12胸神经前支 髂腹下神经 髂腹股沟神经 生殖股神经,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第7-12胸神经前支,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,髂腹下神经：髂前上棘内侧cm处穿入腹内斜肌，腹股沟管浅环上方3 4 cm处穿出。分布于耻骨联合上方皮肤和腹壁下部的肌肉。阑尾手术麦氏切口强调钝性分离腹内外肌，以避免损伤。,髂腹股沟神经：在髂腹下神经的下方，进入腹股沟管，行于精索上方，出腹股沟管浅环。分布于阴囊或大阴唇皮肤，肌支支配腹壁下部的肌肉。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,生殖股神经：在髂总血管附近分为生殖支和股支。生殖支进入腹股沟管，随精索下行，出腹股沟管浅环。 手术处理腹股沟管时应注意。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,局部结构,1、腹直肌鞘 2、腹白线 3、腹股沟管 4、腹股沟三角,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹直肌鞘：是包裹腹直肌和锥状肌的纤维组织，由腹外侧壁三层阔肌的腱膜构成，分前层、后层。在弓状线上、下，前、后两层结构不同。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹直肌鞘后层在脐下4-5cm处缺如，而形成一凹向下方的弓形线，称弓状线或半环线。,弓状线,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹白线：由两侧腹直肌鞘纤维腹前正中线上彼此交织而成。厚而坚韧，血管少。,腹白线,腹白线,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹股沟管：是位于腹股韧带内侧半上方约1.5cm处由肌和筋膜形成的潜在性裂隙，长约45cm。男性有精索、女性有子宫圆韧带通过。是腹前外侧壁的薄弱部位，有两口四壁。,精索,腹股沟管,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹股沟管二口：,外口（皮下环）：来自腹外斜肌腱膜。,内口（腹环）：来自腹横筋膜。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,前壁：是腹外斜肌腱膜和腹内斜肌。,后壁：是腹横筋膜和腹股沟镰。,下壁：是腹股沟韧带,上壁：是腹内斜肌和腹横肌的弓状下缘。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,凡器官或结构从先天或后天形成的裂口或薄弱区脱出者，称为疝。器官或结构从腹股沟管突出为腹股沟斜疝，脏器包在精索的3层被膜内。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腹股沟三角(hesselbach三角):腹直肌外侧缘，腹股沟韧带和腹壁下动脉围成的三角区。,如腹腔内容经海氏三角处膨出，则为腹股沟直疝，疝囊在精索被膜之外。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved