腹膜和腹膜腔解剖

腹膜和腹膜腔 内容： 一、腹膜腔的概念 二、腹膜形成的结构 三、腹膜间隙 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 一、腹膜腔的概念 腹膜腔为壁腹膜 和脏腹膜之间的潜在 腔隙，内有少量（ 100200ml）浆液。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 男性腹膜腔是密 闭的，女性腹膜腔间 接通外界（经输卵管 腹腔口、输卵管、子 宫、阴道与外界相通 ）。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 二、腹膜形成的结构 网膜 系膜 韧带 皱襞 陷窝、陷凹 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （一）网膜 omentum 与胃相连的腹膜 皱襞，有： 小网膜 大网膜 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 1.小网膜 lesser omentum 为从肝门连至胃小 弯和十二指肠上部的双 层腹膜皱襞。又分为： 肝胃韧带 肝十二指肠韧带 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 2.大网膜 greater omentum 形似围裙覆盖 在空、回肠和横结 肠的前面，左缘与 胃脾韧带相连续。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 胃结肠韧带: 自胃大弯和十二指 肠上部至横结肠之间的 大网膜前两层形成胃结 肠韧带。内含胃网膜左 、右血管、胃网膜左、 右淋巴结等。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 3.网膜孔和网膜囊 网膜孔： 位于小网膜游离缘 后方，可容12指，经 网膜孔可进入胃后面的 网膜囊。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 网膜孔的周界 ： 前界： 肝十二指肠韧带 下界： 十二指肠上部 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 后界： 下腔静脉表面的腹膜 上界： 肝尾叶 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 网膜囊 omental bursa （又称小腹膜腔） 位于小网膜和胃后壁 与腹后壁的腹膜之间的一 个扁窄间隙，网膜囊以外 的腹膜腔称大腹膜腔。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 周界 ： 上界： 肝尾叶和膈下面的腹膜。 下界： 大网膜前、后层的愈着处。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 前壁： 小网膜、胃后壁的 腹膜和胃结肠韧带。 后壁： 横结肠及其系膜以 及覆盖胰、左肾、左肾 上腺等处的腹膜。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 左侧界: 脾、胃脾韧带、脾肾韧带。 右侧界：借网膜孔通腹膜腔的其余部分 。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 临床意义： 网膜囊位置较深 ，胃后壁穿孔或某些炎 症导至网膜囊内积液， 早期常局限在囊内，给 诊断带来一定困难。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG (二)系膜 mesentery 与肠相连的双层腹 膜皱襞，将肠管连于腹 后壁，内有出入肠管的 血管、神经及淋巴结等 。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 主要的系膜有： 肠系膜 阑尾系膜 横结肠系膜 乙状结肠系膜 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肠系膜 mesentery： 肠系膜是将空 、回肠连于腹后壁的 双层腹膜结构。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肠系膜根： 长约15cm， 从第二腰椎左 侧至右骶髂关 节前方。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （三）韧带 ligament 为腹膜反折处形成的腹膜皱襞，多数 为双层。韧带对脏器起固定作用。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG (四)皱襞、隐窝和陷凹 在腹膜皱襞之 间形成的凹陷称隐 窝，较大的隐窝称 陷凹。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 1. 腹后壁的腹膜皱襞和隐窝 十二指肠上、下襞 十二指肠上、下隐窝 盲肠后隐窝 肝肾隐窝 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 2.盆腔的腹膜陷凹 男性：膀胱直肠陷凹 女性：女性：膀胱子宫陷凹 子宫直肠陷凹 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （五）腹膜间隙 1. 结肠上区的腹膜间隙 2. 结肠下区的腹膜间隙 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 1.结肠上区的腹膜间隙 位于膈与横结肠 及其系膜之间。又称 为膈下间隙或肝周间 隙。共有6个腹膜间 隙。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 膈下间隙的分区： 肝上间隙： 左肝上间隙：前间隙 后间隙 右肝上间隙 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肝下间隙： 右肝下间隙 （肝肾隐窝） 左肝下间隙： 前间隙 后间隙 （网膜囊 ） January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 另还有1个腹膜外间隙 膈与肝裸区之间。 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 上述7个间隙，任何一个间隙发生脓肿 均称为膈下脓肿，临床上以右肝上、下脓 肿较为多见。 膈下脓肿: January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 4个： 左、右结肠旁沟 左、右系膜窦 2. 结肠下区的腹膜间隙 January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 右结肠旁沟：向上通肝肾隐窝，向 下通右髂窝和盆腔。 左结肠旁沟：向下通盆腔 结肠下区腹膜间隙的通向： January, 2007 Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 左系膜窦：向下通盆腔 右系膜窦：几乎封闭，窦内有感 染不