上腹部脏器解剖腹膜和胃.ppt

Outline讲授大纲,概述Introduction腹壁层次Thelayersoftheabdominalwall腹壁的重要局部Theimportantregionsofabdominalwall腹腔、腹膜及腹膜腔Abdominalcavity,peritoneumandperitonealcavity腹腔重要脏器局解Theimportantorgansofabdominalcavity胃；肝脏；肝外胆道；肾脏,腹腔、腹膜和腹膜腔(Abdominalcavity,PeritoneumandPeritonealcavity)基本概念：腹腔腹膜（壁腹膜和脏腹膜）腹膜腔,Theintroductionoftheperitoneum,DefinitionTheperitoneumisathinserousmembranethatlinesthewallsoftheabdominalandpelviccavitiesandcovertheorganswithinthetwocavities,SubdivisionsandperitonealcavityParietalperitoneum壁腹膜linesthewallsoftheabdominalandpelviccavitiesVisceralperitoneum脏腹膜coverstheorgansPeritonealcavity腹膜腔thepotentialspacebetweentheparietalandviscerallayerofperitoneum.,Isthereanyorgansintheperitonealcavity?,Theperitonitisisverycommonforfemale!,Formale,itisaclosedsac.,Butforfemale,thereisacommunicationwiththeexteriorthroughtheuterinetubes,theuterus,andthevagina.,FunctionSecretesalubricatingserousfluidthatcontinuouslymoistenstheassociatedorgansSupportandprotectviscusSemipermeablemembrane(Peritonealdialysis)Absorption,Therelationshipbetweenvisceraandperitoneum,Intraperitonealviscera腹膜内位器官visceracompletelysurroundedbyperitoneum,example,stomach,superiorpartofduodenum,jejunum,ileum,cecum,vermiformappendix,transverseandsigmoidcolons,spleenandovaryInterperitonealviscera腹膜间位器官mostpartofviscerasurroundedbyperitoneum,example,liver,gallbladder,ascendinganddescendingcolons,upperpartofrectum,urinarybladderanduterusRetroperitonealviscera腹膜外位器官someorganslieontheposteriorabdominalwallandarecoveredbyperitoneumontheiranteriorsurfacesonly,example,kidney,suprarenalgland,pancreas,descendingandhorizontalpartsofduodenum,middleandlowerpartsofrectum,andureter,Structuresformedbyperitoneum,Omentum网膜Thefoldofperitoneumthatextendsfromtwocurvaturesofstomachtoadjacentorgans,Lesseromentum小网膜two-layeredfoldofperitoneumwhichextendsfromportahepatistolessercurvatureofstomachandsuperiorpartofduodenum.,Greateromentum大网膜four-layeredfoldofperitoneum,theanteriortwolayersdescendfromthegreatercurvatureofstomachandinferiorpartofduodenumandhangsdownlikeanaproninfrontofcoilsofsmallintestine,andthenturnsupwardandattachestothetransversecolon.,Mesenterium系膜two-layeredfoldofperitoneumthatattachtheabdominalorpelvicorganstotheposteriorabdominalwall.,mesenterium,Mesentery肠系膜suspendsthesmallintestinefromtheposteriorabdominalwallBroadandafan-shapedIntestinalborderfolded,5-7mlongRadixofmesentery15cmlongDirectedobliquelyfromleftsideofL2toinfrontofrightsacroiliacjoint,Mesoappendix阑尾系膜TriangularmesenteriumextendsfromterminalpartofileumtoappendixAppendiculararteryrunsinfreemarginofthemesoappendix,Transversemesocolon横结肠系膜adoublefoldofperitoneumwhichconnectsthetransversecolontotheposteriorabdominalwallSigmoidmesocolon乙状结肠系膜invertedV-shaped,withapexlocatedinfrontofleftureteranddivisionofcommoniliacartery,Ligaments韧带LigamentsofliverFalciformligamentofliver镰状韧带ConsistsofdoubleperitoneallayerExtendsfromanteriorabdominalwall(umbilicus)toliveFreeborderofligamenthasligamentumteres,Coronaryligament冠状韧带itisformedbytheperitoneumbetweenthediaphragmandtheliver.ThereareleftandrightcoronaryligamentLeftandrighttriangularligaments左、右三角韧带formedbytheleftandrightextremityofcoronaryligamentligament,respectively,Hepatogastricligament肝胃韧带Hepatoduodenalligament肝十二指肠韧带ExtendsfromportahepatistosuperiorpartofduodenumContainscommonbileduct,properhepatica.andhepaticportalv.,LigamentsofspleenGastrosplenicligament胃脾韧带adoublelayerofperitoneumthatconnectsthefundusofstomachtohilumofspleen.Inthisdoublelayerofperitoneum,therearetheshortgastricandleftgastroepiploicvesselsSplenorenalligament脾肾韧带extendsbetweenthehilumofspleenandanterioraspectofleftkidney.Thesplenicvesselslieswithinthisligament,aswellasthetailofpancreasPhrenicosplenicligament膈脾韧带,LigamentsofstomachHepatogastricligament肝胃韧带Gastrosplenicligament胃脾韧带Gastrophrenicligament胃膈韧带Gastrocolicligament胃结肠韧带Gastropancresticligament胃胰韧带,Folds,recessesandfossa皱襞、隐窝和窝,Superiorduodenalfoldandrecess十二指肠上襞和上隐窝Inferiorduodenalfoldandrecess十二指肠下襞和下隐窝Intersigmoidrecess乙状结肠间隐窝formedbytheinvertedVattachmentofsigmoidmesocolon,Hepatorenalrecess肝肾隐窝liesbetweentherightlobeofliver,rightkidney,andrightcolicflexure,andisthelowestpartsoftheperitonealcavitywhenthesubjectissupine,Medianumbilicalfold脐正中襞containtheremnantofurachus(medianumbilicalligaments)Medialumbilicalfold脐内侧襞containsremnantsoftheumbilicalarteries(medialumbilicalligaments)Lateralumbilicalfold脐外侧襞containstheinferiorepigastricvesselsSupravesicalfossa膀胱上窝Medialinguinalfossa腹股沟内侧窝Lateralinguinalfossa腹股沟外侧窝,Pouches陷窝Inmalerectovesicalpouch直肠膀胱陷窝InfemaleRectouterinepouch(Douglas,cavity)直肠子宫陷窝betweenrectumanduterusVesicouterinepouch膀胱子宫陷窝betweenbladderanduterus,Omentalbursa网膜囊,PositionsituatedbehindthelesseromentumandstomachWallsSuperiorperitoneumwhichcoversthecaudatelobeofliveranddiaphragmAnteriorformedbylesseromentum,peritoneumofposteriorwallofstomach,andanteriortwolayersofgreateromentumInferiorconjunctiveareaofanteriorandposteriortwolayersofgreateromentumPosteriorformedbyposteriortwolayersofgreateromentum,transversecolonandtransversemesocolon,peritoneumcoveringpancreas,leftkidneyandsuprarenalgland,腹膜腔的分部Thesubdivisionoftheperitonealcavity(twosacs),Leftformedbythespleen,gastrosplenicligament胃脾韧带andsplenorenalligament脾肾韧带Rightformedbyomentalforamen,Omentalforamen网膜孔BehindtherightborderofhepatoduodenalligamentSuperiorcaudatelobeofliverInferiorsuperiorpartofduodenumAnteriorhepatoduodenalligamentPosteriorperitoneumcoveringtheinferiorvenacavaTheOmentalbursa(lessersac)communicateswiththegreatersacthroughtheomentalforamen.,Thesubregionsoftheperitonealcavity,Thetransversecolonandtransversemesocolondividestheperitonealcavityintosupracolicandinfracoliccompartments.结肠上区和结肠下区,Supracoliccompartment结肠上区(subphrenicspace)liesbetweendiaphragmandtransversecolonandtransversemesocolonSuprahepaticrecess肝上间隙liesbetweenthediaphragmandlivethefalciformligamentdividesitintorightandleftsuprahepaticrecesses,Leftsuprahepaticspace左肝上间隙leftanteriorsuprahepaticspaceleftposteriorsuprahepaticspaceRightsuprahepaticspace右肝上间隙Subphrenicextraperitonealspace膈下腹膜外间隙(correspondingtothebareareaofliver),Infrahepaticspace肝下间隙liesbetweentheliveandtransversecolonandtransversemesocolontheligamentumtereshepaticdividesitintorightandleftinfrahepaticspacesRightinfrahepaticspace右肝下间隙(hepatorenalrecess)Leftinfrahepaticspaces左肝下间隙leftanteriorinfrahepaticspaceleftposteriorinfrahepaticspace,Infracoliccompartment结肠下区liesbelowthetransversecolonandtransversemesocolonRightparacolicsulcus(gutter)右结肠旁沟lieslateraltotheascendingcolon.Itcommunicateswiththehepatorenalrecessandthepelviccavity.Itprovidesarouteforthespreadofinfectionbetweenthepelvicandtheupperabdominalregion.Leftparacolicsulcus(gutter)左结肠旁沟lieslateraltothedescendingcolon.Itisseparatedfromtheareaaroundthespleenbythephrenicocolicligament,afoldofperitoneumthatpassesfromthecolicflexuretothediaphragm.,Rightmesentericsinus右肠系膜窦triangularspace,liesbetweenrootofmesentery,ascendingcolon,right2/3oftransversecolonandtransversemesocolonLeftmesentericsinus左肠系膜窦liesbetweenrootofmesentery,descendingcolon,left1/3oftransversecolonandtransversemesocolon,itswidensbelowwhereitiscontinuouswiththecavityofthepelvis,Theorgansoftheabdominalcavity腹腔脏器：,Supracoliccompartment结肠上区Infracoliccompartment结肠下区Extraperitonealspace腹膜后间隙,结肠上区