疝解剖学.ppt

腹股沟区的临床应用解剖学,丁文龙上海交通大学医学院2009.8.21,浅筋膜及腹壁,Skin,Superficialfasica,Scarpasfascia,Musclesofanteriorabdominal,Campersfascia,Transversalisfascia,wall,一.TheMusclesofAbdomen(TheAnterolateralGroup)腹肌(前外侧群),obliquusexternusabdominis腹外斜肌lineaalba腹白线inguinalligament腹股沟韧带superficialinguinalring腹股沟管浅环,（1）腹外斜肌externalobliquemuscle,腹股沟管皮下环superficialinguinalring:内侧脚medialcrus、外侧脚lateralcrus、脚间纤维intercruralfibers.,腹外斜肌Externaloblique,腹外斜肌腱膜Externaloblique，aponeurosis,Intercruralfibers,Medialcrus,腹股沟管皮下环superficialinguinalring:内侧脚medialcrus、外侧脚lateralcrus、脚间纤维intercruralfibers.,返转韧带reflectedligament、腹股沟韧带inguinalligament、,腹股沟韧带inguinalligament、腔隙韧带lacunarligament、耻骨梳韧带pectinealligament,obliquusinternusabdominis腹内斜肌Cremaster提睾肌transversusabdominis腹横肌inguinalfalx腹股沟镰(conjoinedtendon),提睾肌Cremastermuscle,腹股沟镰Inguinalfalx联合腱Conjoinedtendon,腹横肌下缘,腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构,腹横筋膜Transversefascia,精索内筋膜internalspermaticfascia,腹股沟深环deepinguinalring窝间韧带interfoveolarligament,腹横筋膜Transversefascia,腹前壁内面的皱襞及凹窝,4.壁腹膜Parietalperitoneum,二.TheInguinalRegion腹股沟区,Theboundary境界Thelayersandcharacteristics层次与特点Theinguinalcanal腹股沟管Theinguinaltriangle腹股沟三角hernias疝：Directinguinalhernias腹股沟直疝、indirectinguinalhernias腹股沟斜疝、femoralhernias股疝,（一）Boundary,1.Theskin2.Superficialfascia3.Aponeurosisofexternalobliquusabdominis,（二）TheLayersoftheInguinalRegion,4.Iliohypogastricnerveandilioinguinalnerve5.Obliquusinternusabdominis6.Transversusabdominis,（二）TheLayersoftheInguinalRegion,7.Transversefascia8.Extraperitonealfascia9.Inferiorepigastricarteryanddeepcircumflexartery10.Parietalperitoneum,三.腹股沟区的特点,腹外斜肌在此区移行为腱膜，并在下部形成一裂口(浅环)；腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部，两者间无肌层覆盖；有精索或子宫圆韧带通过，形成了一潜在性裂隙；在人体站立时，该区所承受的腹内压力比平卧时高3倍。因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部位。,四.Theinguinalcanal腹股沟管,PositionStructurespassingthroughitTwoopeningandfourwallsFormingofthespermaticcordIndirectinguinalhernia,TheInguinalCanal腹股沟管,1.位置2.内容3.构成4.临床意义,Theinguinalcanalisanoblique,inferomediallypassage(betweenthesuperficialanddeepinguinialrings)throughtheinferiorpartoftheanteriorabdominalwall),35cmlong.位于腹股沟带内侧半的上方，是由外上斜向内下的肌筋膜裂隙。Theinguinalcanalliesparallelandjustsuperiortothemedialhalfoftheinguinalligament.,Themainoccupantoftheinguinalcanalisthespermaticcordinmalesandtheroundligamentoftheuterusinfemales.Italsocontainsbloodandlymphaticvesselsandtheilioinguinalnerveinbothsexes.有精索（男性）或子宫圆韧带（女性）、髂腹股沟神经通过。,Thedeep(internal)inguinalring,entrancetoinguinalcanal,isanoutpouchingofthetransversalisfasciaapproximately1.25cmsuperiortothemiddleoftheinguinalligamentandlateraltotheinferiorepigastricvessels.内口：即腹股沟深环，位于腹股沟韧带中点上方约一横指处、腹壁下动脉外侧，是腹横筋膜在向外突形成的一个卵圆形孔。,Thesuperficial(external)inguinalring-exitfrominguinalcanal-isaslitlikeopeningbetweenthediagonalfibersoftheaponeurosisfotheexternaloblique,superolateraltothepubictubercle.外口：即腹股沟管浅环，是腹外斜肌腱膜在耻骨结节外上方形成的三角形裂隙。,Theanteriorwalloftheinguinalcanalisformedbytheexternalobliqueaponeurosisthroughoutthelengthofthecanal,withtheanteriorwallofthelateralpartofthecanalbeingreinforcedbyfibersofinternusoblique.前壁：为浅层的腹外斜肌腱膜和深层的腹内斜肌（在管的外侧1/3处）。,Theposteriorwalloftheinguinalcanalisformedbythetransversalisfasciawiththeposteriorwallofthemedialpartofthecanalbeingreinforcedtheconjointtendon.后壁：为腹横筋膜和腹股沟镰（在管的内侧1/3处）。,Roof(superiorwall)isformedbythearchingfibersoftheinternalobliqueandtransverseabdominalmuscles.上壁：为腹内斜肌和腹横肌的弓状下缘。Floor(inferiorwall)isformedbytheinguinalligament.下壁：为腹股沟韧带。,腹股沟三角InguinalTriangle（海氏三角Hesselbachstriangle）,构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域