局解知识总结2.0版(更正版).docx

局部解剖知识重点归纳一、急性单纯性阑尾炎 Acute simple appendicitis1. McBurenys point and incision麦氏点的位置和麦氏切口答：位置：在脐至右髂前上棘连线的中外1/3交界处The surface projection of the root of appendix is the lateral 1/3 point of the line between umbilicus and the right anterior superior iliac spine.切口：从脐到右髂前上棘连线的中外1/3处，所作的垂直于此线的切口，长约5到7厘米At the lateral 1/3 point of the line between umbilicus and the right anterior superior iliac spine, make the incision which is perpendicular to this line. About 5 to 7 cm long.2. Which layers will you meet when you choose the McBurenys incision and the transcrectal incision? 阑尾炎手术切口的腹壁结构答： 9 / 9McBurenys incision(1)skin 皮肤(2)superficial fascia 浅筋膜(3)aponeurosis of extermal abdominal oblique muscle 腹外斜肌腱膜(4)obliquus internus abdominis腹内斜肌(5)transversus abdominis 腹横肌(6)transversalis fascia or transverse fascia 腹横筋膜(7)extraperitoneal fascia 腹膜外筋膜(8)parietal peritoneum 壁腹膜Transcrectal incision(1)skin 皮肤(2)superfacial fascia 浅筋膜(3)anterior layer of rectus of sheath 腹直肌鞘前层(4)rectus abdominis 腹直肌(5)posterior layer rectus of sheath 腹直肌鞘后层(6)transverse fascia腹横筋膜(7)extra-peritoneal fascia 腹膜外筋膜(8)parietal peritoneum 壁腹膜3. During the operation, how to find vermiform appendix? 如何在手术中寻找阑尾？答：First find cecum in the right iliac fossa, and then track down the roots of appendix along with colic bands of cecum. Namely, we can put out the whole appendix. 先在右髂窝内找到盲肠，再沿着盲肠的结肠带往下追踪找到阑尾根部，即可将整条阑尾牵出。4. Why can appendicitis cause liver abscess ?阑尾炎是如可引起肝脓肿的？答：Path1：The bacteria（细菌 ）go with the venous blood（静脉血）orderly through appendicular vein（阑尾静脉）, superior mesenteric vein（肠系膜上静脉）, portal vein into the liver（肝脏）, causing liver abscess（肝脓肿）Path2：The pus（脓）can go along the right paracolic sulcus（右结肠旁沟）to reach the upper and lower gap of right liver（右肝上下叶间隙）/hepatorenal recess（肝肾隐窝）, which infects（感染）liver to have adscess（脓肿）.5.The reason of metastatic right lower abdominal pain转移性右下腹痛的原因答：Inflammation of the acute appendicitis is gradually developed from inside to outside, when inflammation within limited to the size of appendicitis pain belong to visceral pain, characterized by the abdomen or periumbilical pain, when inflammation invasion and serous membrane, can cause the right lower abdomen inflammation of the lining peritoneal, from the pain of visceral pain into the body appear accurate lower abdominal pain. 急性阑尾炎的炎症是由内向外逐渐发展的，当炎症局限于浆膜以内时，阑尾炎的疼痛属于内脏痛，表现为上腹或脐周痛，当炎症侵及浆膜时，就会引起右下腹 壁层腹膜的炎症，从内脏性疼痛变成了躯体性疼痛，出现定位准确的右下腹痛。二、腹股沟疝Inguinal hernia1. What is a hernia? What are the reasons of the inguinal hernia? What are the symptoms of the inguinal hernia? 什么是疝？产生腹股沟疝的原因是什么？腹股沟疝的症状是什么？答：A certain organ or tissue in the human body away from the normal anatomic position, through the vulnerabilities and defects of the congenital or acquired or pore into another area.人体内某个脏器或组织离开其正常解剖位置，通过先天或后天形成的薄弱点、缺损或孔隙进入另一部位。The decrease of strength of abdominal wall and increased intra-abdominal pressure are the two basic factors, the groin area make the tensile strength of the anatomical structure distribution in weaker than other parts of the abdominal wall.腹壁强度降低和腹内压力增高是两个基本发病因素，腹股沟区的解剖结构的分布状态使其抗张强度弱于腹壁其他部分。Clinical manifestations are mainly groin hone mass, larger hernia lump can enter scrotum or labium.临床表现主要为腹股沟部出现可复性肿块，较大的斜疝肿块可进入阴囊或阴唇。2. Recognize and define the inguinal region? 什么是腹股沟区？答：The triangle area surrounded by the lateral border of rectus abdominis. The inguinal ligament and the horizontal line from anterior iliac spine to the lateral border of rectus abdominis. It is a weak region of abdominal wall.腹股沟区为下腹部两侧的三角形区域，其内界是腹直肌的外缘，上界为髂前上棘至腹直肌外缘的水平线，下界为腹股沟韧带。是腹膜的薄弱部位。3. Recognize and define the inguinal triangle （Hesselbanchs Triangle ）? 什么是腹股沟三角（海氏三角）？答：The triangle area surrounded by inferior epigastric artery, inguinal ligament and the lateral border of the rectus abdominis.腹壁下动脉与腹股沟韧带及同侧腹直肌外缘围成的三角形区域。4. The 4 walls and 2 openings of inguinal canal腹股沟管四壁两口答：Four walls:1)the superior wall（上壁）: The arcuate lateral border made by the obliquus internus abdominis and the transverses abdominis上壁为腹内斜肌和腹横肌的弓形下缘2)The inferior wall（下壁）: is formed by inguinal ligament下壁为腹股沟韧带3) The anterior wall（前壁）: aponeurosis of the obliquus externus abdominis and laterally is reinforced by muscle fibers of obliquus internus abdominis in the deep layer cut the outer 1/3 of the canal. 前壁为腹外斜肌腱膜，其外1/3份有腹内斜肌参与构成。4）The posterior wall（后壁）: transversalis fascia腹横筋膜 reinforced by the conjoint tendon at the internal one third. 其外1/3份有联合腱参与构成 Two openings:1）The deep inguinal ring 腹股沟深环: formed by the transversalis abdominis 由腹横肌形成2）The superficial inguinal ring 腹股沟浅环: formed by the aponeurosis of the external oblique abdominis , a triangle foramen formed by the internal crura which is adhered to the superior part of pubic symphysis and external crura adhered to the pubic tubercle constrained by the inguinal ligament. 由腹外斜肌腱膜形成，是一个由内侧脚和外侧脚形成的三角区域内侧角连于耻骨联合上缘，外侧脚连于耻骨结节5. The blood supply of inguinal canal腹股沟的血供答：1) Superficial epigastric artery: start from the femoral artery, over the inguinal ligament, one-third of junction line toward the navel.腹壁浅动脉：起自股动脉，越过腹股沟韧带的中、内1/3交界处行向脐部。2) Inferior abdominal artery: in the inguinal ligament near, 1/3 connection of the inner surface of deep iliac artery, in deep inclined inward of transverse abdominal fascia. (goes along the lateral umbilicus fold)腹壁下动脉：于腹股沟韧带近中、内1/3交界处深面发自髂外动脉，于腹横筋膜深面斜向内上。(行于脐外侧裂)6. How to distinguish the direct and indirect hernia? 如何区分直疝、斜疝？答：Answer 1:You can push the abdominal contents back into the abdominal cavity and then press the deep ring on the condition that the abdominal pressure is increased. If the hernia appeared again, then we can conclude that it is direct inguinal hernia, or it will be indirect inguinal hernia.可以把腹腔内容物推回到腹腔,然后在腹部压力增大的条件下按深环，如果疝气再次出现，可以下结论是直疝，否则是斜疝。Answer 2:Indirect hernia: hernia sac neck goes through deep inguinal ring then goes medial and downward through inguinal canal, and finally drops out from superficial inguinal ring. The hernia sac neck can even drop into scrotum. 斜疝：疝囊腹壁下动脉外侧的腹股沟深环突出，向内，向前斜行经过腹股沟管，在穿出腹股沟管浅环，并可以进入阴囊，称为腹股沟斜疝。Direct hernia: hernia sac neck drops out directly from the inguinal triangle ，and it doesnt go through internal ring or drop into scrotum.直疝：疝囊经腹壁下动脉的腹股沟三角区由后向前突出，不经过内环，也不进入阴囊，为腹股沟直疝。Direct hernia doesnt go through inguinal canal and the indirect hernia is more likely to happen on the males than the females. Direct hernia happens just directly through the weakness of epigastric and at the medial of inferior epigastric artery. The direct hernia happens more likely on old men too.直疝不经过腹股沟管，斜疝男性多于女性，直疝为有腹壁的薄弱部位直接向前突出，位于腹壁下动脉的内侧，直疝老年人多见。斜疝和直疝的鉴别斜疝直疝患者年龄多见于儿童及青壮年多见于老年人突出途径经腹股沟管突出，可进阴囊由直疝三角突出，不进阴囊疝块外形椭圆或梨形，上部呈蒂柄状半球形，基底较宽回纳疝块后压住内环疝块不在突出疝块仍可突出精索与疝囊的关系精索在疝囊后方精索在疝囊前外方疝囊颈与腹壁下动脉的关系疝囊颈在腹壁下动脉外侧疝囊颈在腹壁下动脉内侧嵌顿机会较多极少三、胃穿孔 Perforation of stomach1.The location, formation and blood supply of the stomach胃的位置，结构，血供答：Location：The stomach is situated in the upper left portion of the abdominal cavity, occupying the left hypochondriac region and epigastric region. The cardia lies on the left side of the 11th thoracic vertebra and the pylorus on the right side of the 1st lumbar vertebra.位置：胃位于腹腔左上部，占据左季肋区和腹上区。贲门位于第11胸椎高度，幽门位于第1腰椎下缘的右侧。Formation 结构: fundus of stomach胃底(uponthe horizontalplane of the cardia贲门水平面以上部分) angular notch / pyloric region 角切迹/幽门切迹（lesser curvature of stomach near the pylorus胃小弯近幽门处） body of stomach 胃体 （between fundus of stomach and angular notch胃底与角切迹之间） lesser curvature of stomach 胃小弯 greater curvature of stomach胃大弯Blood supply血供：left gastric artery胃左动脉 right gastric artery 胃右动脉right gastroepiploic artery 胃网膜右动脉left gastroepiploic artery胃网膜左动脉short gastric artery 胃短动脉 retrogastric artery胃后动脉gastroduodenal 胃十二指肠动脉 2. The reason of the gastric perforation in patients with lower abdominal pain, and how to distinguish with appendicitis right lower abdominal pain胃穿孔患者发生右下腹痛的原因，以及如何与阑尾炎的右下腹痛进行区分答：1）The parient with perforation of gastroduodenal ulcer sometimes those of gastrointestinal contents into the abdominal cavity less ascending colon next to the ditch along the stream to the right lower abdomen, causing right lower abdominal pain Erzhi misdiagnosed.胃十二指肠溃疡有时空腹穿孔或穿孔小者，流入腹腔的胃肠内容物较少，可沿着升结肠旁沟流至右下腹，引起右下腹疼痛和压痛，因酷似急性阑尾炎时的转移性右下腹痛而致误诊。2）Perforation of gastroduodenal ulcer under the abdominal digestive broader spread out through the pores, the formation of abdominal pain, pain when involving the cortex would be more specific, typical of peritoneal irritation; metastatic lower abdominal pain of acute appendicitis, because of its origin close to the adjacent organs, nerves, there will be pain involved, so the initial inflammation, stomach pain or similar symptoms of upper abdominal pain, but as the disease progresses, inflammatory lesions increased, more than 1 hours there will be typical of the right lower quadrant McBurneys point tenderness evident.胃十二指肠溃疡下腹痛炎症由于肠道的消化液通过孔道流出波及范围较广，形成下腹疼痛，一旦累及皮层就会疼痛较明确，出现典型的腹膜刺激征；急性阑尾炎转移性右下腹痛，由于其神经起源接近相邻脏器，会有牵涉痛，所以炎症初期出现类似胃痛或者上腹部疼痛的症状，但随着病情发展，病灶炎症加剧，超过1小时就会出现典型的右下腹麦氏点压痛明显。3. The advantages and disadvantages of high vagotomy 高迷走神经切断术的优缺点答：High selective vagotomy is done during which only the anterior and posterior gastric branches of the vagus are sectioned, and other branches such as hepatic branches, celiac branches and the “cows foot” are reserved.High selective vagotomy has a desired effect on the acid-producing cells of the stomach without affecting others structures in the abdomen which are supplied by the vagus nerve.高迷走神经切断术期间只完成前和后胃迷走神经的分支是被分成段,其他的分支如肝,腹腔分支,“牛脚”是保留的。高迷走神经切断术对制造酸性物质的胃细胞有影响而不影响其它腹部结构由迷走神经控制的。4. The advantages and disadvantages of subtotal gastrectomy胃大部切除术吡啰I，II式的优缺点答：Aftermostofthedistalgastricresection anastomosetheresidualstomachandduodenum.Advantages:afteranastomosisofthegastrointestinaltractwasclosetonormalanatomyphysiology,foodenterintotheduodenumthroughtheanastomosedincision.Reducebiliarypancreaticjuicebackstreamintotheresidualstomach,lesspostoperativecomplicationscausedbygastrointestinalfunctiondisorderaftersurgery.Butforduodenalulcerisbigger,inflammation,heavieredema,paralysis mark,moreadhesion,anastomosedresidualstomachandduodenumhassometension,itsmoredifficulttofinishthebillrothItype,easilycausetherangeofgastricresectionisnotenough,increasingtheprobabilityofulcerrecurrent.I式：远端胃大部切除后，将残胃与十二指肠吻合。优点：吻合后的胃肠道接近于正常解剖生理状态，食物经吻合口进入十二指肠，减少胆汁胰液反流入残胃，术后因胃肠功能紊乱而引起的并发症较少。但对十二指肠溃疡较大，炎症、水肿较重，瘫痕、粘连较多，残胃与十二指肠吻合有一定张力，行吡啰I式手术比较困难，易致胃切除范围不够，增加术后溃疡复发几率.Afterresectionofthedistalstomach,suturetheduodenalstump,anastomosetheresidualstomachandtheendsideofupperjejunum.Theadvantageiseventheresectionofgasticismore,thetensionofanastomosedstomachjejunumwillnotbetoomuch,ulcerrecurrencerateislow,thedifficultofresectionofduodenalulceristoallowsettingulcer.Butthismatchchangetherelationshipofthenormalanatomyphysiology,andthepancreaticjuicestreamthroughtheanastomosedincision,postoperativecomplicationsandsequelaearemorethanthebillrothItypeII式：即切除远端胃后，缝合关闭十二指肠残端，残胃和上端空肠端侧吻合。优点是即使胃切除较多，胃空肠吻合也不至张力过大，术后溃疡复发率低，十二指肠溃疡切除困难是允许行溃疡旷置。但这种吻合方式改变了正常解剖生理关系，但胰液流经胃空肠吻合口，术后并发症和后遗症比毕I式多。5. How to identify the duodenum and jejunum? 如何区分十二指肠和空肠？答：The Traize ligament (duodenal suspensor ligament ) which connected to the left crura of the diaphragm 十二指肠悬韧带区分十二指肠和空肠，连在左膈角。 6. The anatomical basis of vagus nerve resection迷走神经切除术的解剖基础答：Parietal cells excessive secretion of gastric acid is the main reason for gastric ulcer and duodenal ulcer. There are three ways to cut off the branches of vagus nerve: truncal vagotomy(TV), selective vogotomy(SV) and highly selective vagotomy.TV and SV need drainage after the treatment. Highly selective vagotomy can cut off the branches of vagus nerve on gastric body,lesser curvature and fundus, reducing the secretion of acid of paretal cells. Meanwhile, highly selective vagotomy preserve the liver branch, abdominal branch, and the Raven Claw-shaped branch of the anterior and posterior gastric branch. Thus, it can preserve emptying function of stomach and avoid dysfunction of liver, gallbladder, pancreas and intestines.壁细胞分泌的胃酸过多是引起胃、十二指肠溃疡的主要原因。共有三种术式切断迷走神经：迷走神经干切断术，选择性迷走神经切断术及高选择性迷走神经切断术。TV和SV术后需附加内引流术。高选择性迷走神经切断术切断迷走神经至胃体、胃小弯和胃底的分支，降低了壁细胞的泌酸功能，达到治疗溃疡的目的，同时，高选择性迷走神经切断术保留肝支、腹腔支和胃前、后支的“鸦爪”形分支，从而保留胃的排空功能，避免肝、胆、胰、肠的功能障碍。四、肝硬化Hepatic cirrhosis1. Whats the positon, blood supply, segment of the liver? 肝脏位置，血供，分段答：Located in the abdomen, beneath right diaphragm, situated at fore gall and the front of right kidney, above stomach.位置：位于人体中的腹部位置，在右侧横隔膜之下，位于胆囊之前端且于右边肾脏的前方，胃的上方。Blood supply:Hepatic artery, nutrition vessel, branched into interlobular artery after entering into the liver, entrances into hepatic sinusoid.Another is hepatoportal vein, function vessel, branched into arteriae interlobular veins after entering into the liver along with interlobular artery血供：进入肝的血管有两条，均从肝门进入。一条为肝动脉，为营养血管，入肝后分支成小叶间动脉走行于肝小叶之间，从小叶周边进入肝血窦。另一条为肝门静脉，为功能血管，入肝后分支成小叶间静脉走行于肝小叶之间，与小叶间动脉伴行。2.Couinaud 肝段划分法答：In Clockwise divide the liver into 8 segments, marked as Roman numerals . Segment：caudate lobe；Segment：upper left lateral lobe左外叶上段；Segment：inferior left lateral lobe；Segment：left inner lobe；Segment：inferior right frontal lobe；Segment：inferior right posterior lobe；Segment：upper right posterior lobe；Segment：upper right frontal lobe. 按顺时针方向将肝脏分为8个肝段，每个肝段分别用罗马数字标记，段：尾状叶；段：左外叶上段；段：左外叶下段；段：左内叶；段：右前叶下段；段：右后叶下段；段：右后叶上段；段：右前叶上段。3. The definition of Calots triangle胆囊三角的概念答：The triangular area is formed by Cystic duct, common hepatic duct and posterior liver, having cystic artery, right hepatic artery and accessory right cystic duct passing through, which stands a good chance to be damaged by mistake during a cystic duct surgery.由胆囊管、肝总管及肝下缘所形成的三角区（Calot三角），胆囊动脉，肝右动脉、副右肝管在此穿过，是胆管手术极易发生误伤的区域。4. What are the Hepatic vein traffic and the symptoms of transport branch varicose are what? 肝门静脉交通支是什么，交通支曲张的症状是什么？答：1）Through esophageal venous of lower esophagus: the gastric coronary vein, short gastric vein and retrogastric vein of the hepatic portal vein, short gastric vein and posterior gastric vein, at the lower level of the esophagus and near cardia through esophageal venous, anastomose with esophagus vein of hemiazygo vein then azygos vein of caval vein system. Therefore, when portal hypertension happens, esophagus, cirsoid vein of fundus of stomach, even break to blood.通过食管下段脉丛：肝门静脉系统的胃冠状静脉、胃短静脉和胃后静脉，在食管下段和贲门附近通过食管静脉丛，与腔静脉系统奇静脉的食管静脉相吻合。因此，当门静脉高压症时，可发生食管、胃底静脉曲张，甚至破裂出血。2) Through rectal venous plexus: portal venous system superior rectal vein of inferior mesenteric vein, at the lower level of rectum and anal canal through rectal venous plexus, anastomose with caval venous system inferior rectal vein of internal iliac vein, anal vein. When portal hypertension happens, the lower level of rectum and vein of anal canal are cirsoid and become hemorrhoids, lead to defecate with blood.通过直肠静脉丛：门静脉系统肠系膜下静脉的直肠上静脉，在直肠下段和肛管通过直肠静脉丛，与腔静脉系统髂内静脉的直肠下静脉、肛静脉吻合。当门静脉高压症时，直肠下段和肛管的静脉曲长形成痔，导致便血。3) Through venous network around umbilic, paraumbilical vein of portal vein system, anastomose with superior epigastric vein of superior vena cava system and vein of breast and abdomen wall through venous plexus around hilum. At the same time, anastomose with inferior epigastric vein of superficial epigastric vein around umbilic. When portal hypertension happens, superficial epigastric vein around umbilic varicosity takes shapes of “caput medusae”.通过脐周静脉网：门静脉系统的附脐静脉，在脐周围通过脐周静脉网与上腔静脉系统的腹壁上静脉及胸腹壁静脉相吻合。同时也与下腔静脉系统的腹壁下静脉及腹壁浅静脉相吻合。当门静脉高压症时，脐周围的腹壁浅表静脉曲张成团形成“海蛇头”。4) Through retzius vein: affiliate splenic vein portal venous system,superior mesenteric vein, superficial epigastric vein, some small veins of inferior mesenteric vein (such as ascending colon descending colon, bare area of liver, pancreas and duodenum and some small veins of back page of peritoneum), anastomose with vein of waist of caval vein system, posterior intercostal vein of lower level, subphrenic wein and testicular(ovary) vein, also can be way of collateral circulation. These small veins which are located at back page of peritoneum and connect portal venous system, are called Retzius vein通过Retzius静脉：门静脉系统的属支脾静脉、肠系膜上、下静脉的部分小静脉（如升结肠、降结肠、肝裸区、胰和十二指肠等器官腹膜后部分的小静脉）， 在腹膜后与腔静脉系统的腰静脉、低位助间后静脉、膈下静脉及睾丸（卵巢）静脉等相吻合，亦可以成为侧支循环的途径。这些位于腹膜后隙连门静脉系与腔静脉系的小静脉，统称为Retzius静脉。5. Whats the structure of extrahepatic bile duct? 肝外胆管的结构答：Intrahepatic bile duct converges into left, right hepatic duct. They join into common hepatic duct after leaving the liver at the hilum hepatis. Common bile duct is converged by common hepatic duct and cystic duct.肝内胆管经多级汇合形成左、右肝管，左、右肝管出肝后，在肝门部汇合形成肝总管。 肝总管与胆囊管汇合形成胆总管。6. When the portal hypertension happens a shunt is needed, but why usually choose the site between the left renal vein and splenic vein? 为什么在门静脉高压时通常选择在脾静脉和深静脉之间进行引流？1) The site chosen as the shunt must close to each other 引流的部位必须彼此靠近2)The venous blood drained to the systematic circulation must not be toxic. The blood from the spleen is less toxic because of the cleaning ability of spleen (spleen is a kind of peripheral外围的 immune organ) 进入体循环的血液不能有毒性 五肾脏 Kidneys1. The location, formation, blood supply of kidneys 肾脏位置，结构，血供答：Location: Kidney is located in the both sides of the spine, tightly attached to the posterior abdominal wall, marked by vertebral body, the higher pole of the kidneys equivalent of T11 or T12, the lower pole of the kidneys equivalent to L2 or L3.位置：肾脏位于脊柱的两侧，紧附于腹后壁，以椎体为标志，上极相当于第11胸椎或第12胸椎，下极相当于第2腰椎或第3腰