腹部解剖图谱ppt课件.ppt

Abdominalwall 1 Anteriorwall Layers fromsuperficialtodeep SkinSuperficialfasciaAnterolateralmusclesTransversalisfascia腹横筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜 2 Superficialfascia divisionsbelowumbilicusSuperficialfattylayer Camper s Membranouslayer Scarpa s 3 Musclesofabdomen AnterolateralgroupObliquusexternusabsominis腹外斜肌Oblequusenternusabdominis腹内斜肌Transversusabdominis腹横肌Rectusabdominis腹直肌 4 PosteriorgroupQuadiatuslumborum腰方肌Psoasmajor腰大肌 5 Obliquusexternusabsominis腹外斜肌 Generaldirectionoffibers downward forwardandmedially rundownandinward StructuresInguinalligament腹股沟韧带Lacunarligament腔隙韧带Superficialinguinalring腹股沟浅环 triangular shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercle 6 7 Obliquusinternusabdominis腹内斜肌 DeeptoobliquusexternusabdominisGeneraldirectionoffibres upwards forwardsandmedially 8 Transverselsabdominis腹横肌 Deeptoobliquusinternus 9 Inguinalfalx腹股沟镰 archoverspermaticcord insertedwithtransversesabdominisfiberintomedialpartofpectenofpubisCremaster提睾肌 aroundthespermaticcordandtestis 10 Rectusabdominis腹直肌 Position lieontoeitherofmidlineOrigin pubiccrestandsymphysisInsertion xiphoidand5th 7thcostalcartilagesHas3 4tendinousintersections腱划lineasemiluaris半月线 11 Similarfunctionsforabovefourpairsofmuscles SupportandcompresstheabdominalvisceraIncreaseintra abdominalpressure aidinexpulsiveefforts vomiting coughing sneezing defecation urinationandchildbirth Depressribs assistin theactofforce 4 expiration Flex lateralflex androtatevertebralcolumn 12 Sheathofrectusabdominis腹直肌鞘 Antlayer formedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisPostlayerFormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversesabdominisAbsentinabout4 5cmbelowtheumbilicus whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuatelineBelowthislinerectusabdominisincontactwithtransversefascia 13 Lineaalba白线 tendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysis 14 Inguinalregion腹股沟区 BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolaeralmarginofrectusabdominis 15 Descentoftestes Seven weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwall 16 Fetusat28weekthetestispassingthroughtheinguinalcanal 17 Newborn 18 Inguinalcanal腹股沟管 Position obliquepassage 4cmlong located1 5cmabovemedialhalfofinguinallig 19 BoundariesAntwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis lateralthirdofwall 20 PostwallTransversefasciaInguinalflaxmediallyRoof archedlowerfibersofobliquusinternusandtransversuaabdominisFloor inguinallig 21 TwoopeningsSuperficialinguinalring腹股沟浅环Deepinguinalring腹股沟深环 defectintransversefascia1 5cmabovemidpointofinguinalligament 22 StructurespassingthroughtheinguinalcanalSpermaticcord精索andilioinguinalnerve髂腹股沟神经inmalesRoundligamentofuterus子宫圆韧带andilioinguinalnerve髂腹股沟神经infemales 23 InguinalTriangle ofHesselbach 腹股沟三角 BoundariesInguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterally 24 Indirectinguinalheiniaanddirecetinguinalheinia 25 Superficialvesselsandcutaneousnerves ArteriesSuperficialepigastrica Superficialiliaccircumflexa VeinsThoracoepigastricv Superficialepigastricv CutaneousnervesAnteriorandlateralcutaneousn oflowersixthoracicIliohypogastricn firstlumbnerves 26 Deepvesselsandnerves ArteresSuperiorandinferiorepigastricarterisLowerposteriorintercostala Subcostala Fourlumbara 27 NervesIliohypogastricn 髂腹下神经ArisesfromlubarplexusPassesforwardintheintervalbetweenobliquusinternusandtranversusabdominisPiecesobliquusinternusabdominis2 5cmmedialtoanteriorsuperioriliacspinePiecesaponeurosisofobliquusexternusabdominisabout2 5cmabovesuperficialinguinalringIlioinguinaln 髂腹股沟神经Runsparallelwithiliohypogastricn atalowerlevelEntersinguinalcanalandemergesthroughsuperficialinguinalringGenitofemoraln 生殖股神经 28 Layer 29 Abdomen2 山东大学医学院解剖教研室李振华 30 Abdominalaorta腹主动脉 ContinuationofthoracicaortaataortichiatusofdiaphragminfrontofT12TerminatesatlowerborderofL4vertebrabydividingintorightandleftcommoniliacarteries 31 ParietalbranchesInferiorphrenica 膈下动脉 onepair Lumbara 腰动脉 fourpairsofarteriesthatsupplytheposteriorabdominalwall Mediansacrala 骶正中动脉 32 VisceralbranchesPairedbranchesMiddlesuprarenalartery肾上腺中动脉Renalartery肾动脉Testicular ovarian artery睾丸 卵巢 动脉 33 UnpairedbranchesCeliactrunk腹腔干 ashortthickvesselthatarisesfromthefrontofaorta atthelevelofT12Superiormesenterica 肠系膜上动脉 arisesfromthefrontofaorta atthelevelofL2Inferiormesenterica 肠系膜下动脉 arisesfromthefrontofaorta atlevelofL3 34 Celiactrunk 35 Celiactrunk 36 37 38 Colicmarginalartery 39 RelationsofabdominalaortaAnteriorly fromabovedownward PancreasAscendingpartofduodenumRadixofmesenteryPosteriorlyUpperfourlumbervertebraeOnitsrightInferiorvenacavaOnitsleftLeftsympathetictrunk 40 Veinsofabdomenandpelvis Internaliliacvein髂内静脉Parietaltributaries accompanywitharteriesVisceraltributaries superiorrectalvein inferiormesentericv Rectalvenousplexus inferiorrectalvein internaliliacv 直肠静脉丛 analvein internalpudendalv Vesicalvenousplexus膀胱静脉丛 vesicalv Uterinevenousplexus子宫静脉丛 uterinev 41 Externaliliacvein髂外静脉 accompanythearteryCommoniliacvein髂总静脉 formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint enduponL4 L5byunitingeachothertoforminferiorvenacava 42 Inferiorvenacava下腔静脉 FormedbyunionoftwocommoniliacveinsanteriortoandjusttotherightofL4 L5Ascendsontherightsideofaorta piercesvenacavaforamenofdiaphragmoppositetheT8anddrainsintotherightatriumConveysbloodfromthewholebodybelowthediaphragmtotherightatrium 43 ChieftributariesParietalPairedinferiorphrenicv 膈下静脉pairedlumbarv 腰静脉 four VisceralRightandleftrenalveins左 右肾静脉Rightsuprarenalvein右肾上腺静脉 leftdrainintoleftrenalvein Righttesticularorovarianv右睾丸 卵巢 静脉 leftdrainintoleftrenalvein Hepaticveins肝静脉 right leftandintermediate 44 RelationsofinferiorvenacavaAnteriorly craniallytocaudally LiverHeadofpancreasHorizontalpartofduodenumRighttesticular orovarian a RadixofmesenteryPosteriorlyRightcrusofdiaphragmUpperfourlumbervertebraeLeftsympathetictrunkParietalbranchesofabdominalaortaOnitsrightPsoasmajorRightkidneyRightsuprarenalglandOnitsleftAbdominalaorta 45 Hepaticportalvein肝门静脉 GeneralfeaturesFormedbehindtheneckofpancreasbytheunionofsuperiormesentericveinandsplenicveinAscendsupwardsandtotheright posteriortothefirstpartofduodenumandthenentersthelesseromentumtotheportahepatis whereitdividesintorightandleftbranchesTherearenofunctioningvalvesinhepaticportalsystemDrainsbloodfromgastrointestinaltractfromthelowerendofoesophagustotheupperendofanalcanal pancreas gallbladder bileductsandspleen 46 Variationandanomaliesofhepaticportalvein 47 Tributariesofhepaticportalvein1 Superiormesentericv 肠系膜上静脉2 Inferiormesentericv 肠系膜下静脉3 Splenicv 脾静脉4 Leftgastricv 胃左静脉5 Rightgastricv 胃右静脉6 Cysticv 胆囊静脉7 Paraumbilicalv 附脐静脉 48 Portal systemicanastomoses1 AtthelowerendoftheoesophagusHepaticportalvein leftgastricvein esophagealvenousplexus esophagealvein azygosvein superiorvenacava2 AtrectalvenousplexusHepaticportalvein splenicvein inferiormesentericvein superiorrectalvein rectalvenousplexus inferiorrectalandanalveins internaliliacvein inferiorvenacava3 AtperiumbilicalvenousplexusHepaticportalvein paraumbilicalvein periumbilicalvenousplexus thoracoepigastricandsuperiorepigastricvein superiorvenacavasuperficialepigastricandinferiorepigastricveins inferiorvenacava 49 4 Portal retroperitonealanastomosisBetweentheretroperitonealbranchesofthecolicveinsandthelumbarveins pancreaticoduodenalveinswiththerenalveinsandthesubcapsularveinsoftheliverwiththephrenicveinstwigsofcolicveins portal anastomosingwithsystemicretroperitonealveins 50 Thelymphaticdrainageofabdomen LymphaticdrainageofabdominalwallToaxillarylymphnodefromregionaboveumbilicusTosuperficialinguinallymphnodefromregionbelowumbilicusTolumbarlymphnodefrompostwallofabdomen 51 LymphaticdrainageofabdominalvisceraLumbarlymphnodes腰淋巴结Lieonposteriorabdominalwall alongtheabdominalaortaandinferiorvenacavaReceivelymphfromkidneys suprarenalglands testes ovarirs fundusofuterus ovary andcommoniliacnodesRightandleftlumbartrunksformedbyefferentvesselPairedviscera draintothelumbarlymphnodes 52 Celiaclymphnodes腹腔淋巴结 situatedaroundtheceliactrunkSuperiormesentericlymphnode肠系膜上淋巴结 situatedaroundsuperiormesenterica Inferiormesentericlymphnode肠系膜下淋巴结 situatedaroundinferiormesenterica Intestinaltrunk腹腔干 formedbyefferentvesselofceliac superiorandinferiorlymphnodes 53 Thoracicduct胸导管BeginsinfrontofL1asadilatedsac thecisternachyli whichformedbyjoiningofleftandrightlumbartrunksandintestinaltrunkEnterthoraciccavitybypassingthroughtheaortichiatusofthediaphragmandascendsalongonthefrontofthevertebralcolumn betweenthoracicaortaandazygosveinTravelsupward veeringtotheleftatthelevelofT5Attheroofoftheneck itturnslaterallyandarchesforwardsanddescendstoentertheleftvenousangleJustbeforetermination itreceivestheleftjugular subclavianandbronchomediastinaltrunksDrainslymphfromlowerlimbs pelviccavity abdominalcavity leftsideofthorax andleftsideofthehead neckandleftupperlimb 54 Spleen脾 Location liesinthelefthypochondriacregion betweenstomachanddiaphragm deeptothe9thto11thrib itslongaxiscorrespondsroughlytothe10thribShape reddishincolour 55 TwosurfacesDiaphragmatic smooth convexVisceral concave hilumofspleenTwoextremitiesAnterior widerPosterior rounderTwoborderSuperior has2 3splenicnotch脾切迹 whichserveasalandmarkonpalpationwhenitisenlarge normallyitisnotpalpableInferior rounderFunctions thespleenisconsideredtobeimportantin FormationoflymphocytesandmonocytePhagocytosisofbacteria inertparticlesandwhitebloodcellsandplateletsDestroyingeffeteorabnormalredbloodcellsMakingantibodies 56 RalationshipsofspleenDiaphragmaticsurface diaphragmVisceralsurfaceAnteriorly fundusofstomachPosteriorly leftsuprarenalglandandkidneyInferiorly tailofpancreasandleftcolicflexure 57 Nerversofabdomen Lumbarplexus腰丛Formation formedbyanteriorramiofL1 L3 apartofanteriorramiofT12andL4Position lieswithinsubstanceofpsoasmajor 58 BranchesIliohypogastricn 髂腹下神经SupplieslowerpartofanteriorabdominalwallIlioinguinaln 髂腹股沟神经PassesthroughinguinalcanaltosupplyskinofthegroinandscrotumLateralfemoralcutaneous股外侧皮神经Femoraln 股神经Obturatorn 闭孔神经Genitofemoraln 生殖股神经 59 Lumbarsympathetictrunk腰交感干 MadeupofpairedchainswithfourtofivelumbargangliaanterolateraltovertebralcolumnEntersabdomenviathediaphragmandasacontinuationofhethoracicpartPassesinferiorlybehindcommoniliacvesselsandterminationsbyjoiningtoformunpairedganglionimpar anteriortosacrum 60 Abdomen3 山东大学医学院解剖教研室李振华 61 Relationshipsofabdominalviscera Firstlayer live gallbladder stomachSecondlayer duodenum pancreas spleenThirdlayer suprarenalgland kidney ureter inferiorvenacava abdominalaorta nervesandlymphatics 62 Relationshipsofthestomach Anterior Live rightpart Diaphragm leftupperpart Anteriorabdominalwall leftlowerpart Posterior separatedbyperitonumoflessersacfromthefollowing stumach bed PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversmesoclon 63 Arteriesofstomach Leftandrightgastricarteriesarisefromceliactrunkandproperhepaticartery repectively Thesetwovesselsruninlesseromentumalonglessercurvature andanastomoseend to end 64 Rightandleftgastroepiploicarteriesarisefromthegastroduodenalandsplenicartery repectively Thesetwovesselspassintothegreateromentum runparalleltothegreatercurvature andanastomoseend to end Shortgastricarteries branchesofsplenicartery coursethroughthegastrosplenicligamentandsupplythefundusofstomach Posteriorgastricartery 72 arisefromthesplenicartery coursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach 65 VenousdrainageRightandleftgastricveinsemptydirectlyintohepaticportalvein Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein Rightgastroepiploicveinjoineithersuperiormesentericvein 66 LymphaticsofstomachRightandleftgastricln liealongthesamevesselsandfinallytotheceliacln Rightandleftgastroomentalln liealongthesamevessels theformerdrainintosubpyloricln thelatterdrainintosplinicln Supra andsubpyloricln receivelymphaticsfrompyloricpartandfinallytotheceliacln Splenicln receivelymphaticsfromfundusandleftthirdofstomach andfinallytotheceliacln 67 NervesupplyParasympatheticinnervationbyanterior left andposterior right vagaltrunksTheanteriortrunkdividesintoanteriorgastricandhepaticbranchesTheposteriortrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthrpyloricantrumtofanoutintobranchescalled crow sfoot tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAffentandeffentfibersderivesfromthoracicsegments T5 L1 68 Theduodenum RelationshipsofsuperiorpartAnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommombileductGastroduodenala Hepaticportalv InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreas 69 RelationshipsofdescendingpartAnteriorlyLiveTransversecolonandmesocolonLoopsofsmallintestinePosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexure 70 RelationshipsofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica andv PosteriorlyRightureterInferiorvenacavaAbdominalaorta 71 RelationshipsofascendingpartRightHeadofpancreasandabdominalaortaLeftLeftkidneyandureter 72 Relationshipsofliver Diaphragmaticsurface separatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanteroly gallb