腹部解剖图谱PPT课件

.,Abdominalwall,山东大学医学院解剖教研室李振华,.,Anteriorwall,Layers(fromsuperficialtodeep)SkinSuperficialfasciaAnterolateralmusclesTransversalisfascia腹横筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜,.,SuperficialfasciadivisionsbelowumbilicusSuperficialfattylayer(Campers)Membranouslayer(Scarpas),.,Musclesofabdomen,AnterolateralgroupObliquusexternusabsominis腹外斜肌Oblequusenternusabdominis腹内斜肌Transversusabdominis腹横肌Rectusabdominis腹直肌,.,PosteriorgroupQuadiatuslumborum腰方肌Psoasmajor腰大肌,.,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,.,.,Obliquusinternusabdominis腹内斜肌,DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmedially,.,Transverselsabdominis腹横肌,Deeptoobliquusinternus,.,Inguinalfalx腹股沟镰:archoverspermaticcord,insertedwithtransversesabdominisfiberintomedialpartofpectenofpubisCremaster提睾肌:aroundthespermaticcordandtestis,.,Rectusabdominis腹直肌,Position:lieontoeitherofmidlineOrigin:pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesHas3-4tendinousintersections腱划lineasemiluaris半月线,.,Similarfunctionsforabovefourpairsofmuscles,SupportandcompresstheabdominalvisceraIncreaseintra-abdominalpressure,aidinexpulsiveefforts-vomiting,coughing,sneezing,defecation,urinationandchildbirth.Depressribs,assistin(theactofforce(4)expiration.Flex,lateralflex,androtatevertebralcolumn,.,Sheathofrectusabdominis腹直肌鞘,AntlayerformedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisPostlayerFormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversesabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuatelineBelowthislinerectusabdominisincontactwithtransversefascia,.,Lineaalba白线tendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysis.,.,Inguinalregion腹股沟区,BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolaeralmarginofrectusabdominis,.,Descentoftestes,Seven-weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwall,.,Fetusat28weekthetestispassingthroughtheinguinalcanal,.,Newborn,.,Inguinalcanal腹股沟管,Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinallig.,.,BoundariesAntwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall),.,PostwallTransversefasciaInguinalflaxmediallyRoofarchedlowerfibersofobliquusinternusandtransversuaabdominisFlooringuinallig,.,TwoopeningsSuperficialinguinalring腹股沟浅环Deepinguinalring腹股沟深环defectintransversefascia1.5cmabovemidpointofinguinalligament,.,StructurespassingthroughtheinguinalcanalSpermaticcord精索andilioinguinalnerve髂腹股沟神经inmalesRoundligamentofuterus子宫圆韧带andilioinguinalnerve髂腹股沟神经infemales,.,InguinalTriangle(ofHesselbach)腹股沟三角,BoundariesInguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterally,.,Indirectinguinalheiniaanddirecetinguinalheinia,.,Superficialvesselsandcutaneousnerves,ArteriesSuperficialepigastrica.Superficialiliaccircumflexa.VeinsThoracoepigastricv.Superficialepigastricv.CutaneousnervesAnteriorandlateralcutaneousn.oflowersixthoracicIliohypogastricn.(firstlumbnerves),.,Deepvesselsandnerves,ArteresSuperiorandinferiorepigastricarterisLowerposteriorintercostala.Subcostala.Fourlumbara.,.,NervesIliohypogastricn.髂腹下神经ArisesfromlubarplexusPassesforwardintheintervalbetweenobliquusinternusandtranversusabdominisPiecesobliquusinternusabdominis2.5cmmedialtoanteriorsuperioriliacspinePiecesaponeurosisofobliquusexternusabdominisabout2.5cmabovesuperficialinguinalringIlioinguinaln.髂腹股沟神经Runsparallelwithiliohypogastricn.atalowerlevelEntersinguinalcanalandemergesthroughsuperficialinguinalringGenitofemoraln.生殖股神经,.,Layer?,.,Abdomen2,山东大学医学院解剖教研室李振华,.,Abdominalaorta腹主动脉,ContinuationofthoracicaortaataortichiatusofdiaphragminfrontofT12TerminatesatlowerborderofL4vertebrabydividingintorightandleftcommoniliacarteries,.,ParietalbranchesInferiorphrenica.膈下动脉(onepair)Lumbara.腰动脉(fourpairsofarteriesthatsupplytheposteriorabdominalwall)Mediansacrala.骶正中动脉,.,VisceralbranchesPairedbranchesMiddlesuprarenalartery肾上腺中动脉Renalartery肾动脉Testicular(ovarian)artery睾丸（卵巢）动脉,.,UnpairedbranchesCeliactrunk腹腔干ashortthickvesselthatarisesfromthefrontofaorta,atthelevelofT12Superiormesenterica.肠系膜上动脉arisesfromthefrontofaorta,atthelevelofL2Inferiormesenterica.肠系膜下动脉arisesfromthefrontofaorta,atlevelofL3,.,Celiactrunk,.,Celiactrunk,.,.,.,Colicmarginalartery,.,RelationsofabdominalaortaAnteriorly(fromabovedownward)PancreasAscendingpartofduodenumRadixofmesenteryPosteriorlyUpperfourlumbervertebraeOnitsrightInferiorvenacavaOnitsleftLeftsympathetictrunk,.,Veinsofabdomenandpelvis,Internaliliacvein髂内静脉Parietaltributaries:accompanywitharteriesVisceraltributariessuperiorrectalveininferiormesentericv.Rectalvenousplexusinferiorrectalveininternaliliacv.直肠静脉丛analveininternalpudendalv.Vesicalvenousplexus膀胱静脉丛vesicalv.Uterinevenousplexus子宫静脉丛uterinev.,.,Externaliliacvein髂外静脉accompanythearteryCommoniliacvein髂总静脉formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4L5byunitingeachothertoforminferiorvenacava,.,Inferiorvenacava下腔静脉,FormedbyunionoftwocommoniliacveinsanteriortoandjusttotherightofL4L5Ascendsontherightsideofaorta,piercesvenacavaforamenofdiaphragmoppositetheT8anddrainsintotherightatriumConveysbloodfromthewholebodybelowthediaphragmtotherightatrium,.,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,.,RelationsofinferiorvenacavaAnteriorly(craniallytocaudally)LiverHeadofpancreasHorizontalpartofduodenumRighttesticular(orovarian)a.RadixofmesenteryPosteriorlyRightcrusofdiaphragmUpperfourlumbervertebraeLeftsympathetictrunkParietalbranchesofabdominalaortaOnitsrightPsoasmajorRightkidneyRightsuprarenalglandOnitsleftAbdominalaorta,.,Hepaticportalvein肝门静脉,GeneralfeaturesFormedbehindtheneckofpancreasbytheunionofsuperiormesentericveinandsplenicveinAscendsupwardsandtotheright,posteriortothefirstpartofduodenumandthenentersthelesseromentumtotheportahepatis,whereitdividesintorightandleftbranchesTherearenofunctioningvalvesinhepaticportalsystemDrainsbloodfromgastrointestinaltractfromthelowerendofoesophagustotheupperendofanalcanal,pancreas,gallbladder,bileductsandspleen,.,Variationandanomaliesofhepaticportalvein,.,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,.,Portal-systemicanastomoses1.AtthelowerendoftheoesophagusHepaticportalveinleftgastricveinesophagealvenousplexusesophagealveinazygosveinsuperiorvenacava2.AtrectalvenousplexusHepaticportalveinsplenicveininferiormesentericveinsuperiorrectalveinrectalvenousplexusinferiorrectalandanalveinsinternaliliacveininferiorvenacava3.AtperiumbilicalvenousplexusHepaticportalveinparaumbilicalveinperiumbilicalvenousplexusthoracoepigastricandsuperiorepigastricveinsuperiorvenacavasuperficialepigastricandinferiorepigastricveinsinferiorvenacava,.,4.Portal-retroperitonealanastomosisBetweentheretroperitonealbranchesofthecolicveinsandthelumbarveins,pancreaticoduodenalveinswiththerenalveinsandthesubcapsularveinsoftheliverwiththephrenicveinstwigsofcolicveins(portal)anastomosingwithsystemicretroperitonealveins,.,Thelymphaticdrainageofabdomen,LymphaticdrainageofabdominalwallToaxillarylymphnodefromregionaboveumbilicusTosuperficialinguinallymphnodefromregionbelowumbilicusTolumbarlymphnodefrompostwallofabdomen,.,LymphaticdrainageofabdominalvisceraLumbarlymphnodes腰淋巴结Lieonposteriorabdominalwall,alongtheabdominalaortaandinferiorvenacavaReceivelymphfromkidneys,suprarenalglands,testes,ovarirs,fundusofuterus,ovary,andcommoniliacnodesRightandleftlumbartrunksformedbyefferentvesselPairedvisceradraintothelumbarlymphnodes,.,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,.,Thoracicduct胸导管BeginsinfrontofL1asadilatedsac,thecisternachyli,whichformedbyjoiningofleftandrightlumbartrunksandintestinaltrunkEnterthoraciccavitybypassingthroughtheaortichiatusofthediaphragmandascendsalongonthefrontofthevertebralcolumn,betweenthoracicaortaandazygosveinTravelsupward,veeringtotheleftatthelevelofT5Attheroofoftheneck,itturnslaterallyandarchesforwardsanddescendstoentertheleftvenousangleJustbeforetermination,itreceivestheleftjugular,subclavianandbronchomediastinaltrunksDrainslymphfromlowerlimbs,pelviccavity,abdominalcavity,leftsideofthorax,andleftsideofthehead,neckandleftupperlimb,.,Spleen脾,Location:liesinthelefthypochondriacregion(betweenstomachanddiaphragm)deeptothe9thto11thrib,itslongaxiscorrespondsroughlytothe10thribShapereddishincolour,.,TwosurfacesDiaphragmatic:smooth,convexVisceral:concave,hilumofspleenTwoextremitiesAnteriorwiderPosteriorrounderTwoborderSuperiorhas2-3splenicnotch脾切迹,whichserveasalandmarkonpalpationwhenitisenlarge;normallyitisnotpalpableInferiorrounderFunctions:thespleenisconsideredtobeimportantin:FormationoflymphocytesandmonocytePhagocytosisofbacteria,inertparticlesandwhitebloodcellsandplateletsDestroyingeffeteorabnormalredbloodcellsMakingantibodies,.,RalationshipsofspleenDiaphragmaticsurfacediaphragmVisceralsurfaceAnteriorlyfundusofstomachPosteriorlyleftsuprarenalglandandkidneyInferiorlytailofpancreasandleftcolicflexure,.,Nerversofabdomen,Lumbarplexus腰丛Formation:formedbyanteriorramiofL1-L3,apartofanteriorramiofT12andL4Position:lieswithinsubstanceofpsoasmajor,.,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,.,Lumbarsympathetictrunk腰交感干,MadeupofpairedchainswithfourtofivelumbargangliaanterolateraltovertebralcolumnEntersabdomenviathediaphragmandasacontinuationofhethoracicpartPassesinferiorlybehindcommoniliacvesselsandterminationsbyjoiningtoformunpairedganglionimpar,anteriortosacrum,.,Abdomen3,山东大学医学院解剖教研室李振华,.,Relationshipsofabdominalviscera,Firstlayerlive,gallbladder,stomachSecondlayerduodenum,pancreas,spleenThirdlayersuprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphatics,.,Relationshipsofthestomach,Anterior:Live(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(leftlowerpart)Posteriorseparatedbyperitonumoflessersacfromthefollowing(“stumach-bed”)PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversmesoclon,.,Arteriesofstomach,Leftandrightgastricarteriesarisefromceliactrunkandproperhepaticartery,repectively.Thesetwovesselsruninlesseromentumalonglessercurvature,andanastomoseend-to-end.,.,Rightandleftgastroepiploicarteriesarisefromthegastroduodenalandsplenicartery,repectively.Thesetwovesselspassintothegreateromentum,runparalleltothegreatercurvature,andanastomoseend-to-end.Shortgastricarteries,branchesofsplenicartery,coursethroughthegastrosplenicligamentandsupplythefundusofstomach.Posteriorgastricartery(72%)arisefromthesplenicartery,coursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach.,.,VenousdrainageRightandleftgastricveinsemptydirectlyintohepaticportalvein.Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein.Rightgastroepiploicveinjoineithersuperiormesentericvein.,.,LymphaticsofstomachRightandleftgastricln.liealongthesamevesselsandfinallytotheceliacln.Rightandleftgastroomentalln.liealongthesamevessels,theformerdrainintosubpyloricln.,thelatterdrainintosplinicln.Supra-andsubpyloricln.receivelymphaticsfrompyloricpartandfinallytotheceliacln.Splenicln.receivelymphaticsfromfundusandleftthirdofstomach,andfinallytotheceliacln.,.,NervesupplyParasympatheticinnervationbyanterior(left)andposterior(right)vagaltrunksTheanteriortrunkdividesintoanteriorgastricandhepaticbranchesTheposteriortrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthrpyloricantrumtofanoutintobranchescalled“crowsfoot”tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAffentandeffentfibersderivesfromthoracicsegments(T5L1,.,Theduodenum,RelationshipsofsuperiorpartAnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommombileductGastroduodenala.Hepaticportalv.InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreas,.,RelationshipsofdescendingpartAnteriorlyLiveTransversecolonandmesocolonLoopsofsmallintestinePosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexure,.,RelationshipsofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica.andv.PosteriorlyRightureterInferiorvenacavaAbdominalaorta,.,RelationshipsofascendingpartRightHeadofpancreasandabdominalaortaLeftLeftkidneyandureter,.,Relationshipsofliver,DiaphragmaticsurfaceseparatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanteroly,