《腹膜后隙解剖》PPT课件

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹膜后隙,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,一、概述,腹膜后隙位置：位于腹后壁，介于腹后壁腹膜与腹内筋膜之间。范围：上起膈，下至骶骨岬，两侧续于腹膜外筋膜，向下续于盆部的腹膜后间隙。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,主要结构：腹膜后隙有肾、肾上腺、输尿管、腹部大血管、神经和淋巴结等重要结构。(胰腺、十二指肠已于结肠上区内介绍),January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,二、肾kidney,内容：（一）肾的位置和毗邻（二）肾门、肾窦和肾蒂（三）肾的血管（四）肾的被膜,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,（一）肾的位置及毗邻,位置：肾位于脊柱两侧，紧贴于腹后壁。由于肝的存在，左肾略高于右肾。左肾：上端平第11胸椎下缘下端平第2腰椎下缘右肾：上端平第12胸椎上缘下端平第3腰椎上缘,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,肾的毗邻：,毗邻（相同点）：两肾上端:肾上腺两肾后面：膈腰大肌腰方肌腹横肌两肾内下方：肾盂输尿管两肾内后方：左右腰交感干,膈肌,腰大肌,腰方肌,腹横肌,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,毗邻（不同点）：两肾内侧：左肾：腹主动脉右肾：下腔静脉左肾前面邻：胃胰空肠结肠左曲右肾前面邻：肝右叶结肠右曲十二指肠降部,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,肾区,竖脊肌外侧缘与第12肋之间所夹的部位称肾区（脊肋角）。在某些肾疾病患者，叩击或触压该区可引起疼痛。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,（二）肾门、肾窦和肾蒂,肾门：肾的内侧缘中部凹陷，是肾的血管、神经、淋巴管和肾盂出入肾的部位，称肾门。肾窦：肾门深入肾实质所围成的腔隙称为肾窦。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,肾蒂：出入肾门的结构合称肾蒂，主要结构有肾动脉、肾静脉、肾盂。肾蒂内主要结构的排列关系:由前向后依次为：肾静脉、肾动脉、肾盂从上向下依次为：肾动脉、肾静脉、肾盂,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,肾动脉和肾段肾段：每一段动脉供给的肾实质区域称为肾段，共5个。,（三）肾血管和肾段,上段动脉,上前段动脉,下段动脉,下前段动脉,后段动脉,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,2.肾静脉,右肾静脉通常无肾外属支，而左肾静脉收纳左肾上腺、左睾丸（卵巢）静脉血，其属支与周围静脉有吻合，借此可建立门-腔静脉间的侧支循环。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,（四）肾的被膜,肾表面包有三层被膜，由内向外为：,纤维囊脂肪囊肾筋膜,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,三、输尿管腹部,输尿管起于肾盂，终于膀胱，全长约2530cm。分为三部:腹部、盆部、壁内部，其中腹部长约13-14cm,紧贴腰大肌前面向下内斜行，在腰大肌前面中点处有睾丸（卵巢）血管斜过其前方。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,右输尿管前方为十二指肠降部、升结肠血管、回结肠血管、睾丸（卵巢血管）、回肠末段。左输尿管前方为十二指肠空肠曲、降结肠血管、斜行跨过的睾丸（卵巢血管）。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹主动脉沿脊柱左前方下行，至第4腰椎下缘平面分为左、右髂总动脉，全长14-15cm，其右侧邻下腔静脉。腹主动脉可分为脏支及壁支，其中脏支又可分为：成对的脏支不成对的脏支,四、腹主动脉Abdominalaorta,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,（1）成对的脏支,有3对:肾上腺中动脉肾动脉睾丸动脉(卵巢动脉),January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,（2）不成对的脏支,有3支：腹腔干肠系膜上动脉肠系膜下动脉,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹主动脉毗邻：前方：为胰腺、十二指肠升部、小肠系膜根后方：为1-4腰椎及椎间盘右侧：下腔静脉左侧：左交感干,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,五、下腔静脉Inferiorvenacava,下腔静脉由左右髂总静脉在第5腰椎右侧汇合而成，收集下肢、盆部和腹部的静脉。下腔静脉在脊柱的右前方沿腹主动脉右侧上行经肝腔静脉沟，穿膈的腔静脉孔，最后开口于右心房。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,3对：(1)肾静脉左侧长于右侧(2)肾上腺静脉右侧注入下腔静脉左侧注入肾静脉。(3)生殖腺静脉右侧注入下腔静脉左侧注入肾静脉,成对脏器的静脉：,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,下腔静脉毗邻：前方：肝脏、胰头、十二指肠水平部及右睾丸（卵巢）血管和肠系膜根后方：右膈脚、1-4腰椎、右交感干和腹主动脉的壁支右侧：腰大肌、右肾和右肾上腺左侧：腹主动脉,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,左侧睾丸静脉曲张较右侧多见，原因如下：（1）左侧回流流程较长（2）左侧睾丸静脉以直角汇入左肾静脉，压力较大（3）左侧前方有乙状结肠跨过，易受其压迫（4）左肾静脉在肠系膜上动脉与腹主动脉夹角中回流，受压时易累及左侧睾丸静脉,January,2007,Copyrigh