腹部解剖图谱

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Superficialfascia－divisionsbelowumbilicusSuperficialfattylayer(Camper’s)Membranouslayer(Scarpa’s)

MusclesofabdomenAnterolateralgroupObliquusexternusabsominis腹外斜肌Oblequusenternusabdominis腹内斜肌Transversusabdominis腹横肌Rectusabdominis腹直肌Posteriorgroup

Quadiatuslumborum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-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercleObliquusinternusabdominis腹内斜肌DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmediallyTransverselsabdominis

腹横肌DeeptoobliquusinternusRectusabdominis腹直肌

Position:lieontoeitherofmidlineOrigin:pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesHas3-4tendinousintersections

腱划lineasemiluaris

半月线

SimilarfunctionsforabovefourpairsofmusclesSupportandcompresstheabdominalvisceraIncreaseintra-abdominalpressure,aidinexpulsiveefforts-vomiting,coughing,sneezing,defecation,urinationandchildbirth.Depressribs,assistin(theactofforce(4)expiration.Flex,lateralflex,androtatevertebralcolumnSheathofrectusabdominis腹直肌鞘Antlayer－formedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisPostlayerFormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversesabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuatelineBelowthislinerectusabdominisincontactwithtransversefasciaLineaalba白线－tendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysis.Inguinalregion腹股沟区BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolaeralmarginofrectusabdominisNewbornInguinalcanal

腹股沟管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinallig.BoundariesAntwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PostwallTransversefasciaInguinalflaxmediallyRoof－archedlowerfibersofobliquusinternusandtransversuaabdominisFloor－inguinallig．TwoopeningsSuperficialinguinalring腹股沟浅环Deepinguinalring腹股沟深环－defectintransversefascia1.5cmabovemidpointofinguinalligamentStructurespassingthroughtheinguinalcanalSpermaticcord

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

Boundaries

InguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterallyIndirectinguinalheiniaanddirecetinguinalheinia

Superficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

Thoracoepigastricv.Superficialepigastricv.CutaneousnervesAnteriorandlateralcutaneousn.oflowersixthoracicIliohypogastricn.(firstlumbnerves)DeepvesselsandnervesArteresSuperiorandinferiorepigastricarterisLowerposteriorintercostala.Subcostala.Fourlumbara.NervesIliohypogastricn.髂腹下神经ArisesfromlubarplexusPassesforwardintheintervalbetweenobliquusinternusandtranversusabdominisPiecesobliquusinternusabdominis2.5cmmedialtoanteriorsuperioriliacspinePiecesaponeurosisofobliquusexternusabdominisabout2.5cmabovesuperficialinguinalringIlioinguinaln.髂腹股沟神经Runsparallelwithiliohypogastricn.atalowerlevelEntersinguinalcanalandemergesthroughsuperficialinguinalringGenitofemoraln.生殖股神经SubcostalincisionMuscle-splittingincisionTransverseincision

MedianormidlineincisionLeftparamedianincisionLayer?SuprapubicincisionAbdomen2山东大学医学院解剖教研室李振华Abdominalaorta腹主动脉ContinuationofthoracicaortaataortichiatusofdiaphragminfrontofT12TerminatesatlowerborderofL4vertebrabydividingintorightandleftcommoniliacarteriesParietalbranchesInferiorphrenica.

膈下动脉(onepair)Lumbara.

腰动脉(fourpairsofarteriesthatsupplytheposteriorabdominalwall)Mediansacrala.骶正中动脉Unpairedbranches

Celiactrunk

腹腔干－ashortthickvesselthatarisesfromthefrontofaorta,atthelevelofT12Superiormesenterica.肠系膜上动脉－arisesfromthefrontofaorta,atthelevelofL2Inferiormesenterica.肠系膜下动脉－arisesfromthefrontofaorta,atlevelofL3Leftgastrica.Commonhepatica.Splenica.Gastroduodenala.Properhepatica.Rightgastrica.LeftbranchRightbranchCystica.Shortgastrica.

Leftgastrioeploica.Rightgastroepiploica.Superiorpancreaticoduodenala.Splemicbranches

Celiactrunk

Celiactrunk

Superiormesenterica.

Inf.pancresticodudenala.Jejunalandileala.Ileocolica.Appendiculara.Rightcolica.Middlecolica.

SuperiorMesentericv.Inferiormesenterica.Leftcolica.Sigmoida.Superiorrectala.

Inferiormesentericv.ColicmarginalarteryVeinsofabdomenandpelvisInternaliliacvein髂内静脉Parietaltributaries:accompanywitharteriesVisceraltributaries

→superiorrectalvein→inferiormesentericv.①Rectalvenousplexus →inferiorrectalvein→internaliliacv.

直肠静脉丛 →analvein→internalpudendalv.②Vesicalvenousplexus膀胱静脉丛→vesicalv.③Uterinevenousplexus子宫静脉丛→uterinev.

Externaliliacvein

髂外静脉–accompanythearteryCommoniliacvein

髂总静脉–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacavaInferiorvenacava

下腔静脉FormedbyunionoftwocommoniliacveinsanteriortoandjusttotherightofL4~L5Ascendsontherightsideofaorta,piercesvenacavaforamenofdiaphragmoppositetheT8anddrainsintotherightatriumConveysbloodfromthewholebodybelowthediaphragmtotherightatriumHepaticportalvein肝门静脉

VariationandanomaliesofhepaticportalveinTributariesofhepaticportalvein

1.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.Atthelowerendoftheoesophagus

Hepaticportalvein→leftgastricvein→esophagealvenousplexus→esophagealvein→azygosvein→superiorvenacava2.Atrectalvenousplexus

Hepaticportalvein→splenicvein→inferiormesentericvein→superiorrectalvein→rectalvenousplexus→inferiorrectalandanalveins→internaliliacvein→inferiorvenacava3.AtperiumbilicalvenousplexusHepaticportalvein→paraumbilicalvein→periumbilicalvenousplexus→thoracoepigastricandsuperiorepigastricvein→superiorvenacavasuperficialepigastricandinferiorepigastricveins→inferiorvenacava4.Portal-retroperitonealanastomosis

Betweentheretroperitonealbranchesofthecolicveinsandthelumbarveins,pancreaticoduodenalveinswiththerenalveinsandthesubcapsularveinsoftheliverwiththephrenicveinstwigsofcolicveins(portal)anastomosingwithsystemicretroperitonealveinsThelymphaticdrainageofabdomenLymphaticdrainageofabdominalwallToaxillarylymphnodefromregionaboveumbilicusTosuperficialinguinallymphnodefromregionbelowumbilicusTolumbarlymphnodefrompostwallofabdomenSpleen脾Location:liesinthelefthypochondriacregion(betweenstomachanddiaphragm)deeptothe9thto11thrib,itslongaxiscorrespondsroughlytothe10thribShape－reddishincolourTwosurfacesDiaphragmatic:smooth,convexVisceral:concave,hilumofspleenTwoextremities

Anterior－widerPosterior－rounderTwoborder

Superior－has2-3splenicnotch脾切迹,whichserveasalandmarkonpalpationwhenitisenlarge;normallyitisnotpalpableInferior－rounderFunctions:thespleenisconsideredtobeimportantin:FormationoflymphocytesandmonocytePhagocytosisofbacteria,inertparticlesandwhitebloodcellsandplateletsDestroyingeffeteorabnormalredbloodcellsMakingantibodiesRalationshipsofspleenDiaphragmaticsurface－diaphragmVisceralsurfaceAnteriorly－fundusofstomachPosteriorly－leftsuprarenalglandandkidneyInferiorly－tailofpancreasandleftcolicflexureNerversofabdomenLumbarplexus腰丛Formation:formedbyanteriorramiofL1-L3,apartofanteriorramiofT12andL4Position:lieswithinsubstanceofpsoasmajorBranchesIliohypogastricn.髂腹下神经SupplieslowerpartofanteriorabdominalwallIlioinguinaln.髂腹股沟神经PassesthroughinguinalcanaltosupplyskinofthegroinandscrotumLateralfemoralcutaneous股外侧皮神经Femoraln.股神经Obturator

n.

闭孔神经Genitofemoraln.生殖股神经Lumbarsympathetictrunk腰交感干MadeupofpairedchainswithfourtofivelumbargangliaanterolateraltovertebralcolumnEntersabdomenviathediaphragmandasacontinuationofhethoracicpartPassesinferiorlybehindcommoniliacvesselsandterminationsbyjoiningtoformunpairedganglionimpar,anteriortosacrumAbdomen3山东大学医学院解剖教研室李振华Relationshipsofabdominalviscera

Firstlayer－live,gallbladder,stomachSecondlayer－duodenum,pancreas,spleenThirdlayer－suprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphatics

RelationshipsofthestomachAnterior:Live(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(leftlowerpart)Posterior－separatedbyperitonumoflessersacfromthefollowing(“stumach-bed”)PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversmesoclonArteriesofstomachLeftandrightgastricarteriesarisefromceliactrunkandproperhepaticartery,repectively.Thesetwovesselsruninlesseromentumalonglessercurvature,andanastomoseend-to-end.Rightandleft

gastroepiploicarteriesarisefromthegastroduodenalandsplenicartery,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.TheduodenumRelationshipsofsuperiorpart

AnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommombileductGastroduodenala.Hepaticportalv.InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreasRelationshipsofascendingpartRightHeadofpancreasandabdominalaortaLeftLeftkidneyandureterRelationshipsofliverDiaphragmaticsurface－separatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanteroly,gallbladderandsuperiorduodenalflexuremedially,rightkidney,superarenalglandposteriorlyBloodsupplyArteriesSuperiorpancreaticoduodenala.Inferiorpancreaticoduodenala.Veins－followarteries,drainingdirectlyintosuperiormesentericandhepaticportalveinsDivisionsandrelationsofcommonbileductSupraduodenalsegment

Descendsalongtherightmarginofhepatoduodenallig.Totherightofproperhepatica.Anteriortohepaticportalv.Retrodu