疝解剖学PPT参考课件.ppt

1、腹股沟区的临床应用解剖学,丁文龙 上海交通大学医学院 2009.8.21,1,浅 筋膜及腹 壁,Skin,Superficial fasica,Scarpas fascia,Muscles of anterior abdominal,Campers fascia,Transversalis fascia,wall,2,一. The Muscles of Abdomen (The Anterolateral Group) 腹肌(前外侧群),obliquus externus abdominis 腹外斜肌 linea alba 腹白线 inguinal ligament 腹股沟韧带 superfi

2、cial inguinal ring 腹股沟管浅环,3,（1）腹外斜肌 external oblique muscle,腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral crus、脚间纤维intercrural fibers.,腹外斜肌 External oblique,腹外斜肌腱膜 External oblique，aponeurosis,Intercrural fibers,Medial crus,4,腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral

3、crus、脚间纤维intercrural fibers.,返转韧带reflected ligament、腹股沟韧带inguinal ligament、,5,腹股沟韧带inguinal ligament、腔隙韧带lacunar ligament、耻骨梳韧带pectineal ligament,6,obliquus internus abdominis 腹内斜肌 Cremaster 提睾肌 transversus abdominis 腹横肌inguinal falx 腹股沟镰 (conjoined tendon),7,提睾肌 Cremaster muscle,腹股沟镰Inguinal falx 联

4、合腱 Conjoined tendon,腹横肌下缘,腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构,8,腹横筋膜 Transverse fascia,精索内筋膜internal spermatic fascia,9,腹股沟深环deep inguinal ring 窝间韧带 interfoveolar ligament,腹横筋膜 Transverse fascia,10,腹前壁内面的皱襞及凹窝,4. 壁腹膜 Parietal peritoneum,11,二. The Inguinal Region腹股沟区,The boundary 境界 The layers and characteristics

5、层次与特点 The inguinal canal 腹股沟管 The inguinal triangle 腹股沟三角 hernias 疝 ： Direct inguinal hernias 腹股沟直疝、 indirect inguinal hernias 腹股沟斜疝 、 femoral hernias 股疝,12,（一）Boundary,1. The skin 2. Superficial fascia 3. Aponeurosis of external obliquus abdominis,（二）The Layers of the Inguinal Region,13,4. Iliohypo

6、gastric nerve and ilioinguinal nerve 5. Obliquus internus abdominis 6. Transversus abdominis,（二）The Layers of the Inguinal Region,14,7. Transverse fascia 8. Extraperitoneal fascia 9. Inferior epigastric artery and deep circumflex artery 10.Parietal peritoneum,15,三. 腹股沟区的特点,腹外斜肌在此区移行为腱膜，并在下部形成一裂口(浅环)

7、； 腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部，两者间无肌层覆盖； 有精索或子宫圆韧带通过，形成了一潜在性裂隙； 在人体站立时，该区所承受的腹内压力比平卧时高3倍。 因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部位。,16,四. The inguinal canal腹股沟管,Position Structures passing through it Two opening and four walls Forming of the spermatic cord Indirect inguinal hernia,17,The Inguinal Canal 腹股沟管,1.位置 2.内容 3.构

8、成 4.临床意义,18,The inguinal canal is an oblique, inferomedially passage(between the superficial and deep inguinial rings) through the inferior part of the anterior abdominal wall), 35cm long. 位于腹股沟带内侧半的上方，是由外上斜向内下的肌筋膜裂隙。 The inguinal canal lies parallel and just superior to the medial half of the ingui

9、nal ligament.,The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. It also contains blood and lymphatic vessels and the ilioinguinal nerve in both sexes. 有精索（男性）或子宫圆韧带（女性）、髂腹股沟神经通过。,19,The deep ( internal ) inguinal ring, entrance to

10、 inguinal canal , is an outpouching of the transversalis fascia approximately 1.25cm superior to the middle of the inguinal ligament and lateral to the inferior epigastric vessels.内口：即腹股沟深环，位于腹股沟韧带中点上方约一横指处、腹壁下动脉外侧，是腹横筋膜在向外突形成的一个卵圆形孔。,The superficial ( external ) inguinal ring-exit from inguinal can

11、al- is a slitlike opening between the diagonal fibers of the aponeurosis fo the external oblique, superolateral to the pubic tubercle. 外口：即腹股沟管浅环，是腹外斜肌腱膜在耻骨结节外上方形成的三角形裂隙。,20,The anterior wall of the inguinal canal is formed by the external oblique aponeurosis throughout the length of the canal, with

12、 the anterior wall of the lateral part of the canal being reinforced by fibers of internus oblique. 前壁：为浅层的腹外斜肌腱膜和深层的腹内斜肌（在管的外侧1/3处）。,The posterior wall of the inguinal canal is formed by the transversalis fascia with the posterior wall of the medial part of the canal being reinforced the conjoint t

13、endon. 后壁：为腹横筋膜和腹股沟镰（在管的内侧1/3处）。,Roof ( superior wall) is formed by the arching fibers of the internal oblique and transverse abdominal muscles. 上壁：为腹内斜肌和腹横肌的弓状下缘。 Floor( inferior wall ) is formed by the inguinal ligament. 下壁：为腹股沟韧带。,21,腹股沟三角 Inguinal Triangle （海氏三角 Hesselbachs triangle）,构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。临床意义：由腹股沟三