Abdominalwall

腹壁

BoundariesoftheabdomenBoundariesSuperiorly－xiphoidprocess,lowerborderofcostalarch,11thand12thribs,vertebraT12Inferiorly－superiorborderofpubicsymphysis,pubiccrest,pubictubercle,foldofinguinalcanal,anteriorsuperioriliacspine,iliaccrest,spinousprocessofL5Theabdominalregions腹部分區(qū)

——NineregionsR.hypochondriacregion右季肋區(qū)Epigastricregion腹上區(qū)L.hypochondriacregion左季肋區(qū)R.lateralregions右外區(qū)Umbilicalregion臍區(qū)L.lateralregions左外側(cè)區(qū)R.inguinalregion右腹股溝區(qū)L.inguinalregion左腹股溝區(qū)Pubicregion恥區(qū)LandmarksofabdomenPubicsymphysisPubictubercleIliaccrestUmbiicusLineasemilunarisTranspyloricplaneAnterolateralabdominalwall

Layers

(fromsuperficialtodeep)SkinSuperficialfasciaAnterolateralmusclesTransversefascia腹橫筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜

Superficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

Thoracoepigastricv.Superficialepigastricv.CutaneousnervesAnteriorandlateralcutaneousn.oflowersixthoracicIliohypogastricn.(firstlumbnerves)MusclesofabdomenMusclesofabdomenPosteriorgroup

Quadratuslumborum腰方肌Psoasmajor腰大肌Obliquusexternusabsominis腹外斜肌Generaldirectionoffibers:downward,forwardandmedially(rundownandinward)Obliquusexternusabsominis腹外斜肌StructuresInguinalligament

腹股溝韌帶Lacunarligament

腔隙韌帶Superficialinguinalring

腹股溝管淺環(huán)

－triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercleSuperficialinguinalringObliquusinternusabdominis腹內(nèi)斜肌DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmediallyTransversusabdominis

腹橫肌Inguinalfalx

腹股溝鐮

Obliquusinternusabdominishasalower,freeborderthatarchesoverspermaticcordInsertedwithtransversusabdominisfiberintomedialpartofpectenofpubisCremaster

提睪肌

DirivedfromthelowerfibersoftheobliquusinternusabdominisandtransversusabdominisAroundthespermaticcordandtestisRectusabdominis腹直肌

Position:lieontoeitherofmidlineOrigin:pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesTendinousintersections

腱劃

3-4lineasemiluaris

半月線

Sheathofrectusabdominis腹直肌鞘AnteriorlayerFormedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisSheathofrectusabdominis腹直肌鞘Posteriorlayer

FormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversusabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuateline弓狀線BelowthislinerectusabdominisincontactwithtransversefasciaDeepvesselsofabdomenArteriesSuperiorandinferiorepigastricarterisLowerposteriorintercostalaa.Subcostala.Deepiliaccircumflexa.Fourlumbara.DeepnervesofabdomenLowerfiveintercostalsnerves

Subcostalnerve

Runbetweenobliquusinternusandtranversusabdominis.DeepnervesofabdomenIliohypogastricn.

髂腹下神經(jīng)ArisesfromlumbarplexusPassesforwardintheintervalbetweenobliquusinternusandtranversusabdominisPiecesobliquusinternusabdominis2.5cmmedialtoanteriorsuperioriliacspinePiecesaponeurosisofobliquusexternusabdominisabout2.5cmabovesuperficialinguinalringDeepnervesofabdomenGenitofemoraln.

生殖股神經(jīng)ArisesfromlumbarplexusEmergesthroughsuperficialinguinalringandsuppliesthecremastermuscleInguinalregion腹股溝區(qū)BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolateralmarginofrectusabdominisInguinalcanal腹股溝管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinalligamentBoundariesofinguinalcanalAnteriorwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PosteriorwallTransversefasciaInguinalflaxmediallyRoof－archingfibersofobliquusinternusandtransversusabdominisFloor－inguinalligamentBoundariesofinguinalcanalTwoopeningsSuperficialinguinalring

腹股溝管淺環(huán)－atriangular-shapeddefectintheaponeurosisoftheobliquusexternusabdominisandliesimmediatelyaboveandmedialtothepubictubercleBoundariesofinguinalcanalTwoopeningsDeepinguinalring

腹股溝管深環(huán)－anovalopeningintransversefasciaandliesapproximately1.5cmabovemidpointofinguinalligamentMechanicsoftheinguinalcanalTheinguinalcanalisasiteofpotentialweaknessinbothsexes.Oncoughingandstraining(asinmicturition,defecation,andparturition),thearchinglowersfibersoftheobliquusinternusandtransversusabdominiscontractandflattenthearch.Inturn,thislowerstheroofofthecanaltowardthefloorandvirtuallyclosesthecanal.Structurespassingthroughtheinguinalcanal

Inmales

Spermaticcord精索

Ilioinguinalnerve髂腹股溝神經(jīng)Infemales

Roundligamentofuterus子宮圓韌帶Ilioinguinalnerve髂腹股溝神經(jīng)DescentoftestesSeven-weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwallDescentoftestesFetusat28weekthetestispassingthroughtheinguinalcanalDescentoftestesNewbornInguinalTriangle(ofHesselbach)腹股溝三角

Boundaries

Medially:LateralborderofrectusabdominisLaterally:InferiorepigastricarteryInferiorly:InguinalligamentIndirectinguinalherniaand

directinguinalhernia

DirectinguinalherniaIndirectinguinalherniaAnteriorabdominalwallTransversefascia腹橫筋膜Extraperitonealfascia腹膜外筋膜Parietalperitoneum壁腹膜

LandmarksandsurfaceanatomyXiphoidprocessCostalarchAnteriorsuperioriliacspineIliaccrestSuperiorborderofpubicsymphysisPubictubercleLandmarksa