Abdomen

腹部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)Theabdominalregions腹部分區(qū)

——Fourquadrants

LeftupperquadrantsrightupperquadrantsrightlowerquadrantsLeftlowerquadrantsLandmarksofabdomenXiphoidprocess劍突Costalarch肋弓Anteriorsuperioriliacspine髂前上棘Iliaccrest髂嵴Pubicsymphysis恥骨聯(lián)合Pubictubercle恥骨結(jié)節(jié)Umbiicus臍atthelevelofL3~L4Lineaalba白線Lineasemilunaris半月線LandmarksandsurfaceanatomyXiphoidprocessCostalarchAnteriorsuperioriliacspineIliaccrestSuperiorborderofpubicsymphysisPubictubercleLandmarksandsurfaceanatomyLineaalbaRectusabdominisTendinousintersectionsLineasemilunarisUmbilicus:atthelevelofL3~L4InguinalligamentSuperficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

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

SuperficiallymphvesselsabovetheleveloftheumbilicusgrainupwardintothepectoralLn.ThevesselsbelowthisleveldraindownwardintothesuperficialinguinalLn.

AnterolateralMusclesObliquusexternusabdominis腹外斜肌Obliquusinternusabdominis腹內(nèi)斜肌Transversusabdominis腹橫肌Rectusabdominis腹直肌Obliquusexternusabsominis腹外斜肌Generaldirectionoffibers:downward,forwardandmedially(rundownandinward)Origin－fromoutersurfaceoflowereightribsInsertionPosteriorfibersextensverticallysownwardtoanteriorhalfofiliaccrestRemainderextenddownandmediallyintoabroadaponeurosis,which:MeetsitsfellowatlineaalbabycrossinganteriortorectusabdominsObliquusexternusabsominis腹外斜肌Attachestoanteriorsuperioriliacspineandpubictubercletoformafreelowerborder(theinguinalligament

腹股溝韌帶)betweenthesetwopointsInguinalligament

腹股溝韌帶LowerfreeborderofaponeurosisofobliquusexternusabdominisbetweenanteriorsuperioriliacspineandpubictubercleSuperficialinguinalring

腹股溝管淺環(huán)

triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercleLacunarligament

腔隙韌帶ExtentionofinguinalligamentcurvingdownwardandposteriorlyfrompubictuberclePectinealligament(Cooper’s)恥骨梳韌帶ContinuationoffibersoflacunarligmentalongthepectineallineSuperficialinguinalring腹股溝淺環(huán)Obliquusinternusabdominis腹內(nèi)斜肌DeeptoobliquusexternusabdominisOriginLateral2/3ofinguinalligamentAnterior2/3ofiliaccrestThoracolumbarfaciaInsertionExtensionofmostfibersupwardsandmediallyTolowerfourribsandcostalcatilagesIntobroadaponurosis,whichsplitsintoanteriorandposteriorleavestoencloserectusabdominis,meetingatlineaalbaFibersfrominguinalligament－archoverspermaticcord,insertedwithtransversusabdominisfibersintopubiccrestandadjacentpectineallinetoforminguinalfalx

腹股溝鐮DerivationofcremastermuscleandfaciaTransversusabdominis腹橫肌DeeptoobliquusinternusGeneraldirectionoffibers:runhorizontallyforwardOriginLateral1/3ofinguinalligamentAnterior2/3ofiliaccrestThoracolumbarfaciaLowersixribsandcostalcartilagesInsertionMostfibers－runhorizontallyintoabroadaponurosis,mostofwhichpassesposteriortorectusabdominisandmeetsitsfellowatthelineaalbaTransversusabdominis

腹橫肌Inguinalfalx

腹股溝鐮

FormedbyinsertionofobliquusinternusabdominisandtransversusabdominisfibersintopubiccrestandadjacentpectineallineStrengthensabdominalwallposteriortosuperficialringCremaster

提睪肌

DirivedfromthelowerfibersoftheobliquusinternusabdominisandtransversusabdominisAroundthespermaticcordandtestisRectusabdominis腹直肌

Position:lieontoeitherofmidlineOrigin－pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesHasthreetendinousintersections

腱劃

attachedtoanteriorrectussheathLineasemiluaris半月線Sheathofrectusabdominis腹直肌鞘EnclosesrectusabdominisAnteriorlayerFormedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofobliquusinternusabdominisLowest?formedbyaponeurosesofallthreemusclesSheathofrectusabdominis腹直肌鞘PosteriorlayerFormedbyfusionofposteriorleafofaponeurosisofobliquusinternusabdominisandtransversusaponeurosisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorsheath.Thelowerfreebordernamedarcuateline

弓狀線BelowthislinerectusabdominisincontactwithtransversefasciaAnterolateralMusclesLineaalba

白線TendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysisDeepvesselsofabdomenArteriesSuperiorepigastrica.－frominternalthoracica.Inferiorepigastrica.－fromexternaliliaca.Lowerposteriorintercostalaa.－fromthoracicaortaSubcostala.－fromthoracicaortaDeepiliaccircumflexa.－fromexternaliliaca.Fourlumbara.－fromabdominalaortaDeepnervesofabdomenLowerfiveintercostalsnerves

Subcostalnerve

Runbetweenobliquusinternusandtranversusabdominis.DeepnervesofabdomenIliohypogastricn.

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

髂腹股溝神經(jīng)ArisesfromlumbarplexusRunsparallelwithiliohypogastricn.atalowerlevelEntersinguinalcanalandexitsthroughsuperficialinguinalringSuppliesthetransversusabdominis,obliquusinternus,andobliquuseexternusabdiminis.Italsosuppliestheskinjustabovethesymphysispubisandthescrotumorgreaterlipofpudendum.DeepnervesofabdomenGenitofemoraln.

生殖股神經(jīng)ArisesfromlumbarplexusEmergesthroughsuperficialinguinalringandsuppliesthecremastermuscleInguinalregion腹股溝區(qū)BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolateralmarginofrectusabdominisInguinalcanal腹股溝管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinalligamentInguinalcanal腹股溝管BoundariesAnteriorwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PosteriorwallTransversefasciaInguinalflaxmediallyRoofarchingfibersofobliquusinternusandtransversusabdominisFloor－inguinalligamentInguinalcanal腹股溝管BoundariesTwoopeningsSuperficialinguinalring

腹股溝管淺環(huán)atriangular-shapeddefectintheaponeurosisoftheobliquusexternusabdominisliesimmediatelyaboveandmedialtothepubictubercleDeepinguinalring腹股溝管深環(huán)anovalopeningintransversefascialiesapproximately1.5cmabovemidpointofinguinalligamentMechanicsoftheinguinalcanalTheinguinalcanalisasiteofpotentialweaknessinbothsexes.Oncoughingandstraining(asinmicturition,defecation,andparturition),thearchinglowersfibersoftheobliquusinternusandtransversusabdominiscontractandflattenthearch.Inturn,thislowerstheroofofthecanaltowardthefloorandvirtuallyclosesthecanal.Structurespassingthroughinguinalcanal

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-weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwallFetusat28weekthetestispassingthroughtheinguinalcanalDescentoftestesNewbornInguinalTriangle(ofHesselbach)腹股溝三角

Boundaries

LateralborderofrectusabdominismediallyInferiorepigastricarterylaterallyInguinalligamentinferiorlyIndirectinguinalhernia腹股溝斜疝

Followpathoftestisthroughdeepinguinalring,inguinalcanal,andsuperficialinguinalringIndirectinguinalherniaDirectinguinalhernia腹股溝直疝Protrudethroughposteriorwallofinguinalcanal(transversefasciaoringuinalfalx),medialtoinferiorepigastrica.,i.e.,throughareaofinguinaltriangleDirectinguinalherniaAnteriorabdominalwallTransversefascia腹橫筋膜Extraperitonealfascia腹膜外筋膜Parietalperitoneum壁腹膜

SubcostalincisionMuscle-splittingincisionTransverseincision

MedianormidlineincisionLeftparamedianincisionLayer?SuprapubicincisionPeritoneum腹膜Theperitoneum腹膜GeneralfeaturesAthinserousmembranethatlinethewallsoftheabdominalandpelviccavitiesandcovertheorganswithinthesecavitiesParietalperitoneum

壁腹膜

Coversanterior,lateral,posteriorabdominalwalls,inferiorsurfaceofdiaphragm,andwallsofpelviccavityVisceralperitoneum

臟腹膜

ReflectsparietalperitoneumfromposteriorabdominalwallandcoversmuchofthedigestivetractandcertainorgansTheperitoneum腹膜Peritonealcavity腹膜腔PotentialspacebetweentheparietalandviscerallayerofperitoneumUsuallyemptyexceptforasmallamountofserousfluidthathelpstokeepthesurfaceepitheliummoistInthemaleisanenclosedcavityInthefemaleopenstotheexteriorviatheostiumofuterinetubesRelationshipbetween

visceraandperitoneum

Intraperitonealviscera腹膜內(nèi)位器官

VisceraarealmosttotallycoveredwithvisceralperitoneumExampleStomachSuperiorpartofduodenumJejunumIleumCecumVermiformappendixTransverseandsigmoidcolons,SpleenandovaryRelationshipbetween

visceraandperitoneumInterperitonealviscera

腹膜間位器官MostpartofviscerasurroundedbyperitoneumExampleLiverGallbladderAscendinganddescendingcolonUpperpartofrectumUrinarybladderanduterusRelationshipbetween

visceraandperitoneumRetroperitonealviscera

腹膜外位器官SomeorganslieontheposteriorabdominalwallandarecoveredbyperitoneumontheiranteriorsurfacesonlyExampleKidneySuprarenalglandPancreasDescendingandhorizontalpartsofduodenumMiddleandlowerpartsofrectumUreterStructureswhichareformedbyperitoneumOmentum網(wǎng)膜Mesenteries

系膜Ligaments韌帶Folds,recessesorpouches皺襞，隱窩和陷凹Omenta網(wǎng)膜Two-layeredfoldofperitoneumthatconnectthestomachwithanotherviscusLessoromentum小網(wǎng)膜Greateromentum大網(wǎng)膜

Lessoromentum小網(wǎng)膜Two-layeredfoldofperitoneumwhichextendsfromportahepatistolessercurvatureofstomachandsuperiorpartofduodenumHepatogastricligament肝胃韌帶－extendsfromportahepatistolessercurvatureofstomachHepatoduodenalligament肝十二指腸韌帶－extendsfromportahepatistosuperiorpartofduodenum.Contains:CommonbileductProperhepatica.Hepaticportalv.Lessoromentum小網(wǎng)膜Omentalforamen

網(wǎng)膜孔BehindtherightborderofhepatoduodenalligamentSuperior－caudatelobeofliverInferior－superiorpartofduodenumAnteriorly－freeborderofhepatodudenalligamentPosteriorly－peritoneumcoveringtheinferiorvenacava

Greateromentum大網(wǎng)膜

Four-layeredfoldofperitoneumConnectsthegreatercurvatureofthestomachandsuperiorpartofduodenumwiththetransversecolon.Ithangsdownlikeanaproninfrontofcoilsofsmallintestineandisfoldedbackonitself.Ifaninfectionoccursintheintestine,plasmacellsformedinthelymphnodescombattheinfectionandhelppreventitfromspreadingtotheperitoneum.LessoromentumGreateromentumLesseromentumOmentalbursa網(wǎng)膜囊Position－liesbehindthelesseromentumandstomachWallsSuperiorly－peritoneumwhichcoversthecaudatelobeofliveranddiaphragmAnteriorly－formedbylesseromentum,peritoneumofposteriorwallofstomach,andanteriortwolayersofgreateromentumInferiorly－conjunctiveareaofanteriorandposteriortwolayersofgreateromentumPosteriorly－formedbyposteriortwolayersofgreateromentum,transversecolonandtransversemesocolon,peritoneumcoveringpancreas,leftkidneyandsuprarenalglandOmentalbursa網(wǎng)膜囊LeftSpleengastrosplenicligament胃脾韌帶

splenorenalligament脾腎韌帶Right－omentalforamenCommunication

TheOmentalbursa(lessersac)communicateswiththegreatersacthroughtheomentalforamen.Mesenteries系膜Two-layeredfoldofperitoneumconnectingpartoftheintestineswiththeposteriorabdominalwall

Mesenteries系膜Mesentery

腸系膜

Two-layeredfoldofperitoneumsuspendsthesmallintestinefromtheposteriorabdominalwallBroadandafan-shapedRadixofmesentery15cmlongDirectedobliquelyfromleftsideofL2toinfrontofrightsacroiliacjointIntestinalborder－folded,7mlongMesenteries系膜Mesoappendix

闌尾系膜Triangularmesentery－extendsfromterminalpartofileumtoappendixAppendiculararteryrunsinfreemarginofthemesoappendixthenalongwallofappendix

Mesenteries系膜Transversemesocolon

橫結(jié)腸系膜－adoublefoldofperitoneumwhichconnectsthetransversecolontotheposteriorabdominalwallSigmoidmesocolon

乙狀結(jié)腸系膜－invertedV-shaped,withapexlocatedinfrontofleftureteranddivisionofcommoniliacarteryLigaments韌帶Two-layeredfoldsofperitoneumthatconnectthelessermobilesolidviscerawiththeabdominalwalls

LigamentsofliverFalciformligamentofliver

鐮狀韌帶Coronaryligament

冠狀韌帶Bareareaoflive肝裸區(qū)Leftandrighttriangularligaments

左、右三角韌帶Hepatogastricligament肝胃韌帶Hepatoduodenalligament肝十二指腸韌帶Ligamentumtereshepatis肝圓韌帶LigamentsofspleenGastrosplenicligament胃脾韌帶－adoublelayerofperitoneumthatconnectsthefundusofstomachtohilumofspleen.InthisdoublelayerofperitoneumaretheshortgastricandleftgastroepiploicvesselsSplenorenalligament脾腎韌帶－extendsbetweenthehilumofspleenandanterioraspectofleftkidney.Thesplenicvesselslieswithinthisligament,aswellasthetailofpancreasPhrenicosplenicligament

膈脾韌帶Splenocolicligament脾結(jié)腸韌帶Ligamentsofstomach

Hepatogastricligament肝胃韌帶Gastrosplenicligament胃脾韌帶Gastrophrenicligament胃膈韌帶Gastrocolicligament胃結(jié)腸韌帶Gastropancresticligament胃胰韌帶FoldsandrecessesofposteriorabdominalwallSuperiorduodenalfoldandrecess十二指腸上襞和上隱窩Inferiorduodenalfoldandrecess十二指腸下襞和下隱窩Intersigmoidrecess乙狀結(jié)腸間隱窩－formedbytheinvertedVattachmentofsigmoidmesocolonRetrocecalrecess盲腸后隱窩

－inwhichtheappendixfrequentlyliesFoldsandrecessesofposteriorabdominalwallHepatorenalrecess

肝腎隱窩－liesbetweentherightlobeofliver,rightkidney,andrightcolicflexure,andisthelowestpartsoftheperitonealcavitywhenthesubjectissupinePouches陷凹Inmale－rectovesicalpouch

直腸膀胱陷凹Infemale

Rectouterinepouch直腸子宮陷凹

－betweenrectumanduterusVesicouterinepouch膀胱子宮陷凹

－betweenbladderanduterus

Peritonealcavitysubdivisions

Thetransversecolonandtransversemesocolondividesthegreatersacinto:

Supracolic

compartment結(jié)腸上區(qū)（subphrenicspace膈下間隙）

－liesbetweendiaphragmandtransversecolonandtransversemesocolon

Infracoliccompartment結(jié)腸下區(qū)

－liesbetweentransversecolonandtransversemesocolonandpelvicinletSpacesofsupracoliccompartmentsSuprahepaticspace

肝上間隙Rightsuprahepaticspace右肝上間隙Rightanteriorsuprahepaticspace

右肝上前間隙Rightposteriorsuprahepaticspace

右肝上后間隙Bareareaoflive

肝裸區(qū)Leftsuprahepaticspace

左肝上間隙Leftanteriorsuprahepaticspace

左肝上前間隙Leftposteriorsuprahepaticspace

左肝上后間隙SpacesofsupracoliccompartmentsSubhepaticspace

肝下間隙Rightsubhepaticspacees右肝下間隙(hepatorenalrecess肝腎隱窩

)Leftsubhepaticspace左肝下間隙leftanteriorsubhepaticspaceleftposteriorsubhepaticspaceSpacesofinfracoliccompartmentsRightparacolicsulcus(gutter)右結(jié)腸旁溝Lieslateraltotheascendingcolon.ItcommunicateswiththehepatorenalrecessandthepelviccavityItprovidesarouteforthespreadofinfectionbetweenthepelvicandtheupperabdominalregionLeftparacolicsulcus(gutter)左結(jié)腸旁溝

Lieslateraltothedescendingcolon.Itisseparatedfromtheareaaroundthespleenbytheleftphrenicocolicligament,afoldofperitoneumthatpassesfromthecolicflexuretothediaphragm.SpacesofinfracoliccompartmentsRightmesentericsinus右腸系膜竇TriangularspaceLiesbetweenrootofmesentery,ascendingcolon,right2/3oftransversecolonandtransversemesocolonLeftmesentericsinus左腸系膜竇Liesbetweenrootofmesentery,descendingcolon,right1/3oftransversecolonandtransversemesocolonItswidensbelowwhereitiscontinuouswiththecavityofthepelvis上下流通，左溝不暢，右竇封閉，左入盆腔。Relationsofabdominalviscera

FirstlayerLive,gallbladder,stomachSecondlayerDuodenum,pancreas,spleenThirdlayerSuprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphaticsSupracolic

Compartment結(jié)腸上區(qū)Supracolic

compartment結(jié)腸上區(qū)Maincontents

Esophagus(abdomenpart)StomachLiveExtrahepaticbiliaryapparatusSpleenDuodenumEsophagus(abdomenpart)食管腹段Extendsfromesophagealhiatusofdiaphragm(levelofT10vertebra)tocardiacorificeofstomach1-2cmlong,dependingonmuscletoneandstomachcontentAnteriorvagaltrunk(leftvagus)andposteriorvagaltrunk(rightvagus)－accompanyesophagusStomach胃

LocationMainlypartsissituatedinthelefthypochondriacregionSmallintheepigastricregionThecardiaissituatedtotheleftofT11,thepylorusliestotherightofL1

Stomach胃RelationshipsAnteriorly:Live(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(leftlowerpart)Posteriorly－separatedbyperitoneumoflessersacfromthefollowing(“stomach-bed”)PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversemesocolonStomach胃ArteriesofstomachLeftandrightgastricarteries

Arisefromceliactrunkandproperhepaticartery,respectivelyRuninlesseromentumalonglessercurvature,andanastomoseend-to-endRightandleft

gastroepiploicarteries

Arisefromthegastroduodenalandsplenicartery,respectively.Thesetwovesselspassintothegreateromentum,runparalleltothegreatercurvature,andanastomoseend-to-endStomach胃ArteriesofstomachShortgastricarteries

BranchesofsplenicarteryCoursethroughthegastrosplenicligamentSupplythefundusofstomachPosteriorgastricartery(72%)

ArisefromthesplenicarteryCoursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomachStomach胃VenousdrainageofstomachRightandleftgastricveins

emptydirectlyintohepaticportalveinLeftgastroepiploicandshortgastricveins

drainintohepaticportalveinviathesplenicvein.Rightgastroepiploicvein

drainintosuperiormesentericvein.Stomach胃Lymphdrainageofstomach

Rightandleftgastricln.liealongthesamevesselsandfinallytotheceliacln.Rightandleftgastroomentalln.liealongthesamevessels,theformerdrainintosubpyloricln.thelatterdrainintosplenicln.Suprapyloricandsubpyloricln.receivelymphaticsfrompyloricpartandfinallytotheceliacln.Splenicln.receivelymphaticsfromfundusandleftthirdofstomachfinallytotheceliacln.Stomach胃NervesupplyofstomachParasympatheticinnervationbyanterior(left)andposterior(right)vagatrunkTheanteriorvagaltrunkdividesintoanteriorgastricandhepaticbranchesTheposteriorvagaltrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthepyloricantrumtofanoutintobranchescalled“crow’sfoot”tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAfferentandefferentfibersderivesfromthoracicsegments(T5－L1)Stomach胃NervesupplyofstomachParasympatheticinnervationbyanterior(left)andposterior(right)vagatrunkTheanteriorvagaltrunkdividesintoanteriorgastricandhepaticbranchesTheposteriorvagaltrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthepyloricantrumtofanoutintobranchescalled“crow’sfoot”tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAfferentandefferentfibersderivesfromthoracicsegments(T5－L1)Postganglionicfibers－accompanyateriestostomachDuodenum十二指腸Generalfeaturesapproximately25cmlongand4-5cmindiameterC-shapedandmouldedaroundheadofpancreasParts

Superiorpart

上部Descendingpart

降部Horizontalpart

水平部Ascendingpart

升部Duodenum十二指腸MainstructuresinDescendingpartLongitudinalfoldofduodenum

十二指腸縱襞Majorduodenalpapilla

十二指腸大乳頭

thecommonopeningofthecommonbileductandpancreaticduct,75cmfromincisorsMinorduodenalpapilla

十二指腸小乳頭Duodenum十二指腸Surroundingstructuresofsuperiorpart

AnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommonbileductGastroduodenala.Hepaticportalv.InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreasDuodenum十二指腸SurroundingstructuresofdescendingpartAnteriorlyLiveTransversecolonandtransversemesocolonLoopsofsmallintestine

PosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexureDuodenum十二指腸SurroundingstructuresofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica.andv.PosteriorlyRightureterInferiorvenacavaAbdominalaortaDuodenum十二指腸SurroundingstructuresofascendingpartRight—HeadofpancreasandabdominalaortaLeft—leftkidneyandureterDuodenojejunalflexureisfixedbythesuspensorymuscleofduodenum(ligamentofTreitz),asurgicallandmarkDuodenum十二指腸

BloodsupplyArteriesSuperiorpancreaticoduodenala.Inferiorpancreaticoduodenala.VeinsFollowarteriesDrainingdirectlyintosuperiormesentericandhepaticportalveinsLiver肝Position:MostofliverliesintherighthypochondriacregionandepigastricregionlesspartextendingintothelefthypochondriacregionLiver肝SurfaceprojectionUpperborder:ontherightmidclavicularlineitextendsthelevelof5thribLowerborder:Normally,therightlobeextendsjustbeneaththecostalmargin,itdoesn’tdownbeyondthecostalmargin;ontheanteriormedianlineitslowerbordercrossesapointabout3~5cmbelowthexiphoidprocess.Inchildren,theliverbeinglargerinproportiontothebodythanintheadultstage,itextendsbelowthecostalarchwithinin2cm.Liver肝Thesegmentsoftheliver

肝段Thesegmentationoftheliver,basesupontheprincipaldivisionsoftheproperhepaticarteryandaccompanyinghepaticductsandhepaticportalvein－Glissonsystem.Thehepaticveins,howeverdonotfollowthesamepatternandvary:theirmaintributariestendtorunratherintersegmental.Liver肝RelationshipsDiaphragmaticsurfaceSeparatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanterioly,gallbladderandsuperiorduodenalflexuremedially,rightkidney,superarenalglandposteriorlyLiver肝Portahepatis

肝門

TraversedbyRightandlefthepaticductsLeftandrightbranchesofproperhepaticarteryandhepaticportalveinNervesandlymphaticvesselsThesestructureswhicharesurroundedbyconnectivetissueinthefreeborderofhepatoduodenalligamentcalledhepaticpedicle

肝蒂Liver肝Secondportahepatic第二肝門InthesuperiormarginofthesulcusforvanacavaonthediaphragmaticsurfaceoftheliveThirdportahepatic第三肝門IntheinferiorpartofthesulcusforvanacavawheretheinferiorvanacavareceivesseveralsmallveinsGallbladder

膽囊Position:LiesinfossaforgallbladderonvisceralsurfaceofliverFourpartsFundusofgallbladder

膽囊底Surfaceprojection:atthejunctionofrightmidclavicularlineandrightcostalarchBodyofgallbladder膽囊體Neckofgallbladder膽囊頸Cysticduct膽囊管RelationshipsSuperior－liveinferior－duodenumandtrasvescolonLeft－pylorusRight－rightcolicfexure

Cystohepatictriangle(Calot’sTriangle)膽囊三角

BoundariesCommonhepaticductontheleftCysticductontherightLivesuperiorlyContent－cysticarteryCommonbileduct膽總管Divisions

Supraduodenalsegment十二指腸上段Retroduodenalsegment十二指腸后段Pancreaticsegment胰腺段Intraduodenalsegment十二指腸壁段Commonbileduct膽總管RelationsSupraduodenalsegmentDescendsalongtherightmarginofhepatoduodenallig.Totherightofproperhepatica.Anteriortohepaticportalv.RetroduodenalsegmentBehindthesuperiorpartofduodenumAnteriortothevenacavaTotherightofthehepaticportalv.Commonbileduct膽總管RelationsPancreaticsegmentLiesinagroovebetweenposteriorsurfaceofheadofpancreasandduodenumIntraduodenalsegmentEntersthewallofdescendingpartofduodenumobliquelywherejionsthepancreaticducttoformthehepatopancreaticampullaOpensatthemajorduodenalpapillaPancreas胰

PositionLiesinepigastricandlefthypochondriacredions,behindtheperitoneumontheposteriorabdominalwall,roughlyatthelevelofofL1~L2SurfaceprojectionUpperborder:about10cmaboveumbilicusLowerborder:about5cmaboveumbilicusPancreas胰

DescriptivepartHeadLieswithinthecancavityoftheC-