Abdominalwall山東大學(xué)醫(yī)學(xué)院解剖教研室李振華Anteriorwall

Layers(fromsuperficialtodeep)SkinSuperficialfasciaAnterolateralmusclesTransversalisfascia腹橫筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜Superficialfascia－divisionsbelowumbilicusSuperficialfattylayer(Camper’s)Membranouslayer(Scarpa’s)

MusclesofabdomenAnterolateralgroupObliquusexternusabsominis腹外斜肌Oblequusenternusabdominis腹內(nèi)斜肌Transversusabdominis腹橫肌Rectusabdominis腹直肌Posteriorgroup

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

腹股溝韌帶Lacunarligament

腔隙韌帶Superficialinguinalring

腹股溝淺環(huán)－triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercleObliquusinternusabdominis腹內(nèi)斜肌DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmediallyTransverselsabdominis

腹橫肌DeeptoobliquusinternusRectusabdominis腹直肌

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

腱劃lineasemiluaris

半月線(xiàn)

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

腹股溝管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinallig.BoundariesAntwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PostwallTransversefasciaInguinalflaxmediallyRoof－archedlowerfibersofobliquusinternusandtransversuaabdominisFloor－inguinallig．TwoopeningsSuperficialinguinalring腹股溝淺環(huán)Deepinguinalring腹股溝深環(huán)－defectintransversefascia1.5cmabovemidpointofinguinalligamentStructurespassingthroughtheinguinalcanalSpermaticcord

精索

andilioinguinalnerve髂腹股溝神經(jīng)

inmalesRoundligamentofuterus

子宮圓韌帶andilioinguinalnerve髂腹股溝神經(jīng)

infemales

InguinalTriangle(ofHesselbach)腹股溝三角

Boundaries

InguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterallyIndirectinguinalheiniaanddirecetinguinalheinia

Superficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

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

MedianormidlineincisionLeftparamedianincisionLayer?SuprapubicincisionAbdomen2山東大學(xué)醫(yī)學(xué)院解剖教研室李振華Abdominalaorta腹主動(dòng)脈ContinuationofthoracicaortaataortichiatusofdiaphragminfrontofT12TerminatesatlowerborderofL4vertebrabydividingintorightandleftcommoniliacarteriesParietalbranchesInferiorphrenica.

膈下動(dòng)脈(onepair)Lumbara.

腰動(dòng)脈(fourpairsofarteriesthatsupplytheposteriorabdominalwall)Mediansacrala.骶正中動(dòng)脈Unpairedbranches

Celiactrunk

腹腔干－ashortthickvesselthatarisesfromthefrontofaorta,atthelevelofT12Superiormesenterica.腸系膜上動(dòng)脈－arisesfromthefrontofaorta,atthelevelofL2Inferiormesenterica.腸系膜下動(dòng)脈－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髂內(nèi)靜脈Parietaltributaries:accompanywitharteriesVisceraltributaries

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

直腸靜脈叢 →analvein→internalpudendalv.②Vesicalvenousplexus膀胱靜脈叢→vesicalv.③Uterinevenousplexus子宮靜脈叢→uterinev.

Externaliliacvein

髂外靜脈–accompanythearteryCommoniliacvein

髂總靜脈–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacavaInferiorvenacava

下腔靜脈FormedbyunionoftwocommoniliacveinsanteriortoandjusttotherightofL4~L5Ascendsontherightsideofaorta,piercesvenacavaforamenofdiaphragmoppositetheT8anddrainsintotherightatriumConveysbloodfromthewholebodybelowthediaphragmtotherightatriumHepaticportalvein肝門(mén)靜脈

VariationandanomaliesofhepaticportalveinTributariesofhepaticportalvein

1.Superiormesentericv.腸系膜上靜脈2.Inferiormesentericv.腸系膜下靜脈3.Splenicv.脾靜脈4.Leftgastricv.胃左靜脈5.Rightgastricv.胃右靜脈6.Cysticv.膽囊靜脈7.Paraumbilicalv.附臍靜脈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－h(huán)as2-3splenicnotch脾切跡,whichserveasalandmarkonpalpationwhenitisenlarge;normallyitisnotpalpableInferior－rounderFunctions:thespleenisconsideredtobeimportantin:FormationoflymphocytesandmonocytePhagocytosisofbacteria,inertparticlesandwhitebloodcellsandplateletsDestroyingeffeteorabnormalredbloodcellsMakingantibodiesRalationshipsofspleenDiaphragmaticsurface－diaphragmVisceralsurfaceAnteriorly－fundusofstomachPosteriorly－leftsuprarenalglandandkidneyInferiorly－tailofpancreasandleftcolicflexureNerversofabdomenLumbarplexus腰叢Formation:formedbyanteriorramiofL1-L3,apartofanteriorramiofT12andL4Position:lieswithinsubstanceofpsoasmajorBranchesIliohypogastricn.髂腹下神經(jīng)SupplieslowerpartofanteriorabdominalwallIlioinguinaln.髂腹股溝神經(jīng)PassesthroughinguinalcanaltosupplyskinofthegroinandscrotumLateralfemoralcutaneous股外側(cè)皮神經(jīng)Femoraln.股神經(jīng)Obturator

n.

閉孔神經(jīng)Genitofemoraln.生殖股神經(jīng)Lumbarsympathetictrunk腰交感干MadeupofpairedchainswithfourtofivelumbargangliaanterolateraltovertebralcolumnEntersabdomenviathediaphragmandasacontinuationofhethoracicpartPassesinferiorlybehindcommoniliacvesselsandterminationsbyjoiningtoformunpairedganglionimpar,anteriortosacrumAbdomen3山東大學(xué)醫(yī)學(xué)院解剖教研室李振華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