上腹部臟器解剖腹膜和胃new

1、主講：許杰華主講：許杰華e-mail: 西安交通大學(xué)醫(yī)學(xué)院西安交通大學(xué)醫(yī)學(xué)院人體解剖與組織胚胎學(xué)系人體解剖與組織胚胎學(xué)系the introduction of the peritoneumudefinition the peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavitiesusubdivisions and peritoneal cavity parietal perito

2、neum 壁腹壁腹膜膜 lines the walls of the abdominal and pelvic cavities visceral peritoneum 臟腹臟腹膜膜 covers the organs peritoneal cavity 腹膜腔腹膜腔the potential space between the parietal and visceral layer of peritoneum. is there any organs in the peritoneal cavity?the peritonitis is very common for female!for

3、male, it is a closed sac. but for female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.ufunction secretes a lubricating serous fluid that continuously moistens the associated organs support and protect viscus semipermeable membrane (peritoneal dial

4、ysis) absorptionthe relationship between viscera and peritoneum intraperitoneal viscerainterperitoneal visceraretroperitoneal visceravintraperitoneal viscera 腹膜內(nèi)位器官腹膜內(nèi)位器官viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendi

5、x, transverse and sigmoid colons, spleen and ovaryvinterperitoneal viscera 腹膜間位器官腹膜間位器官most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colons, upper part of rectum, urinary bladder and uterusvretroperitoneal viscera 腹膜外位器官腹膜外位器官some organs lie on

6、the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureterstructures formed by peritoneum omentum 網(wǎng)膜網(wǎng)膜 the fold of peritoneum that e

7、xtends from two curvatures of stomach to adjacent organs l lesser omentum 小網(wǎng)膜小網(wǎng)膜 two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.l greater omentum 大網(wǎng)膜大網(wǎng)膜 four-layered fold of peritoneum, the anterior two layers descend from

8、 the greater curvature of stomach and inferior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. lesser omentumgreater omentummesenterium 系膜系膜two-layered fold of peritoneum that attach the abdominal or pelv

9、ic organs to the posterior abdominal wall. mesenteriuml mesentery 腸系膜腸系膜 suspends the small intestine from the posterior abdominal wallvbroad and a fan-shaped vintestinal borderfolded, 5-7 m longvradix of mesentery15 cm longdirected obliquely from left side of l2 to in front of right sacroiliac join

10、tlmesoappendix 闌尾闌尾系膜系膜vtriangular mesenteriumextends from terminal part of ileum to appendixvappendicular artery runs in free margin of the mesoappendix ltransverse mesocolon 橫結(jié)腸系橫結(jié)腸系膜膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal walllsigmoid mesocolon

11、乙狀結(jié)腸系膜乙狀結(jié)腸系膜inverted v-shaped, with apex located in front of left ureter and division of common iliac arteryligaments 韌帶韌帶 lligaments of liver vfalciform ligament of liver 鐮狀韌帶鐮狀韌帶consists of double peritoneal layer extends from anterior abdominal wall (umbilicus) to livefree border of ligament has

12、ligamentum teres vcoronary ligament 冠狀韌帶冠狀韌帶it is formed by the peritoneum between the diaphragm and the liver. there are left and right coronary ligamentvleft and right triangular ligaments 左、右三角韌帶左、右三角韌帶formed by the left and right extremity of coronary ligament ligament, respectivelyvhepatogastri

13、c ligament 肝胃韌帶肝胃韌帶vhepatoduodenal ligament 肝十二指肝十二指腸韌帶腸韌帶extends from porta hepatis to superior part of duodenumcontains common bile duct, proper hepatic a. and hepatic portal v.lligaments of spleenvgastrosplenic ligament 胃脾韌帶胃脾韌帶a double layer of peritoneum that connects the fundus of stomach to h

14、ilum of spleen. in this double layer of peritoneum, there are the short gastric and left gastroepiploic vesselsvsplenorenal ligament 脾腎韌帶脾腎韌帶extends between the hilum of spleen and anterior aspect of left kidney. the splenic vessels lies within this ligament, as well as the tail of pancreasvphrenico

15、splenic ligament 膈脾韌帶膈脾韌帶lligaments of stomach vhepatogastric ligament 肝胃韌帶肝胃韌帶vgastrosplenic ligament 胃脾韌帶胃脾韌帶vgastrophrenic ligament 胃膈韌帶胃膈韌帶vgastrocolic ligament 胃結(jié)腸韌帶胃結(jié)腸韌帶vgastropancrestic ligament 胃胰韌帶胃胰韌帶folds, recesses and fossa皺襞、隱窩和窩皺襞、隱窩和窩l superior duodenal fold and recess 十二指腸上襞和上隱窩十二指腸上

16、襞和上隱窩l inferior duodenal fold and recess 十二指腸下襞和下隱窩十二指腸下襞和下隱窩l intersigmoid recess 乙狀結(jié)腸間隱窩乙狀結(jié)腸間隱窩formed by the inverted v attachment of sigmoid mesocolon l hepatorenal recess 肝腎隱窩肝腎隱窩lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritonea

17、l cavity when the subject is supinel median umbilical fold 臍正中襞臍正中襞contain the remnant of urachus (median umbilical ligaments)l medial umbilical fold 臍內(nèi)側(cè)襞臍內(nèi)側(cè)襞contains remnants of the umbilical arteries (medial umbilical ligaments)l lateral umbilical fold 臍外側(cè)襞臍外側(cè)襞contains the inferior epigastric vess

18、elsl supravesical fossa 膀胱上窩膀胱上窩l medial inguinal fossa 腹股溝內(nèi)側(cè)窩腹股溝內(nèi)側(cè)窩l lateral inguinal fossa 腹股溝外側(cè)窩腹股溝外側(cè)窩pouches 陷窩陷窩l in malerectovesical pouch 直腸膀胱陷窩直腸膀胱陷窩l in female rectouterine pouch(douglas,cavity) 直腸子宮陷窩直腸子宮陷窩between rectum and uterus vesicouterine pouch 膀胱子宮陷窩膀胱子宮陷窩between bladder and uterus

19、 lomental bursa 網(wǎng)膜囊網(wǎng)膜囊positionsituated behind the lesser omentum and stomachwallsvsuperiorperitoneum which covers the caudate lobe of liver and diaphragmvanteriorformed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentumvinferiorconjunctive area of

20、anterior and posterior two layers of greater omentumvposteriorformed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland腹膜腔的分部腹膜腔的分部 the subdivision of the peritoneal cavity (two sacs)vleftformed by the

21、 spleen, gastrosplenic ligament胃脾韌帶胃脾韌帶 and splenorenal ligament 脾腎韌帶脾腎韌帶vrightformed by omental foramen omental foramen 網(wǎng)膜孔網(wǎng)膜孔vbehind the right border of hepatoduodenal ligamentvsuperiorcaudate lobe of liver vinferiorsuperior part of duodenumvanteriorhepatoduodenal ligamentvposteriorperitoneum cove

22、ring the inferior vena cava the omental bursa (lesser sac) communicates with the greater sac through the omental foramen. the subregions of the peritoneal cavityvthe transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments. 結(jié)腸結(jié)腸上區(qū)和結(jié)腸下區(qū)上區(qū)和結(jié)腸下

23、區(qū)supracolic compartment 結(jié)腸上區(qū)結(jié)腸上區(qū)(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon suprahepatic recess 肝上間肝上間隙隙 lies between the diaphragm and livethe falciform ligament divides it into right and left suprahepatic recessesvleft suprahepatic space 左肝上間隙左肝上間隙left an

24、terior suprahepatic spaceleft posterior suprahepatic spacevright suprahepatic space 右肝上間隙右肝上間隙vsubphrenic extraperitoneal space膈下腹膜外間隙膈下腹膜外間隙 (corresponding to the bare area of liver) infrahepatic space 肝下間隙肝下間隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres

25、hepatic divides it into right and left infrahepatic spacesvright infrahepatic space 右肝右肝下間隙下間隙 (hepatorenal recess)vleft infrahepatic spaces 左肝左肝下間隙下間隙 left anterior infrahepatic spaceleft posterior infrahepatic spaceinfracolic compartment 結(jié)腸下區(qū)結(jié)腸下區(qū) lies below the transverse colon and transverse meso

26、colon vright paracolic sulcus (gutter) 右結(jié)腸旁溝右結(jié)腸旁溝lies lateral to the ascending colon. it communicates with the hepatorenal recess and the pelvic cavity. it provides a route for the spread of infection between the pelvic and the upper abdominal region.vleft paracolic sulcus (gutter) 左結(jié)腸旁溝左結(jié)腸旁溝 lies l

27、ateral to the descending colon. it is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm.vright mesenteric sinus 右腸系膜竇右腸系膜竇triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolonvleft mesenteri