腹部解剖經(jīng)典圖演示文稿

腹部解剖經(jīng)典圖演示文稿當前1頁，總共83頁。優(yōu)選腹部解剖經(jīng)典圖當前2頁，總共83頁。主要內(nèi)容MainContent境界與分區(qū)Theboundaryandregion表面解剖Thesurfaceanatomy腹前外側(cè)壁TheAnterolateralAbdominalWall當前3頁，總共83頁。一、境界與分區(qū)

BoundaryandRegion當前4頁，總共83頁。1.腹部的境界上界：為胸廓下口，即劍突、肋弓、第11肋前端、第12肋下緣和第12胸椎圍成；下界：為恥骨聯(lián)合上緣、恥骨嵴、恥骨結(jié)節(jié)、腹股溝韌帶、髂嵴至第5腰椎下緣的連線。當前5頁，總共83頁。2.(固有)腹腔的境界上界：膈下界：骨盆上口當前6頁，總共83頁。3A.腹部的分區(qū)(九分法)當前7頁，總共83頁。3B.腹部的分區(qū)(四分法)當前8頁，總共83頁。二、表面解剖

TheSurfaceAnatomy體表標志Surfacelandmark表面投影Surfaceprojection當前9頁，總共83頁。Xiphoidprocess劍突Costalarch肋弓Iliaccrest髂嵴Anteriorsuperioriliacspine髂前上棘Pubictubercle恥骨結(jié)節(jié)Superioredgeofpubicsymphysis恥骨聯(lián)合上緣Pubiccrest恥骨嵴1.骨性標志當前10頁，總共83頁。2.軟組織標志Locationofinguinalligament當前11頁，總共83頁。3.體表投影當前12頁，總共83頁。三、腹前外側(cè)壁

TheAnterolateralAbdominalWall淺層結(jié)構(gòu)Superficialstructures深層結(jié)構(gòu)Deepstructures當前13頁，總共83頁。皮膚淺筋膜腹膜下筋膜深筋膜和肌肉Thelayersoftheanterolateralabdominalwall1.Skin2.Superficialfascia3.Deepfasciaandmuscles4.Transversefascia5.Extraperitonealfascia6.Parietalfascia腹橫筋膜壁腹膜當前14頁，總共83頁。（一）淺層結(jié)構(gòu)

Thesuperficialstructures皮膚Skin淺筋膜Superficialfascia當前15頁，總共83頁。1.Skin:thinnerandmoreelastic薄而富有彈性當前16頁，總共83頁。2.Superficialfascia：主要由脂肪和疏松結(jié)締組織組成。Camper筋膜在腹壁下部（約在臍平面以下），淺筋膜分為兩層：淺層稱為Camper`sfascia,含有豐富的脂肪組織，又稱脂肪層，向下與股部的淺筋膜相互延續(xù)；當前17頁，總共83頁。深層稱為Scarpa`fascia，是富有彈性纖維的膜性層，在中線附于白線，向下在腹股溝下方約一橫指處，緊附于股部的深筋膜，在恥骨結(jié)節(jié)之間，越過恥骨聯(lián)合向下至會陰，與會陰淺筋膜（Colles筋膜）相延續(xù)。Scarpa筋膜當前18頁，總共83頁。淺

筋

膜SkinSuperficialfasica

Scarpa’sfasciaMusclesofanteriorabdominalCamper’sfasciaTransversalisfasciawall當前19頁，總共83頁。2.Superficial

fasciaSuperficial

fasciaconsistsofalayerofconnectivetissuethatcontainsavariableamountoffat.Abovethelevelofumbilicus,itisafattylayer.Intheinferiorpartoftheanterolateralwall,thesubcutaneoustissueiscomposedoftwolayers,thefattyouterlayer,knownasCamper`sfascia,andthemembranousinnerlayer,theScarpa`fascia.TheScarpa`fascia:1)isattachedtolineaalbamedially.2)continusedownwardscrosstheinguinalligamenttoblendwiththefascialataofthethighabout1.5cmbelowtheinguinalligament.3)iscontinuouswiththesuperficialfasciaoftheperineum(Colles’fascia).當前20頁，總共83頁。淺動脈、淺靜脈、皮神經(jīng)當前21頁，總共83頁。髂腹股溝區(qū)和下腹部的皮瓣Theilioinguinalandthelowerabdominalflaps當前22頁，總共83頁。（二）深層結(jié)構(gòu)

TheDeepStructures肌肉層次Muscularlayer血管、淋巴及神經(jīng)Vessels,lymphandnerve腹橫筋膜Transversalisfascia腹膜下筋膜Extraperitonealfascia壁腹膜Parietalperitoneum當前23頁，總共83頁。1.肌層

TheMuscularlayer前外側(cè)群TheAnterolateralGroupThethreeflatmusclesarethe:腹外斜肌externalobliquemuscle腹內(nèi)斜肌internalobliquemuscle腹橫肌transversusabdominis：腹直肌rectusabdominis錐狀肌pyramidalis當前24頁，總共83頁。（1）腹外斜肌externalobliquemuscle

腹股溝管皮下環(huán)superficialinguinalring:內(nèi)側(cè)腳medialcrus、外側(cè)腳lateralcrus、腳間纖維intercruralfibers.腹外斜肌Externaloblique腹外斜肌腱膜Externaloblique，aponeurosisIntercruralfibersMedialcrus當前25頁，總共83頁。腹股溝管皮下環(huán)superficialinguinalring:內(nèi)側(cè)腳medialcrus、外側(cè)腳lateralcrus、腳間纖維intercruralfibers.返轉(zhuǎn)韌帶reflectedligament、腹股溝韌帶inguinalligament、腔隙韌帶lacunarligament、恥骨梳韌帶pectinealligament當前26頁，總共83頁。腹股溝韌帶inguinalligament、腔隙韌帶lacunarligament、恥骨梳韌帶pectinealligament當前27頁，總共83頁。（2）腹內(nèi)斜肌及其腱膜internalobliquemuscle&aponeurosis

：參與構(gòu)成腹直肌鞘前、后層，結(jié)合腱和提睪肌。InternalobliquemuscleInternalobliquem.aponeurosis當前28頁，總共83頁。Transversusabdominis,aponeurosisTransversusabdominis（3）腹橫肌及其腱膜transversusmuscle&aponeurosis：參與構(gòu)成腹直肌鞘前層（弓狀線以下）、后層（弓狀線以上），結(jié)合腱和提睪肌。當前29頁，總共83頁?！钐岵G肌Cremastermuscle☆腹股溝鐮Inquinalfalx聯(lián)合腱Conjoinedtendon☆腹橫肌下緣

腹內(nèi)斜肌及其腱膜和腹橫肌及其腱膜形成的結(jié)構(gòu)

當前30頁，總共83頁。Rectussheath,posteriorlayer腱劃tendinousintersectionsRectusabdominis弓狀線ArcuatelinePyramidalm.（4）腹直肌rectusabdominis（5）錐狀肌pyramidalmuscletendinousintersectionsRectussheath,anteriorlayer當前31頁，總共83頁。腹直肌鞘

當前32頁，總共83頁。☆腹直肌鞘rectussheath當前33頁，總共83頁?！罡怪奔∏蔙ectussheath腹直肌鞘包繞腹直肌，由腹外側(cè)壁三個扁肌的腱膜構(gòu)成，分為前、后兩層。在弓狀線以上：腹直肌鞘前層anteriorlayeroftherectussheath由腹外斜肌腱膜和腹內(nèi)斜肌腱膜前層構(gòu)成；腹直肌鞘后層posteriorlayeroftherectussheath由腹內(nèi)斜肌腱膜的后層和腹橫肌腱膜構(gòu)成。在弓狀線以下：腹直肌鞘前層由三個扁肌的腱膜構(gòu)成；腹直肌鞘后層缺如。當前34頁，總共83頁。2.血管、淋巴及神經(jīng)

Vessels,LymphandNerve當前35頁，總共83頁。(1)動脈當前36頁，總共83頁。當前37頁，總共83頁。(2)靜脈當前38頁，總共83頁。(3)神經(jīng)當前39頁，總共83頁。3.腹橫筋膜Transversalis

Fascia當前40頁，總共83頁。腹橫筋膜Transversefascia精索內(nèi)筋膜internalspermaticfascia當前41頁，總共83頁。腹股溝深環(huán)deepinguinalring窩間韌帶interfoveolarligament腹橫筋膜Transversefascia當前42頁，總共83頁。腹前壁內(nèi)面的皺襞及凹窩4.壁腹膜Parietalperitoneum當前43頁，總共83頁。5.腹前壁手術常用切口ThoracoabdominalincisionSuperiormedianincisionTransrectusincisionPararectusincisionParamedianincision當前44頁，總共83頁。SubcostalincisionSuperiortransverseincisionMcBurney’sincisionInferiormedianincisionInferiortransverseincision當前45頁，總共83頁。AbovethearcuatelineBelowthearcuateline當前46頁，總共83頁。四、腹股溝區(qū)

TheInguinalRegion境界Theboundary層次與特點Thelayersandcharacteristics腹股溝管Theinguinalcanal腹股溝三角Theinguinaltriangle疝hernias：腹股溝直疝D(zhuǎn)irectinguinalhernias、腹股溝斜疝indirectinguinalhernias、股疝femoralhernias當前47頁，總共83頁。（一）境界Boundary1.皮膚skin2.淺筋膜superficialfascia3.腹外斜肌aponeurosisofexternalobliquusabdominis（二）腹股溝區(qū)層次結(jié)構(gòu)TheLayersoftheInguinalRegion當前48頁，總共83頁。4.髂腹下神經(jīng)Iliohypogastricn.和髂腹股溝神經(jīng)ilioinguinaln.5.腹內(nèi)斜肌Obliquusinternusabdominis6.腹橫肌Transversusabdominis（二）腹股溝區(qū)層次結(jié)構(gòu)

TheLayersoftheInguinalRegion當前49頁，總共83頁。7.腹橫筋膜Transversefascia8.腹膜外筋膜Extraperitonealfascia9.腹璧下動脈Inferiorepigastrica.and旋髂深動脈deepcircumflexiliaca.10.璧腹膜Parietalperitoneum特點：①腹外斜肌在此區(qū)移行為腱膜，并在下部形成一裂口(淺環(huán))；②腹內(nèi)斜肌與腹橫肌的下緣未達腹股溝韌帶的內(nèi)側(cè)部，兩者間無肌層覆蓋；③有精索或子宮圓韌帶通過，形成了一潛在性裂隙；④在人體站立時，該區(qū)所承受的腹內(nèi)壓力比平臥時高3倍。因此，腹股溝區(qū)為腹壁的薄弱區(qū)，是腹壁疝的多發(fā)部位。當前50頁，總共83頁。（三）腹股溝管

Theinguinalcanal位置Position通過的結(jié)構(gòu)Structurespassingthroughit兩口、四璧Twoopeningandfourwalls精索Formingofthespermaticcord腹股溝斜疝Indirectinguinalhernia當前51頁，總共83頁。（三）腹股溝管InguinalCanal1.位置2.內(nèi)容3.構(gòu)成4.臨床意義當前52頁，總共83頁。

Theinguinalcanalisanoblique,inferomediallypassage(betweenthesuperficialanddeepinguinialrings)throughtheinferiorpartoftheanteriorabdominalwall),3~5cmlong.

Theinguinalcanalliesparallelandjustsuperiortothemedialhalfoftheinguinalligament.Themainoccupantoftheinguinalcanalisthespermaticcordinmalesandtheroundligamentoftheuterusinfemales.Italsocontainsbloodandlymphaticvesselsandtheilioinguinalnerveinbothsexes.當前53頁，總共83頁。當前54頁，總共83頁。Thedeep(internal)inguinalring,entrancetoinguinalcanal,isanoutpouchingofthetransversalisfasciaapproximately1.25cmsuperiortothemiddleoftheinguinalligamentandlateraltotheinferiorepigastricvessels.Theanteriorwalloftheinguinalcanalisformedbytheexternalobliqueaponeurosisthroughoutthelengthofthecanal,withtheanteriorwallofthelateralpartofthecanalbeingreinforcedbyfibersofinternusoblique.

Theposteriorwall

oftheinguinalcanalisformedbythetransversalisfasciawiththeposteriorwallofthemedialpartofthecanalbeingreinforcedtheconjointtendon.Roof(superiorwall)isformedbythearchingfibersoftheinternalobliqueandtransverseabdominalmuscles.Floor(inferiorwall)isformedbytheinguinalligament.Thesuperficial(external)inguinalring-exitfrominguinalcanal-isaslitlikeopeningbetweenthediagonalfibersoftheaponeurosisfotheexternaloblique,superolateraltothepubictubercle.當前55頁，總共83頁。腹股溝三角InguinalTriangle（海氏三角Hesselbach’striangle）①構(gòu)成：腹壁下動脈、腹直肌外側(cè)緣和腹股溝韌帶內(nèi)側(cè)半所圍成的三角形區(qū)域。②臨床意義：由腹股溝三角突出的疝，稱腹股溝直疝。當前56頁，總共83頁。腹股溝三角腹股溝直疝、腹股溝斜疝、股疝當前57頁，總共83頁。IndirectHerniaDirectHernia股疝femoralhernia當前58頁，總共83頁。睪丸下降過程當前59頁，總共83頁。卵巢下降過程當前60頁，總共83頁。睪丸下降過程descendingprocessofthetestis當前61頁，總共83頁。

先天性腹股溝斜疝Acongenitalindirectinguinalhernia后天性腹股溝斜疝

Aacquiredindirectinguinalhernia當前62頁，總共83頁。

先天性腹股溝斜疝Acongenitalindirectinguinalhernia后天性腹股溝斜疝

Aacquiredindirectinguinalhernia當前63頁，總共83頁。精索的被膜與腹前外側(cè)壁層次的關系當前64頁，總共83頁。精索或睪丸被膜與腹前外側(cè)壁層次的關系當前65頁，總共83頁。解剖與觀察

DissectionandObservation淺層結(jié)構(gòu)superficialstructures三層闊肌、血管和神經(jīng)Threeflatmuscles,vesselsandnerves腹直肌rectusabdominis腹直肌rectussheath腹股溝區(qū)inguinalregion腹股溝管inguinalcanal腹股溝三角inguinaltriangle當前66頁，總共83頁。1.切口Incision當前67頁，總共83頁。2.將皮瓣翻向外側(cè)reflectskinflapslaterally.

當前68頁，總共83頁。3.

Identifythefattylayerofthesuperificialfascia.當前69頁，總共83頁。4.Identifythesuperficialepigastricvessels.當前70頁，總共83頁。5.Removethesuperficialfascia.當前71頁，總共83頁。6.Identifythemembranouslayerofthesuperficialfascia.當前72頁，總共83頁。7.Identifyseveralanteriorcutaneousbranchesofthelowestfiveintercostalnerves(T7~T11)andthesubcostalnerve(T12).當前73頁，總共83頁。8.Identifytheterminalbranchesoftheiliohypogastricnerve(L1)andtheilioinguinalnerve(L1).當前74頁，總共83頁。9.Removedeepinvestingcoveringtheexternalabdominalobliquemuscle.10.Identifythedirectionofthefibersandtheaponeurosisoftheexternalabdominalobliquemuscle.當前75頁，總共83頁。11.Identifytheinguinalligament,thesuperficialinguinalring,themedialcrus,thelateralcrusandtheintercruralfibers.當前76頁，總共83頁。12.Reflecttheexternalabdominalobliqueandexposeth