腹部解剖圖譜

Abdominalwall山東大學(xué)醫(yī)學(xué)院解剖教研室李振華腹部解剖圖譜Anteriorwall

Layers(fromsuperficialtodeep)SkinSuperficialfasciaAnterolateralmusclesTransversalisfascia腹橫筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜腹部解剖圖譜Superficialfascia－divisionsbelowumbilicusSuperficialfattylayer(Camper’s)Membranouslayer(Scarpa’s)腹部解剖圖譜

MusclesofabdomenAnterolateralgroupObliquusexternusabsominis腹外斜肌Oblequusenternusabdominis腹內(nèi)斜肌Transversusabdominis腹橫肌Rectusabdominis腹直肌腹部解剖圖譜Posteriorgroup

Quadiatuslumborum腰方肌Psoasmajor腰大肌腹部解剖圖譜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-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercle腹部解剖圖譜腹部解剖圖譜Obliquusinternusabdominis腹內(nèi)斜肌DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmedially腹部解剖圖譜Transverselsabdominis

腹橫肌Deeptoobliquusinternus腹部解剖圖譜Inguinalfalx腹股溝鐮:archoverspermaticcord,insertedwithtransversesabdominisfiberintomedialpartofpectenofpubisCremaster提睪肌:aroundthespermaticcordandtestis腹部解剖圖譜Rectusabdominis腹直肌

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

腱劃lineasemiluaris

半月線

腹部解剖圖譜SimilarfunctionsforabovefourpairsofmusclesSupportandcompresstheabdominalvisceraIncreaseintra-abdominalpressure,aidinexpulsiveefforts-vomiting,coughing,sneezing,defecation,urinationandchildbirth.Depressribs,assistin(theactofforce(4)expiration.Flex,lateralflex,androtatevertebralcolumn腹部解剖圖譜Sheathofrectusabdominis腹直肌鞘Antlayer－formedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisPostlayerFormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversesabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuatelineBelowthislinerectusabdominisincontactwithtransversefascia腹部解剖圖譜Lineaalba白線－tendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysis.腹部解剖圖譜Inguinalregion腹股溝區(qū)BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolaeralmarginofrectusabdominis腹部解剖圖譜DescentoftestesSeven-weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwall腹部解剖圖譜Fetusat28weekthetestispassingthroughtheinguinalcanal腹部解剖圖譜Newborn腹部解剖圖譜Inguinalcanal

腹股溝管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinallig.腹部解剖圖譜BoundariesAntwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)腹部解剖圖譜PostwallTransversefasciaInguinalflaxmediallyRoof－archedlowerfibersofobliquusinternusandtransversuaabdominisFloor－inguinallig．腹部解剖圖譜TwoopeningsSuperficialinguinalring腹股溝淺環(huán)Deepinguinalring腹股溝深環(huán)－defectintransversefascia1.5cmabovemidpointofinguinalligament腹部解剖圖譜StructurespassingthroughtheinguinalcanalSpermaticcord

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

腹部解剖圖譜InguinalTriangle(ofHesselbach)腹股溝三角

Boundaries

InguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterally腹部解剖圖譜Indirectinguinalheiniaanddirecetinguinalheinia

腹部解剖圖譜Superficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

Thoracoepigastricv.Superficialepigastricv.CutaneousnervesAnteriorandlateralcutaneousn.oflowersixthoracicIliohypogastricn.(firstlumbnerves)腹部解剖圖譜DeepvesselsandnervesArteresSuperiorandinferiorepigastricarterisLowerposteriorintercostala.Subcostala.Fourlumbara.腹部解剖圖譜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)腹部解剖圖譜SubcostalincisionMuscle-splittingincisionTransverseincision

MedianormidlineincisionLeftparamedianincisionLayer?Suprapubicincision腹部解剖圖譜Abdomen2山東大學(xué)醫(yī)學(xué)院解剖教研室李振華腹部解剖圖譜Abdominalaorta腹主動脈ContinuationofthoracicaortaataortichiatusofdiaphragminfrontofT12TerminatesatlowerborderofL4vertebrabydividingintorightandleftcommoniliacarteries腹部解剖圖譜ParietalbranchesInferiorphrenica.

膈下動脈(onepair)Lumbara.

腰動脈(fourpairsofarteriesthatsupplytheposteriorabdominalwall)Mediansacrala.骶正中動脈腹部解剖圖譜Visceralbranches

PairedbranchesMiddlesuprarenalartery腎上腺中動脈Renalartery腎動脈Testicular(ovarian)artery睪丸（卵巢）動脈腹部解剖圖譜Unpairedbranches

Celiactrunk

腹腔干－ashortthickvesselthatarisesfromthefrontofaorta,atthelevelofT12Superiormesenterica.腸系膜上動脈－arisesfromthefrontofaorta,atthelevelofL2Inferiormesenterica.腸系膜下動脈－arisesfromthefrontofaorta,atlevelofL3腹部解剖圖譜Leftgastrica.Commonhepatica.Splenica.Gastroduodenala.Properhepatica.Rightgastrica.LeftbranchRightbranchCystica.Shortgastrica.

Leftgastrioeploica.Rightgastroepiploica.Superiorpancreaticoduodenala.Splemicbranches

Celiactrunk

腹部解剖圖譜Celiactrunk

腹部解剖圖譜Superiormesenterica.

Inf.pancresticodudenala.Jejunalandileala.Ileocolica.Appendiculara.Rightcolica.Middlecolica.

SuperiorMesentericv.腹部解剖圖譜Inferiormesenterica.Leftcolica.Sigmoida.Superiorrectala.

Inferiormesentericv.腹部解剖圖譜Colicmarginalartery腹部解剖圖譜RelationsofabdominalaortaAnteriorly(fromabovedownward)PancreasAscendingpartofduodenumRadixofmesenteryPosteriorlyUpperfourlumbervertebraeOnitsrightInferiorvenacavaOnitsleftLeftsympathetictrunk腹部解剖圖譜VeinsofabdomenandpelvisInternaliliacvein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.腹部解剖圖譜

Externaliliacvein

髂外靜脈–accompanythearteryCommoniliacvein

髂總靜脈–formedbyunionofinternalandexternaliliacveinsinfrontofsacroiliacjoint,enduponL4~L5byunitingeachothertoforminferiorvenacava腹部解剖圖譜Inferiorvenacava

下腔靜脈FormedbyunionoftwocommoniliacveinsanteriortoandjusttotherightofL4~L5Ascendsontherightsideofaorta,piercesvenacavaforamenofdiaphragmoppositetheT8anddrainsintotherightatriumConveysbloodfromthewholebodybelowthediaphragmtotherightatrium腹部解剖圖譜ChieftributariesParietalPairedinferiorphrenicv.膈下靜脈pairedlumbarv.腰靜脈

(four)VisceralRightandleftrenalveins左、右腎靜脈Rightsuprarenalvein右腎上腺靜脈(leftdrainintoleftrenalvein) Righttesticularorovarianv右睪丸（卵巢）靜脈.(leftdrainintoleftrenalvein) Hepaticveins肝靜脈:right,leftandintermediate腹部解剖圖譜RelationsofinferiorvenacavaAnteriorly(craniallytocaudally)LiverHeadofpancreasHorizontalpartofduodenumRighttesticular(orovarian)a.RadixofmesenteryPosteriorlyRightcrusofdiaphragmUpperfourlumbervertebraeLeftsympathetictrunkParietalbranchesofabdominalaortaOnitsrightPsoasmajorRightkidneyRightsuprarenalglandOnitsleftAbdominalaorta腹部解剖圖譜Hepaticportalvein肝門靜脈

GeneralfeaturesFormedbehindtheneckofpancreasbytheunionofsuperiormesentericveinandsplenicveinAscendsupwardsandtotheright,posteriortothefirstpartofduodenumandthenentersthelesseromentumtotheportahepatis,whereitdividesintorightandleftbranchesTherearenofunctioningvalvesinhepaticportalsystemDrainsbloodfromgastrointestinaltractfromthelowerendofoesophagustotheupperendofanalcanal,pancreas,gallbladder,bileductsandspleen腹部解剖圖譜Variationandanomaliesofhepaticportalvein腹部解剖圖譜Tributariesofhepaticportalvein

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.附臍靜脈腹部解剖圖譜Portal-systemicanastomoses1.Atthelowerendoftheoesophagus

Hepaticportalvein→leftgastricvein→esophagealvenousplexus→esophagealvein→azygosvein→superiorvenacava2.Atrectalvenousplexus

Hepaticportalvein→splenicvein→inferiormesentericvein→superiorrectalvein→rectalvenousplexus→inferiorrectalandanalveins→internaliliacvein→inferiorvenacava3.AtperiumbilicalvenousplexusHepaticportalvein→paraumbilicalvein→periumbilicalvenousplexus→thoracoepigastricandsuperiorepigastricvein→superiorvenacavasuperficialepigastricandinferiorepigastricveins→inferiorvenacava腹部解剖圖譜4.Portal-retroperitonealanastomosis

Betweentheretroperitonealbranchesofthecolicveinsandthelumbarveins,pancreaticoduodenalveinswiththerenalveinsandthesubcapsularveinsoftheliverwiththephrenicveinstwigsofcolicveins(portal)anastomosingwithsystemicretroperitonealveins腹部解剖圖譜ThelymphaticdrainageofabdomenLymphaticdrainageofabdominalwallToaxillarylymphnodefromregionaboveumbilicusTosuperficialinguinallymphnodefromregionbelowumbilicusTolumbarlymphnodefrompostwallofabdomen腹部解剖圖譜LymphaticdrainageofabdominalvisceraLumbarlymphnodes腰淋巴結(jié)Lieonposteriorabdominalwall,alongtheabdominalaortaandinferiorvenacavaReceivelymphfromkidneys,suprarenalglands,testes,ovarirs,fundusofuterus,ovary,andcommoniliacnodesRightandleftlumbartrunksformedbyefferentvesselPairedviscera－draintothelumbarlymphnodes腹部解剖圖譜Celiaclymphnodes腹腔淋巴結(jié)－situatedaroundtheceliactrunkSuperiormesentericlymphnode腸系膜上淋巴結(jié)－situatedaroundsuperiormesenterica.Inferiormesentericlymphnode腸系膜下淋巴結(jié)－situatedaroundinferiormesenterica.Intestinaltrunk腹腔干－formedbyefferentvesselofceliac,superiorandinferiorlymphnodes腹部解剖圖譜Thoracicduct胸導(dǎo)管BeginsinfrontofL1asadilatedsac,thecisternachyli,whichformedbyjoiningofleftandrightlumbartrunksandintestinaltrunkEnterthoraciccavitybypassingthroughtheaortichiatusofthediaphragmandascendsalongonthefrontofthevertebralcolumn,betweenthoracicaortaandazygosveinTravelsupward,veeringtotheleftatthelevelofT5Attheroofoftheneck,itturnslaterallyandarchesforwardsanddescendstoentertheleftvenousangleJustbeforetermination,itreceivestheleftjugular,subclavianandbronchomediastinaltrunksDrainslymphfromlowerlimbs,pelviccavity,abdominalcavity,leftsideofthorax,andleftsideofthehead,neckandleftupperlimb腹部解剖圖譜Spleen脾Location:liesinthelefthypochondriacregion(betweenstomachanddiaphragm)deeptothe9thto11thrib,itslongaxiscorrespondsroughlytothe10thribShape－reddishincolour腹部解剖圖譜TwosurfacesDiaphragmatic:smooth,convexVisceral:concave,hilumofspleenTwoextremities

Anterior－widerPosterior－rounderTwoborder

Superior－h(huán)as2-3splenicnotch脾切跡,whichserveasalandmarkonpalpationwhenitisenlarge;normallyitisnotpalpableInferior－rounderFunctions:thespleenisconsideredtobeimportantin:FormationoflymphocytesandmonocytePhagocytosisofbacteria,inertparticlesandwhitebloodcellsandplateletsDestroyingeffeteorabnormalredbloodcellsMakingantibodies腹部解剖圖譜RalationshipsofspleenDiaphragmaticsurface－diaphragmVisceralsurfaceAnteriorly－fundusofstomachPosteriorly－leftsuprarenalglandandkidneyInferiorly－tailofpancreasandleftcolicflexure腹部解剖圖譜NerversofabdomenLumbarplexus腰叢Formation:formedbyanteriorramiofL1-L3,apartofanteriorramiofT12andL4Position:lieswithinsubstanceofpsoasmajor腹部解剖圖譜BranchesIliohypogastricn.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)腹部解剖圖譜Lumbarsympathetictrunk腰交感干MadeupofpairedchainswithfourtofivelumbargangliaanterolateraltovertebralcolumnEntersabdomenviathediaphragmandasacontinuationofhethoracicpartPassesinferiorlybehindcommoniliacvesselsandterminationsbyjoiningtoformunpairedganglionimpar,anteriortosacrum腹部解剖圖譜Abdomen3山東大學(xué)醫(yī)學(xué)院解剖教研室李振華腹部解剖圖譜Relationshipsofabdominalviscera

Firstlayer－live,gallbladder,stomachSecondlayer－duodenum,pancreas,spleenThirdlayer－suprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphatics腹部解剖圖譜

RelationshipsofthestomachAnterior:Live(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(leftlowerpart)Posterior－separatedbyperitonumoflessersacfromthefollowing(“stumach-bed”)PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversmesoclon腹部解剖圖譜ArteriesofstomachLeftandrightgastricarteriesarisefromceliactrunkandproperhepaticartery,repectively.Thesetwovesselsruninlesseromentumalonglessercurvature,andanastomoseend-to-end.腹部解剖圖譜Rightandleft

gastroepiploicarteriesarisefromthegastroduodenalandsplenicartery,repectively.Thesetwovesselspassintothegreateromentum,runparalleltothegreatercurvature,andanastomoseend-to-end.Shortgastricarteries,branchesofsplenicartery,coursethroughthegastrosplenicligamentandsupplythefundusofstomach.Posteriorgastricartery(72%)arisefromthesplenicartery,coursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach.腹部解剖圖譜VenousdrainageRightandleftgastricveinsemptydirectlyintohepaticportalvein.Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein.Rightgastroepiploicveinjoineithersuperiormesentericvein.腹部解剖圖譜LymphaticsofstomachRightandleftgastricln.liealongthesamevesselsandfinallytotheceliacln.Rightandleftgastroomentalln.liealongthesamevessels,theformerdrainintosubpyloricln.,thelatterdrainintosplinicln.Supra-andsubpyloricln.receivelymphaticsfrompyloricpartandfinallytotheceliacln.Splenicln.receivelymphaticsfromfundusandleftthirdofstomach,andfinallytotheceliacln.腹部解剖圖譜NervesupplyParasympatheticinnervationbyanterior(left)andposterior(right)vagaltrunksTheanteriortrunkdividesintoanteriorgastricandhepaticbranchesTheposteriortrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthrpyloricantrumtofanoutintobranchescalled“crow’sfoot”tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAffentandeffentfibersderivesfromthoracicsegments(T5－L1腹部解剖圖譜TheduodenumRelationshipsofsuperiorpart

AnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommombileductGastroduodenala.Hepaticportalv.InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreas腹部解剖圖譜RelationshipsofdescendingpartAnteriorlyLiveTransversecolonandmesocolonLoopsofsmallintestinePosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexure腹部解剖圖譜RelationshipsofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica.andv.PosteriorlyRightureterInferiorvenacavaAbdominalaorta腹部解剖圖譜RelationshipsofascendingpartRightHeadofpancreasandabdominalaortaLeftLeftkidneyandureter腹部解剖圖譜RelationshipsofliverDiaphragmaticsurface－separatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanteroly,gallbladderandsuperiorduodenalflexuremedially,rightkidney,superarenalglandposteriorly腹部解剖圖譜BloodsupplyArteriesSuperiorpancreaticoduodenala.Inferiorpancreaticoduodenala.Veins－followarteries,drainingdirectlyintosuperiormesentericandhepaticportalveins腹部解剖圖譜DivisionsandrelationsofcommonbileductSupraduodenalsegment

Descendsal