人體形態(tài)科學學習資料：PBL重點終結(jié)版

PBL重點考點----99K82B138211朱浩Case11.McBureny’spoint麥氏點Thesurfaceprojectionoftherootofappendixisthelateral1/3pointofthelinebetweenumbilicus臍andtherightanteriorsuperioriliacspine.右髂前上棘臍右髂前上棘在臍至右髂前上棘連線的中外1/3交界處。2.麥氏切口Atthelateral1/3pointofthelinebetweenumbilicusandtherightanteriorsuperioriliacspine,maketheincisionwhichisperpendiculartothisline.About5to7cmlong.從臍到右髂前上棘連線的中外1/3處，所作的垂直于此線的切口，長約5到7厘米3.WhichlayerswillyoumeetwhenyouchoosetheMcBureny’sincision?闌尾交錯切口所經(jīng)過的層次(1)skin皮膚(2)superficialfascia淺筋膜(3)aponeurosisofexternalabdominalobliquemuscle腹外斜肌腱膜(4)obliquusinternusabdominis腹內(nèi)斜肌(5)transversusabdominis腹橫肌(6)transversalisfasciaortransversefascia腹橫筋膜(7)extraperitonealfascia腹膜外筋膜(8)parietalperitoneum壁腹膜4.Duringtheoperation,howtofindvermiformappendix?如何在手術(shù)中尋找闌尾Firstfindcecum盲腸intherightiliacfossa右髂窩,andthentrackdowntherootsofappendixalongwithcolicbandsofcecum.Namely,wecanputoutthewholeappendix.盲腸右髂窩先在右髂窩內(nèi)找到盲腸，再沿盲腸的結(jié)腸帶往下追蹤找到闌尾根部，即可將整條闌尾牽出。Case21.Recognizeanddefinetheinguinalregion?什么是腹股溝區(qū)？（P53）Thetriangleareasurroundedbythelateralborderofrectusabdominis,Theinguinalligamentandthehorizontallinefromanterioriliacspinetothelateralborderofrectusabdominis.Itisaweakregionofabdominalwall.腹腹股溝區(qū)為下腹部兩側(cè)的三角形區(qū)域，其內(nèi)界是腹直肌的外緣，上界為髂前上棘至腹直肌外緣的水平線，下界為腹股溝韌帶。是腹膜的薄弱部位。2.Recognizeanddefinetheinguinaltriangle(Hesselbanch’sTriangle)?.什么是腹股溝三角（海氏三角）？Thetriangleareasurroundedbyinferiorepigastricartery腹壁下動脈,inguinalligament腹股溝韌帶andthelateralborderoftherectusabdominis腹直肌.腹壁下動脈腹股溝韌帶腹直肌腹壁下動脈與腹股溝韌帶及同側(cè)腹直肌外緣圍成的三角形區(qū)域。3.The4wallsand2openingsofinguinalcanal腹股溝管四壁兩口Fourwalls:1).thesuperiorwall（上壁）:thearcuatelateralbordermadebytheobliquusinternusabdominis腹內(nèi)斜肌andthetransversesabdominis腹橫肌腹內(nèi)斜肌腹橫肌上壁為腹內(nèi)斜肌和腹橫肌的弓形下緣2).theinferiorwall（下壁）:isformedbyinguinalligament腹股溝韌帶腹股溝韌帶下壁為腹股溝韌帶3).theanteriorwall（前壁）:aponeurosisoftheobliquusexternusabdominis腹外斜肌腱膜andlaterallyisreinforcedbymusclefibersofobliquusinternusabdominis腹內(nèi)斜肌inthedeeplayercuttheouter1/3ofthecanal.腹外斜肌腱膜腹內(nèi)斜肌前壁為腹外斜肌腱膜，其外1/3份有腹內(nèi)斜肌參與構(gòu)成。4).theposteriorwall（后壁）:transversalisfascia腹橫筋膜,腹橫筋膜Twoopenings:Thedeepinguinalring腹股溝深環(huán)Thesuperficialinguinalring腹股溝淺環(huán)2.Howtodistinguishthedirectandindirecthernia?如何鑒別直疝和斜疝？p56indirecthernia斜疝directhernia直疝Positonthedeepinguinalring腹股溝深環(huán)theinguinaltriangle腹股溝三角inferiorepigastricartery腹壁下動脈fromoutsidefrominsideperitonealfossa腹膜窩fromlateralinguinalfossa

腹股溝外側(cè)窩frommedialinguinalfossa腹股溝內(nèi)側(cè)窩DirectionfromhighoutsidetolowinsideanteriorAnswer1: Youcanalsopushtheabdominalcontentsbackintotheabdominalcavityandthenpressthedeepringontheconditionthattheabdominalpressureisincreased.Iftheherniaappearedagain,thenwecanconcludethatitisdirectinguinalhernia,oritwillbeindirectinguinalhernia.也可以把腹腔內(nèi)容物推回到腹腔,然后在腹部壓力增大的條件下按深環(huán)，如果疝氣再次出現(xiàn)，可以下結(jié)論是直疝，否則是斜疝。Answer2:Indirecthernia:herniasacneckgoesthroughdeepinguinalringthengoesmedialanddownwardthroughinguinalcanal,andfinallydropsoutfromsuperficialinguinalring.Theherniasacneckcanevendropintoscrotum陰囊.陰囊斜疝：疝囊腹壁下動脈外側(cè)的腹股溝深環(huán)突出，向內(nèi)，向前斜行經(jīng)過腹股溝管，在穿出腹股溝管淺環(huán)，并可以進入陰囊，稱為腹股溝斜疝。Directhernia:herniasacneckdropsoutdirectlyfromtheinguinaltriangle腹股溝三角，anditdoesn’tgothroughinternalringordropintoscrotum.腹股溝三角直疝：疝囊經(jīng)腹壁下動脈的腹股溝三角區(qū)由后向前突出，不經(jīng)過內(nèi)環(huán)，也不進入陰囊，為腹股溝直疝。Inaword,directherniadoesn’tgothroughinguinalcanalandtheindirectherniaismorelikelytohappenonthemalesthanthefemales.Directherniahappensjustdirectlythroughtheweaknessofepigastricandatthemedialofinferiorepigastricartery腹壁下動脈.Theindirectherniahappensmorelikelyonoldmentoo.腹壁下動脈直疝不經(jīng)過腹股溝管，斜疝男性多于女性，直疝為有腹壁的薄弱部位直接向前突出，位于腹壁下動脈的內(nèi)側(cè)，斜疝老年人多見。Case31. Whicharteriessupplythestomach?胃的血供leftgastricartery胃左動脈rightgastricartery胃右動脈rightgastroepiploicartery胃網(wǎng)膜右動脈leftgastroepiploicartery胃網(wǎng)膜左動脈shortgastricartery胃短動脈posteriorgastricartery胃后動脈2.omentalbursa網(wǎng)膜囊，epiploicforamen網(wǎng)膜孔（概念）Theomentalbursaisanarrowandirregularspacethatexistsbetweenthestomachandtheposteriorwalloftheabdominalcavity.網(wǎng)膜囊是小網(wǎng)膜和胃后壁與腹后壁的腹膜之間的一個偏窄而不規(guī)則的間隙。Theboundariesoftheomentalbursaareasfollows:網(wǎng)膜囊的邊界superior（上壁）:caudatelobeofliver肝尾狀葉ventral:thestomachposterior（后壁）:posteriorabdominalwallinferior（下壁）:theduodenumepiploicforamen網(wǎng)膜孔:Theonlywaytoperitonealsacandperitonealcavity.腹膜囊與腹膜腔的唯一通道。3.迷走神經(jīng)切除術(shù)的解剖基礎Parietalcells’excessivesecretionofgastricacidisthemainreasonforgastriculcerandduodenalulcer.Highlyselectivevagotomycancutoffthebranchesofvagusnerveongastricbody,lessercurvatureandfundus,reducingthesecretionofacidofparetalcells.Meanwhile,highlyselectivevagotomypreservetheliverbranch,abdominalbranch,andthe"RavenClaw"-shapedbranchoftheanteriorandposteriorgastricbranch.Thus,itcanpreserveemptyingfunctionofstomachandavoiddysfunctionofliver,gallbladder,pancreasandintestines.壁細胞分泌的胃酸過多是引起胃、十二指腸潰瘍的主要原因。高選擇性迷走神經(jīng)切斷術(shù)切斷迷走神經(jīng)至胃體、胃小彎和胃底的分支，降低了壁細胞的泌酸功能，達到治療潰瘍的目的，同時，高選擇性迷走神經(jīng)切斷術(shù)保留肝支、腹腔支和胃前、后支的“鴉爪”形分支，從而保留胃的排空功能，避免肝、膽、胰、腸的功能障礙。）Case41.門靜脈吻合支(1)esophagealvenousofloweresophagus食管下段靜脈叢(2)rectalvenousplexus直腸靜脈叢(3)venousnetworkaroundumbilic臍周靜脈網(wǎng)(4)RetziusveinRetzius靜脈Case51.Thethreenarrowingsitesoftheureters.輸尿管的三個狹窄(1)thepelviuretericjunction(腎盂輸尿管移行處)d=0.2cm(2)crossingthepelvicbrim(跨越髂血管處)d=0.3cm(3)traversingthebladderwall(進入膀胱壁內(nèi))depands2.HowtolocatetheureterintheX-ray?影像學中如何定位輸尿管？YoucanfindthatthereisashadowwithhighdensityinfrontofthetransverseprocessofL3andL4.Thepathoftheureteristhelinemakesbetweenthe2points.Weusuallycant’tfindtheureterintheX-