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1、.,1,局部解剖学（十四）,腹部的局部解剖与操作（1）,.,2,主要内容 Main Content,境 界 与 分 区 The boundary and region 表 面 解 剖 The surface anatomy 腹 前 外 侧 壁 The Anterolateral Abdominal Wall,.,3,一、境界与分区Boundary and Region,.,4,1. 腹部的境界,上界：为胸廓下口，即剑突、肋弓、第11肋前端、第12肋下缘和第12胸椎围成；,下界：为耻骨联合上缘、耻骨嵴、耻骨结节、腹股沟韧带、髂嵴至第5腰椎下缘的连线。,.,5,2. (固有)腹腔的境界,上界：膈
2、下界：骨盆上口,.,6,3A. 腹部的分区,(九分法),.,7,3B. 腹部的分区,(四分法),.,8,二、表 面 解 剖The Surface Anatomy,体表标志 Surface landmark 表面投影 Surface projection,.,9,Xiphoid process剑 突,Costal arch肋 弓,Iliac crest髂嵴,Anterior superior iliac spine 髂前上棘,Pubic tubercle 耻骨结节,Superior edge of pubic symphysis 耻骨联合上缘,Pubic crest 耻骨嵴,1.骨性标志,.,1
3、0,2. 软 组 织 标 志,Location of inguinal ligament,.,11,3.体表投影,.,12,三、腹 前 外 侧 壁The Anterolateral Abdominal Wall,浅层结构 Superficial structures 深层结构 Deep structures,.,13,皮肤,浅筋膜,腹膜下筋膜,深筋膜和肌肉,The layers of the anterolateral abdominal wall,1.Skin 2.Superficial fascia 3.Deep fascia and muscles 4.Transverse fascia
4、 5.Extraperitoneal fascia 6.Parietal fascia,腹横筋膜,壁腹膜,.,14,（一）浅 层 结 构The superficial structures,皮肤 Skin 浅筋膜 Superficial fascia,.,15,1. Skin: thinner and more elastic 薄而富有弹性,.,16,2. Superficial fascia：主要由脂肪和疏松结缔组织组成。,Camper 筋膜,在腹壁下部（约在脐平面以下），浅筋膜分为两层：浅层称为 Campers fascia,含有丰富的脂肪组织，又称脂肪层，向下与股部的浅筋膜相互延续；,.
5、,17,深层称为Scarpa fascia，是富有弹性纤维的膜性层，在中线附于白线，向下在腹股沟下方约一横指处，紧附于股部的深筋膜，在耻骨结节之间，越过耻骨联合向下至会阴，与会阴浅筋膜（Colles筋膜）相延续。,Scarpa 筋膜,.,18,浅 筋膜,Skin,Superficial fasica,Scarpas fascia,Muscles of anterior abdominal,Campers fascia,Transversalis fascia,wall,.,19,2. Superficial fascia,Superficial fascia consists of a lay
6、er of connective tissue that contains a variable amount of fat. Above the level of umbilicus, it is a fatty layer. In the inferior part of the anterolateral wall, the subcutaneous tissue is composed of two layers, the fatty outer layer, known as Campers fascia, and the membranous inner layer, the Sc
7、arpa fascia. The Scarpa fascia: 1) is attached to linea alba medially. 2) continuse downwards cross the inguinal ligament to blend with the fascia lata of the thigh about 1.5cm below the inguinal ligament. 3) is continuous with the superficial fascia of the perineum (Colles fascia).,.,20,浅动脉、浅静脉、皮神经
8、,.,21,髂腹股沟区和下腹部的皮瓣 The ilioinguinal and the lower abdominal flaps,.,22,（二）深层结构 The Deep Structures,肌肉层次 Muscular layer 血管、淋巴及神经 Vessels, lymph and nerve 腹横筋膜 Transversalis fascia 腹膜下筋膜 Extraperitoneal fascia 壁腹膜 Parietal peritoneum,.,23,1. 肌层 The Muscular layer,前外侧群 The Anterolateral Group The three
9、 flat muscles are the: 腹外斜肌 external oblique muscle 腹内斜肌 internal oblique muscle 腹横肌 transversus abdominis： 腹直肌 rectus abdominis 锥状肌 pyramidalis,.,24,（1）腹外斜肌 external oblique muscle,腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral crus、脚间纤维intercrural fibers.,腹外斜肌 External oblique,腹外斜肌腱膜
10、External oblique，aponeurosis,Intercrural fibers,Medial crus,.,25,腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral crus、脚间纤维intercrural fibers.,返转韧带reflected ligament、腹股沟韧带inguinal ligament、腔隙韧带lacunar ligament、耻骨梳韧带pectineal ligament,.,26,腹股沟韧带inguinal ligament、腔隙韧带lacunar ligament、耻骨梳韧带p
11、ectineal ligament,.,27,（2）腹内斜肌及其腱膜 internal oblique muscle & aponeurosis ：参与构成腹直肌鞘前、后层，结合腱 和提睾肌。,Internal oblique muscle,Internal oblique m. aponeurosis,.,28,Transversus abdominis, aponeurosis,Transversus abdominis,（3）腹横肌及其腱膜 transversus muscle & aponeurosis：参与构成腹直肌鞘前层（弓状线以下）、后层（弓状线以上） ，结合腱 和提睾肌。,.,
12、29,提睾肌 Cremaster muscle,腹股沟镰Inquinal falx 联合腱 Conjoined tendon,腹横肌下缘,腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构,.,30,Rectus sheath, posterior layer,腱 划 tendinous intersections,Rectus abdominis,弓状线 Arcuate line,Pyramidal m.,（4）腹直肌 rectus abdominis （5）锥状肌 pyramidal muscle,tendinous intersections,Rectus sheath, anterior la
13、yer,.,31,腹直肌鞘,.,32,腹直肌鞘 rectus sheath,.,33, 腹直肌鞘 Rectus sheath,腹直肌鞘包绕腹直肌，由腹外侧壁三个扁肌的腱膜构成，分为前、后两层。 在弓状线以上： 腹直肌鞘前层 anterior layer of the rectus sheath 由腹外斜肌腱膜和腹内斜肌腱膜前层构成； 腹直肌鞘后层 posterior layer of the rectus sheath 由腹内斜肌腱膜的后层和腹横肌腱膜构成。 在弓状线以下： 腹直肌鞘前层由三个扁肌的腱膜构成； 腹直肌鞘后层缺如。,.,34,2.血管、淋巴及神经Vessels, Lymph an
14、d Nerve,.,35,(1)动脉,.,36,.,37,(2)静脉,.,38,(3)神经,.,39,3.腹横筋膜,Transversalis Fascia,.,40,腹横筋膜 Transverse fascia,精索内筋膜internal spermatic fascia,.,41,腹股沟深环deep inguinal ring 窝间韧带 interfoveolar ligament,腹横筋膜 Transverse fascia,.,42,腹前壁内面的皱襞及凹窝,4. 壁腹膜 Parietal peritoneum,.,43,5. 腹前壁手术常用切口,Thoracoabdominal inc
15、ision,Superior median incision,Transrectus incision,Pararectus incision,Paramedian incision,.,44,Subcostal incision,Superior transverse incision,McBurneys incision,Inferior median incision,Inferior transverse incision,.,45,Above the arcuate line,Below the arcuate line,.,46,四、腹 股 沟 区The Inguinal Regi
16、on,境界 The boundary 层次与特点 The layers and characteristics 腹股沟管 The inguinal canal 腹股沟三角 The inguinal triangle 疝 hernias ：腹股沟直疝 Direct inguinal hernias 、腹股沟斜疝 indirect inguinal hernias、股疝 femoralhernias,.,47,（一）境界 Boundary,1. 皮肤 skin 2. 浅筋膜 superficial fascia 3. 腹外斜肌 aponeurosis of external obliquus abdominis,（二）腹股沟区层次结构 The La
