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1、腹腔间隙影像解剖 Anatomy of the Peritoneal Spaces,2018/8/31,add footer here (go to view menu and choose header),2,主要内容,一、腹膜,皱襞,二、隐窝和陷凹,四、腹膜后间隙,8/31/2018,add footer here (go to view menu and choose header),3,网 膜,8/31/2018,add footer here (go to view menu and choose header),4,大网膜（Greater omentum）,连接于胃大弯及横结肠之间
2、，由四层腹膜返折而成，前两层由胃大弯及十二指肠上段前后壁浆膜延续而成，呈围裙状下垂，遮盖横结肠、空回肠前面，而后返折向上附着于横结肠前后壁浆膜层，成人前两层与后两层通常愈着，形成连接胃大弯及横结肠的胃结肠韧带 当腹腔发生感染时，炎性分泌物能刺激大网膜粘连包绕感染器官，限制炎症蔓延，局限感染范围，避免弥漫性腹膜炎；手术有时也将大网膜覆盖在肝的断面、胃穿孔缝合处、十二指肠断端，以促进其愈合。,8/31/2018,add footer here (go to view menu and choose header),5,胃结肠韧带,2018/8/31,add footer here (go to v
3、iew menu and choose header),6,小网膜（Lesser omentum）,分为左、右两部分，左侧部从膈、肝静脉韧带裂连于胃小弯，成为肝胃韧带；右侧部从肝门连于十二指肠上部，成为肝十二指肠韧带（内有进入肝门的三个重要结构，胆总管、肝固有动脉、门静脉） 小网膜右侧游离，其后方为网膜孔,2018/8/31,add footer here (go to view menu and choose header),7,系膜,2018/8/31,add footer here (go to view menu and choose header),8,肝的韧带,镰状韧带是双层腹膜结
4、构，联系肝脏与前腹壁及膈肌，镰状韧带在膈肌连接处向两侧分开包绕肝裸区，其左层向左延续为左冠状韧带上层，并继续延续为左三角韧带，其右层延续为右冠状韧带上层，并继续向右下延续为右三角韧带，右三角韧带下层越过下腔静脉形成小网膜右叶，然后在尾状叶前方呈半圆形绕过，左三角韧带下层延续为小网膜左叶 肝脏三处未被腹膜覆盖的区域肝裸区、胆囊床、肝门是与膈腹膜、小网膜及韧带连接处 肝胃韧带及肝十二指肠韧带,2018/8/31,add footer here (go to view menu and choose header),9,Ligaments of liver,2018/8/31,add footer
5、here (go to view menu and choose header),10,胃的韧带,肝胃韧带如前所述 胃脾韧带联系胃底和脾门的双层腹膜，其内包含胃短动脉及胃网膜左动脉 胃膈韧带由胃底后面连至膈下的双层腹膜结构，两层间相距较远，形成胃裸区 胃结肠韧带如前所述 胃胰韧带由胃幽门窦后壁至胰头、颈及颈与体的移行部的腹膜皱襞,2018/8/31,add footer here (go to view menu and choose header),11,Ligaments of stomach,Hepatogastric ligament 肝胃韧带 Gastrosplenic ligame
6、nt 胃脾韧带 Gastrophrenic ligament 胃膈韧带 Gastrocolic ligament 胃结肠韧带 Gastropancrestic ligament 胃胰韧带,2018/8/31,add footer here (go to view menu and choose header),12,脾的韧带,胃脾韧带如前所述 脾肾韧带是自脾门至左肾前面的双层腹膜结构，内含胰尾及脾血管、淋巴结构和神经丛等。 膈脾韧带由脾肾韧带向上延伸至膈，此韧带很短 脾结肠韧带位于脾前端和结肠左曲之间，此韧带也很短,2018/8/31,add footer here (go to view m
7、enu and choose header),13,Ligaments of spleen,Gastrosplenic ligament 胃脾韧带 Splenorenal ligament 脾肾韧带 Phrenicosplenic ligament 膈脾韧带 Splenocolic ligament 脾结肠韧带,2018/8/31,add footer here (go to view menu and choose header),14,皱 襞,胃胰襞和肝胰襞胃胰襞是胃左动脉从腹后壁走向胃小弯时形成的腹膜皱襞分隔网膜囊中间部及侧部肝胰襞是肝总动脉或肝固有动脉从腹后壁向前进入小网膜时所形成的腹
8、膜皱襞 十二指肠上、下襞,8/31/2018,add footer here (go to view menu and choose header),15,Folds and recesses of posterior abdominal wall,Superior duodenal fold and recess 十二指肠上襞和上隐窝 Inferior duodenal fold and recess 十二指肠下襞和下隐窝 Intersigmoid recess 乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon,8
9、/31/2018,add footer here (go to view menu and choose header),16,Retrocecal recess 盲肠后隐窝阑尾常位于其中 Hepatorenal recess 肝肾隐窝位于肝右后叶与右肾及结肠肝曲之间，是仰卧位腹腔最低点,8/31/2018,add footer here (go to view menu and choose header),17,Pouches In malerectovesical pouch 直肠膀胱陷窝 In female Rectouterine pouch 直肠子宫陷窝between rectum
10、 and uterus Vesicouterine pouch 膀胱子宫陷窝between bladder and uterus,为腹盆腔积液和肿瘤种植转移的好发部位,2018/8/31,add footer here (go to view menu and choose header),18,结肠上区（膈下间隙）,右膈下腹膜外间隙（肝裸区） 左膈下腹膜外间隙（胃裸区）,肝脏,左三角韧带,镰状韧带,肝圆韧带,胃及小网膜,肝周间隙相互沟通，其中小网膜分隔右肝下间隙和网膜囊，网膜囊仅借网膜孔（the foramen of Winslow）与腹腔交通,2018/8/31,add footer he
11、re (go to view menu and choose header),19,Perihepatic spaces,2018/8/31,add footer here (go to view menu and choose header),20,Perihepatic spaces,2018/8/31,add footer here (go to view menu and choose header),21,网膜囊借网膜孔与腹腔相通,境界：前方为肝十二指肠韧带，后方为覆盖下腔静脉的腹膜，上界为肝尾状叶，下界为十二指肠上部,网膜孔,2018/8/31,add footer here (g
12、o to view menu and choose header),22,网膜囊,位置：位于小网膜和胃的后方 境界：前壁由上而下依次为小网膜、胃后壁腹膜和大网膜前两层；下壁为大网膜前两层与后两层返折处；后壁由下而上依次为大网膜后两层、横结肠及其系膜、覆盖胰、左肾、左肾上腺的腹膜；上壁为膈下面的腹膜，此处肝尾状叶自右侧套入网膜囊内形成网膜囊上隐窝；左界为胃脾韧带、脾和脾肾韧带；右界为网膜孔,2018/8/31,add footer here (go to view menu and choose header),23,四部分：网膜孔所对的前庭部；胃胰襞以上为上隐窝，位于小网膜与膈之间，内有尾状叶
13、套入；沿胰体伸向左后上方达脾门部分为脾隐窝；下隐窝位于胃胰襞以下，在胃与胰及横结肠系膜之间。,2018/8/31,add footer here (go to view menu and choose header),24,1 = peritoneal reflection of cava forming roof of foramen of Winslow; 2= peritoneal reflection of cava adjacent to bare area of right hepatic lobe; 3 =medial segment of left inferior coron
14、ary ligament; 4 = peritoneum of ligamentum teres; 5 = gastrophrenic ligament; 6 = gastrosplenic ligament; 7 = splenorenal ligament; 8 = transverse mesocolon;,2018/8/31,add footer here (go to view menu and choose header),25,Lesser sac,CT scan shows fluid in the superior (*) and splenic (S) recesses o
15、f lesser sac outlining the gastropancreatic fold (arrowhead).,,Company Logo,26,肝裸区,于第一肝门以上平面，可见此间隙位于冠状韧带上、下层之间。“肝右后上间隙”是不存在的，由于肝裸区存在，腹腔积液不能到达脊柱旁，可与胸腔积液区别。,,Company Logo,27,肝周积液与胸腔积液鉴别,2018/8/31,add footer here (go to view menu and choose header),28,胃裸区 Bare area of stomach,是否侵犯胃裸区是胃癌预后的影响因素之一,2018/8
16、/31,add footer here (go to view menu and choose header),29,2018/8/31,add footer here (go to view menu and choose header),30,8/31/2018,add footer here (go to view menu and choose header),31,Infracolic compartments 结肠下区 位于横结肠及横结肠系膜以下 Right paracolic sulcus (gutter) 右结肠旁沟位于升结肠旁，是联系肝肾隐窝和盆腔的通路；感染可通过此途径传播，如膈下脓肿可经此沟流入右髂窝和盆腔，阑尾化脓时也可向上蔓延至肝下 Left paracolic sulcus (gutter) 左结肠旁沟位于降结肠旁，上缘由左膈结肠韧带（the phrenicocolic ligament）与结肠上区分隔, 因此左结肠旁沟积液只能向下流入盆腔,
