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1、Anterolateral Abdominal WallRegional anatomyThe Anterolateral Abdominal WallSuperficial structures 浅层结构浅层结构 Deep structures 深层结构深层结构皮肤皮肤浅筋膜浅筋膜腹膜下筋膜腹膜下筋膜 深筋膜和肌肉深筋膜和肌肉 The layers of the anterolateral abdominal wallThe layers of the anterolateral abdominal wall1.Skin2.Superficial fascia3.Deep fascia an
2、d muscles4.Transverse fascia5.Extraperitoneal fascia6.Parietal fascia腹横筋膜腹横筋膜 壁腹膜壁腹膜 .The superficial structures 浅层结构浅层结构Surface Features of SkinSuperficial fascia 浅筋膜浅筋膜Surface Features of the Abdomen Divisions below umbilicus（脐以下）Superficial fatty layer (Campers)Membranous layer (Scarpas)Superfici
3、al fasciaSuperficial vessels and cutaneous nerves Arteries Superficial epigastric a.Superficial iliac circumflex a.Veins Thoracoepigastric v.Superficial epigastric v.Cutaneous nervesAnterior and lateral cutaneous n. of lower six thoracic Iliohypogastric n. (first lumb nerves)浅动脉、浅静脉、皮神经浅动脉、浅静脉、皮神经Th
4、e ilioinguinal and the lower abdominal flaps髂腹股沟区和下腹部的皮瓣髂腹股沟区和下腹部的皮瓣.The Deep Structures 深层结构深层结构Muscular layer 肌层肌层 Vessels, lymph and nerve 血管、淋巴及神经血管、淋巴及神经 Transversalis fascia 腹横筋膜腹横筋膜 Extraperitoneal fascia 腹膜下筋膜腹膜下筋膜 Parietal peritoneum 壁腹膜壁腹膜 Muscles of abdomenAnterolateral groupobliquus exte
5、rnus abdominis 腹外斜肌腹外斜肌oblequus enternus abdominis 腹内斜肌腹内斜肌transversus abdominis 腹横肌腹横肌rectus abdominis 腹直肌腹直肌Posterior group Quadiatus lumborum 腰方肌腰方肌Psoas major 腰大肌腰大肌Obliquus externus absominis 腹外斜肌腹外斜肌General direction of fibers: downward, forward and medially (run down and inward)StructuresIngu
6、inal ligament 腹股沟韧带腹股沟韧带Lacunar ligament 腔隙韧带腔隙韧带pectineal ligament 耻骨梳韧带耻骨梳韧带Superficial inguinal ring 腹股沟浅环腹股沟浅环 triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercleInguinal ligamentLacunar ligamentSuperficial inguinal ringpectineal ligamentSuperficial inguin
7、al ringObliquus internus abdominis 腹内斜肌腹内斜肌Deep to obliquus externus abdominisGeneral direction of fibres: upwards, forwards and mediallyTransversels abdominis 腹横肌腹横肌Deep to obliquus internus inguinal ligamentinguinal ligament腹股沟韧带、腹股沟韧带、腹股沟韧带、腹股沟韧带、lacunar ligamentlacunar ligament腔隙韧带、腔隙韧带、腔隙韧带、腔隙韧
8、带、 pectineal ligamentpectineal ligament耻骨梳韧带耻骨梳韧带耻骨梳韧带耻骨梳韧带Inguinal falx 腹股沟镰腹股沟镰: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睾肌提睾肌: around the spermatic cord and testisInguinal falxRectus abdominis 腹直肌腹直肌Position: lie on to eit
9、her of midlineOrigin: pubic crest and symphysisInsertion: xiphoid and 5th-7th costal cartilagesHas 3-4 tendinous intersections 腱划腱划linea semiluaris 半月线半月线 arcuate line Linea alba 白线白线tendinous raphe between right and left recti from xiphoid to pubic symphysis.Linea albaDeep vessels and nervesArteres
10、 Superior and inferior epigastric arterisLower posterior intercostal a.Subcostal a.Four lumbar a. NervesIntercostal n.(6-11)Subcostal n.Nerves Iliohypogastric n. 髂腹下神经髂腹下神经Ilioinguinal n. 髂腹股沟神经髂腹股沟神经Genitofemoral n. 生殖股神经生殖股神经Regional anatomySheath of rectus abdominis 腹直肌鞘腹直肌鞘Ant layerformed by fus
11、ion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominisPost layerFormed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominisAbsent in about 4-5cm below the umbilicus, where aponeur
12、oses of all three muscles form anterior layer the lower free border named arcuate lineBelow this line rectus abdominis in contact with transverse fasciaarcuate lineThe Inguinal Region 腹股沟区腹股沟区Boundary 境界境界 Layers and characteristics 层次与特点层次与特点 Inguinal canal 腹股沟管腹股沟管Inguinal triangle 腹股沟三角腹股沟三角Herni
13、as 疝疝 ： Direct inguinal hernias 腹股沟直疝腹股沟直疝 Indirect inguinal hernias 腹股沟斜疝腹股沟斜疝 Femoralhernias 股疝股疝Inguinal region 腹股沟区腹股沟区Boundaries Inguinal ligament Lateral margin of rectus abdominisA horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominisInguinal canal 腹股沟管腹股沟管
14、Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal lig.BoundariesAnt wallAponeurosis of obliquus externus abdominisObliquus internus abdominis (lateral third of wall)Posterior wallTransverse fascia Inguinal flax mediallyRoofarched lower fibers of obliquus internus and t
15、ransversua abdominisFlooringuinal ligTwo openingsSuperficial inguinal ring 腹股沟浅环腹股沟浅环Deep inguinal ring 腹股沟深环腹股沟深环 defect in transverse fascia 1.5cm above midpoint of inguinal ligamentStructures passing through the inguinal canal Spermatic cord 精索精索 and ilioinguinal nerve髂腹股沟神经髂腹股沟神经 in males Round
16、ligament of uterus 子宫圆韧带子宫圆韧带and ilioinguinal nerve髂腹股沟神经髂腹股沟神经 in females Descent of testesSeven-week embryo showing the testis before its descent from the dorsal abdominal wallFetus at 28 week the testis passing through the inguinal canalNewborn Inguinal Triangle (of Hesselbach) 腹股沟三角腹股沟三角 Boundar
17、ies Inguinal ligament inferiorlyLateral border of rectus abdominis medially Inferior epigastric artery laterallyInguinal Triangle 腹股沟三角腹股沟三角 （Hesselbachs triangle 海氏三角海氏三角 ）构成：构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。临床意义：临床意义：由腹股沟三角突出的疝，称腹股沟直疝。由腹股沟三角突出的疝，称腹股沟直疝。腹腹股股沟沟三三角角腹腹股
18、股沟沟直直疝、疝、腹腹股股沟沟斜斜疝、疝、股股疝疝Indirect inguinal heinia and direcet inguinal heinia 斜疝斜疝Indirect inguinal ehinia直疝直疝Direcet heiniaHerniasHerniasHerniasSubcostal incision Muscle-splitting incisionTransverse incision Median or midline incisionLeft paramedian incisionLayer ?Suprapubic incisionThe peritoneumL
19、ing ShucaiRegional anatomyThe peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavitiesParietal peritoneum 壁腹膜壁腹膜 lines the walls of the abdominal and pelvic cavitiesVisceral peritoneum 脏腹膜脏腹膜 covers the organsPeritoneal
20、cavity 腹膜腔腹膜腔the potential space between the parietal and visceral layer of peritoneum, in the mail, is a closed sac, but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.General featuresFunctionSecretes a lubricating serous fluid that c
21、ontinuously moistens the associated organsAbsorbSupport visceraIntraperitoneal viscera 腹膜内位器官腹膜内位器官Interperitoneal viscera 腹膜间位器官腹膜间位器官Retroperitoneal viscera 腹膜外位器官腹膜外位器官Intraperitoneal visceraInterperitoneal visceraRetroperitoneal viscera.The relationship between viscera and peritoneumInterperiton
22、eal viscera 腹膜间位器官腹膜间位器官 The omentum 网膜网膜 The mesenteries and mesocolons 系膜系膜 The ligaments 韧带韧带 The peritoneal recesses, pouches, fossae and folds 隐窝和陷凹隐窝和陷凹. Formative formation by peritoneum two-layered fold of peritoneum that extends from stomach to adjacent organs pLessor omentum 小网膜小网膜pGreater
23、 omentum 大网膜大网膜Omentum 网膜网膜Lessor omentum 小网膜小网膜 Hepatogastric ligament 肝胃韧带肝胃韧带extends from porta hepatis to lesser curvature of stomach Hepatoduodenal ligament 肝十二指肠韧带肝十二指肠韧带Extends from porta hepatis to superior part of duodenumContains common bile duct, proper hepatic a. and hepatic portal v.Ome
24、ntal foramen 网膜孔网膜孔Behind the right border of hepatoduodenal ligamentSuperiorcaudate lobe of liver Inferiorsuperior part of duodenumAnteriorhepatodudenal ligamentPosteriorperitoneum covering the inferior vena cava Greater omentum 大网膜大网膜 four-layered fold of peritoneum, the anterior two layers descen
25、d from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. If an infection occurs in the intestine, plasma cells formed in the lymph nodes combat the infection an
26、d help prevent it from spreading to the peritoneum.Lessor omentumGreater omentumOmental bursa 网膜囊网膜囊Positionsituated behind the lesser omentum and stomachWallsSuperiorperitoneum which covers the caudate lobe of liver and diaphragmAnteriorformed by lesser omentum, peritoneum of posterior wall of stom
27、ach, and anterior two layers of greater omentumInferiorconjunctive area of anterior and posterior two layers of greater omentumPosteriorformed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal glandLeftform
28、ed by the spleen, gastrosplenic ligament胃脾韧带胃脾韧带 and splenorenal ligament 脾肾韧带脾肾韧带Rightformed by omental foramen The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen.Mesenteries or mesocolonstwo-layered fold of peritoneum that attach part of the intestines to
29、the posterior abdominal wall Mesentery 肠系膜肠系膜 suspends the small intestine from the posterior abdominal wallBroad and a fan-shaped Consists of two peritoneal layers Intestinal borderfolded, 7 m longRadix of mesentery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac jo
30、intThe mesenteries and mesocolons 系膜系膜Mesoappendix 阑尾系膜阑尾系膜Triangular mesenteryextends from terminal part of ileum to appendixAppendicular artery runs in free margin of the mesoappendix Transverse mesocolon 横结肠系膜横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior ab
31、dominal wallSigmoid mesocolon 乙状结肠系膜乙状结肠系膜 inverted V-shaped, with apex located in front of left ureter and division of common iliac artery two-layered folds of peritoneum that attached the lesser mobile solid visera to the abdominal wall Ligaments of liver Falciform ligament of liver 镰状韧带镰状韧带Corona
32、ry ligament 冠状韧带冠状韧带Left and right triangular ligaments 左、右三角韧带左、右三角韧带Ligaments 韧带韧带Hepatogastric ligament 肝胃韧带肝胃韧带Hepatoduodenal ligament 肝十二指肠韧带肝十二指肠韧带Ligamentum teres hepatis 肝圆韧带肝圆韧带Ligaments of spleenGastrosplenic ligament 胃脾韧带胃脾韧带Splenorenal ligament 脾肾韧带脾肾韧带Phrenicosplenic ligament 膈脾韧带膈脾韧带Sp
33、lenocolic ligament 脾结肠韧带脾结肠韧带Ligaments of stomach Hepatogastric ligament 肝胃韧带肝胃韧带Gastrosplenic ligament 胃脾韧带胃脾韧带Gastrophrenic ligament 胃膈韧带胃膈韧带Gastrocolic ligament 胃结肠韧带胃结肠韧带Gastropancrestic ligament 胃胰韧带胃胰韧带Superior duodenal fold and recess 十二指肠上襞和上隐窝十二指肠上襞和上隐窝Inferior duodenal fold and recess 十二指肠
34、下襞和下隐窝十二指肠下襞和下隐窝Intersigmoid recess 乙状结肠乙状结肠间隐窝间隐窝formed by the inverted V attachment of sigmoid mesocolon The peritoneal recesses, pouches, fossae and foldsSuperior duodenal fold and recess 十二指肠上襞和上隐窝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十二指肠下襞和下隐窝Intersigmoid recess 乙状结肠乙状结肠间隐窝间隐窝f
35、ormed by the inverted V attachment of sigmoid mesocolon The peritoneal recesses, pouches, fossae and foldsRetrocecal recess 盲肠后隐窝盲肠后隐窝in which the appendix frequenty liesHepatorenal recess 肝肾隐窝肝肾隐窝lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of
36、 the peritoneal cavity when the subject is supine Folds and fossas of anterior abdominal wallMedian umbilical fold 脐正中襞脐正中襞contain the remnant of urachus (median umbilical ligaments)Medial umbilical fold 脐内侧襞脐内侧襞contains remnants of the umbilical arteries (medial umbilical ligaments)Lateral umbilica
37、l fold 脐外侧襞脐外侧襞contains the inferior epigastric vesselsSupravesical fossa 膀胱上窝膀胱上窝Medial inguinal fossa 腹股沟内侧窝腹股沟内侧窝Lateral inguinal fossa 腹股沟外侧窝腹股沟外侧窝Pouches In male - rectovesical pouch 直肠膀胱陷窝直肠膀胱陷窝In female Rectouterine pouch 直肠子宫陷窝直肠子宫陷窝between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝膀胱子宫陷窝b
38、etween bladder and uterus .Peritoneal subdivisionsThe transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic compartments. Supracolic compartments 结肠上区结肠上区(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Infracolic compa
39、rtments. 结肠下区结肠下区lies below the transverse colon and transverse mesocolon Subphrenic Space 结肠上区结肠上区p Suprahepatic recess 肝上间隙肝上间隙 Left suprahepatic recesses 左肝上间隙左肝上间隙 left anterior suprahepatic spaces 左肝上前间隙 left posterior suprahepatic spaces 左肝上后间隙Right suprahepatic recesses 右肝上间隙右肝上间隙 right anter
40、ior suprahepatic spaces 右肝上前间隙 right posterior suprahepatic spaces 右肝上后间隙 bare area of live (extraperitoneal space) 肝裸区p Infrahepatic recess 肝下间隙肝下间隙 Right infrahepatic recesses 右肝下间隙右肝下间隙 (hepatorenal recess) Left infrahepatic recesses 左肝下间隙左肝下间隙 left anterior infrahepatic space 左肝下前间隙 left posteri
41、or infrahepatic space 左肝下后间隙(网膜囊）Suprahepatic recess 肝上间隙肝上间隙 lies between the diaphragm and livethe falciform ligament divides it into right and left suprahepatic recessesLeft suprahepatic recesses 左肝上间隙左肝上间隙left anterior suprahepatic spacesleft posterior suprahepatic spacesRight suprahepatic reces
42、ses 右肝上间隙右肝上间隙right anterior suprahepatic spacesright posterior suprahepatic spaces bare area of live (extraperitoneal space) Infrahepatic recess 肝下间隙肝下间隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic reces
43、sesRight infrahepatic recesses 右肝下间隙右肝下间隙 (hepatorenal recess 肝肾隐窝肝肾隐窝)Left infrahepatic recesses 左肝下间隙左肝下间隙 left anterior infrahepatic space 左肝下前间隙左肝下前间隙left posterior infrahepatic space 左肝下后间隙（网膜囊）左肝下后间隙（网膜囊）Infracolic compartments 结肠下区结肠下区 lies below the transverse colon and transverse mesocolon
44、Right paracolic sulcus 右结肠旁沟右结肠旁沟 lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal region.Left paracolic sulcus 左结肠旁沟左结肠旁沟 lies lateral to the descending
45、colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm.Right mesenteric sinus 右肠系膜窦右肠系膜窦triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transve
46、rse mesocolonLeft mesenteric sinus 左肠系膜窦左肠系膜窦lies between root of mesentery, descending colon, right 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis上下流通，左沟不畅，右窦封闭，左窦入盆。上下流通，左沟不畅，右窦封闭，左窦入盆。思考题思考题分别叙述腹前壁各种纵、斜切口经过哪几层? 试述腹股沟斜疝、直疝及股疝的解剖学基础。打开腹膜腔可以看到哪些器官，如何进行腹膜腔探查? 什么是膈下间隙？试述其分区。为什么阑尾炎穿孔可引起膈下脓肿?从形态学的特点来看，应采取什么措施予以防止？
