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1、The peritoneum and the abdominal organs 1 腹膜及腹腔脏器（腹膜及腹腔脏器（1）主讲：许杰华主讲：许杰华E-mail: 西安交通大学医学院西安交通大学医学院人体解剖与组织胚胎学系人体解剖与组织胚胎学系Outline 讲授大纲讲授大纲vv概述概述概述概述IntroductionIntroductionvv腹壁层次腹壁层次腹壁层次腹壁层次The layers of the abdominal wallThe layers of the abdominal wallvv腹壁的重要局部腹壁的重要局部腹壁的重要局部腹壁的重要局部 The important reg
2、ions of The important regions of abdominal wallabdominal wallvv腹腔、腹膜及腹膜腔腹腔、腹膜及腹膜腔腹腔、腹膜及腹膜腔腹腔、腹膜及腹膜腔Abdominal cavity, Abdominal cavity, peritoneum and peritoneal cavityperitoneum and peritoneal cavityvv腹腔重要脏器局解腹腔重要脏器局解腹腔重要脏器局解腹腔重要脏器局解The important organs of The important organs of abdominal cavityabd
3、ominal cavity 胃；胃；胃；胃； 肝脏；肝外胆道；肾脏肝脏；肝外胆道；肾脏肝脏；肝外胆道；肾脏肝脏；肝外胆道；肾脏腹腔、腹膜和腹膜腔腹腔、腹膜和腹膜腔(Abdominal cavity, Peritoneum and Peritoneal cavity) 基本概念：基本概念：基本概念：基本概念：腹腔腹腔腹腔腹腔 腹膜（腹膜（腹膜（腹膜（壁腹膜和脏腹膜）壁腹膜和脏腹膜）壁腹膜和脏腹膜）壁腹膜和脏腹膜）腹膜腔腹膜腔腹膜腔腹膜腔The introduction of the peritoneumuDefinition The peritoneum is a thin serous mem
4、brane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavitiesuSubdivisions and peritoneal cavityParietal peritoneum 壁腹壁腹膜膜 lines the walls of the abdominal and pelvic cavitiesVisceral peritoneum 脏腹脏腹膜膜 covers the organsPeritoneal cavity 腹膜腔腹膜腔the potent
5、ial space between the parietal and visceral layer of peritoneum. Is there any organs in the peritoneal cavity?The peritonitis is very common for female!For male, it is a closed sac. But for female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.uFunc
6、tionSecretes a lubricating serous fluid that continuously moistens the associated organsSupport and protect viscusSemipermeable membrane (Peritoneal dialysis)AbsorptionThe relationship between viscera and peritoneum Intraperitoneal visceraInterperitoneal visceraRetroperitoneal visceravIntraperitonea
7、l viscera 腹膜内位器官腹膜内位器官viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovaryvInterperitoneal viscera 腹膜间位器官腹膜间位器官most part of viscera surrounded by peritoneum, example, liver
8、, gallbladder, ascending and descending colons, upper part of rectum, urinary bladder and uterusvRetroperitoneal viscera 腹膜外位器官腹膜外位器官some organs lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending
9、and horizontal parts of duodenum, middle and lower parts of rectum, and ureterStructures formed by peritoneum Omentum 网膜网膜 The fold of peritoneum that extends from two curvatures of stomach to adjacent organs lLesser omentum 小网膜小网膜 two-layered fold of peritoneum which extends from porta hepatis to l
10、esser curvature of stomach and superior part of duodenum.lGreater omentum 大网膜大网膜 four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and inferior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upwa
11、rd and attaches to the transverse colon. Lesser omentumGreater omentumMesenterium 系膜系膜two-layered fold of peritoneum that attach the abdominal or pelvic organs to the posterior abdominal wall. mesenteriumlMesentery 肠系膜肠系膜 suspends the small intestine from the posterior abdominal wallvBroad and a fan
12、-shaped vIntestinal borderfolded, 5-7 m longvRadix of mesentery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac jointlMesoappendix 阑尾阑尾系膜系膜vTriangular mesenteriumextends from terminal part of ileum to appendixvAppendicular artery runs in free margin of the mesoappend
13、ix lTransverse mesocolon 横结肠系横结肠系膜膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal walllSigmoid 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 arteryLigaments 韧带韧带 lLigaments of liver vFalcifo
14、rm ligament of liver 镰镰状韧带状韧带Consists of double peritoneal layer Extends from anterior abdominal wall (umbilicus) to liveFree border of ligament has ligamentum teres vCoronary ligament 冠状韧带冠状韧带it is formed by the peritoneum between the diaphragm and the liver. There are left and right coronary ligam
15、entvLeft and right triangular ligaments 左、右三角韧带左、右三角韧带formed by the left and right extremity of coronary ligament ligament, respectivelyvHepatogastric ligament 肝胃韧带肝胃韧带vHepatoduodenal ligament 肝十二指肝十二指肠韧带肠韧带Extends from porta hepatis to superior part of duodenumContains common bile duct, proper hepa
16、tic a. and hepatic portal v.lLigaments of spleenvGastrosplenic ligament 胃脾韧带胃脾韧带a double layer of peritoneum that connects the fundus of stomach to hilum of spleen. In this double layer of peritoneum, there are the short gastric and left gastroepiploic vesselsvSplenorenal ligament 脾肾韧带脾肾韧带extends be
17、tween the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreasvPhrenicosplenic ligament 膈脾韧带膈脾韧带lLigaments of stomach vHepatogastric ligament 肝胃韧带肝胃韧带vGastrosplenic ligament 胃脾韧带胃脾韧带vGastrophrenic ligament 胃膈韧带胃膈韧带vGastroc
18、olic ligament 胃结肠韧带胃结肠韧带vGastropancrestic ligament 胃胰韧带胃胰韧带Folds, recesses and fossa皱襞、隐窝和窝皱襞、隐窝和窝lSuperior duodenal fold and recess 十二指肠上襞和上隐窝十二指肠上襞和上隐窝lInferior duodenal fold and recess 十二指肠下襞和下隐窝十二指肠下襞和下隐窝lIntersigmoid recess 乙状结肠间隐窝乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon
19、lHepatorenal 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 the peritoneal cavity when the subject is supinelMedian umbilical fold 脐正中襞脐正中襞contain the remnant of urachus (median umbilical ligaments)lMedial umbilical fold 脐内侧襞脐内侧
20、襞contains remnants of the umbilical arteries (medial umbilical ligaments)lLateral umbilical fold 脐外侧襞脐外侧襞contains the inferior epigastric vesselslSupravesical fossa 膀胱上窝膀胱上窝lMedial inguinal fossa 腹股沟内侧窝腹股沟内侧窝lLateral inguinal fossa 腹股沟外侧窝腹股沟外侧窝Pouches 陷窝陷窝lIn malerectovesical pouch 直肠膀胱陷窝直肠膀胱陷窝lIn f
21、emale Rectouterine pouch(Douglas,cavity) 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between bladder and uterus lOmental bursa 网膜囊网膜囊Positionsituated behind the lesser omentum and stomachWallsvSuperiorperitoneum which covers the caudate lobe of liver and diaphragmvAnteriorf
22、ormed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentumvInferiorconjunctive area of anterior and posterior two layers of greater omentumvPosteriorformed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, periton
23、eum covering pancreas, left kidney and suprarenal gland腹膜腔的分部腹膜腔的分部 The subdivision of the peritoneal cavity (two sacs)vLeftformed by the spleen, gastrosplenic ligament胃脾韧带胃脾韧带 and splenorenal ligament 脾肾韧带脾肾韧带vRightformed by omental foramen Omental foramen 网膜孔网膜孔vBehind the right border of hepatodu
24、odenal ligamentvSuperiorcaudate lobe of liver vInferiorsuperior part of duodenumvAnteriorhepatoduodenal ligamentvPosteriorperitoneum covering the inferior vena cava The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen. The subregions of the peritoneal cavityvT
25、he transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments. 结肠结肠上区和结肠下区上区和结肠下区Supracolic compartment 结肠上区结肠上区(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间肝上间隙隙 lies between th
26、e diaphragm and livethe falciform ligament divides it into right and left suprahepatic recessesvLeft suprahepatic space 左肝上间隙左肝上间隙left anterior suprahepatic spaceleft posterior suprahepatic spacevRight suprahepatic space 右肝上间隙右肝上间隙vSubphrenic extraperitoneal space膈下腹膜外间隙膈下腹膜外间隙 (corresponding to the
27、 bare area of liver) Infrahepatic space 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 spacesvRight infrahepatic space 右肝右肝下间隙下间隙 (hepatorenal recess)vLeft infrahepatic spaces 左肝左肝下间隙下间隙 left anteri
28、or infrahepatic spaceleft posterior infrahepatic spaceInfracolic compartment 结肠下区结肠下区 lies below the transverse colon and transverse mesocolon vRight paracolic sulcus (gutter) 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 provide
29、s a route for the spread of infection between the pelvic and the upper abdominal region.vLeft paracolic sulcus (gutter) 左结肠旁沟左结肠旁沟 lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flex
30、ure to the diaphragm.vRight 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 transverse mesocolonvLeft mesenteric sinus 左肠系膜窦左肠系膜窦lies between root of mesentery, descending colon, left 1/3 of transverse colon and transver
31、se mesocolon, its widens below where it is continuous with the cavity of the pelvisu The organs of the abdominal cavity 腹腔脏器：腹腔脏器：Supracolic compartment 结肠上区结肠上区结肠上区结肠上区 Infracolic compartment 结肠下区结肠下区结肠下区结肠下区 Extraperitoneal space 腹膜后间隙腹膜后间隙腹膜后间隙腹膜后间隙结肠上区脏器解剖结肠上区脏器解剖vv胃的局解胃的局解vv肝脏的局解肝脏的局解vv肝外胆道的局解肝
32、外胆道的局解胃的局解（胃的局解（Anatomy of stomach）vv形态和分部形态和分部Features and divisionsvv位置和毗邻位置和毗邻Position and relationshipvv胃的网膜和韧带胃的网膜和韧带Omentum and Ligamentsvv血供和淋巴血供和淋巴Blood vessels and lymphaticsvv神经支配神经支配NerveFeatures and divisions Position and Relationship of stomach位置位置 中度充盈时，大部分位于左季肋区，小部分位于腹中度充盈时，大部分位于左季肋区，
33、小部分位于腹中度充盈时，大部分位于左季肋区，小部分位于腹中度充盈时，大部分位于左季肋区，小部分位于腹上区。上区。上区。上区。 贲门在第贲门在第贲门在第贲门在第11111111胸椎左侧，幽门在第胸椎左侧，幽门在第胸椎左侧，幽门在第胸椎左侧，幽门在第1 1 1 1腰椎右侧。腰椎右侧。腰椎右侧。腰椎右侧。2. 2. 毗邻毗邻?： Position and Relationship of stomach Position and Relationship of stomach位置位置 中度充盈时，大部分位于左季肋区（中度充盈时，大部分位于左季肋区（中度充盈时，大部分位于左季肋区（中度充盈时，大部分位于
34、左季肋区（3/4)3/4)3/4)3/4)，小部分，小部分，小部分，小部分位于腹上区位于腹上区位于腹上区位于腹上区(1/4)(1/4)(1/4)(1/4)。 贲门在第贲门在第贲门在第贲门在第11111111胸椎左侧，幽门在第胸椎左侧，幽门在第胸椎左侧，幽门在第胸椎左侧，幽门在第1 1 1 1腰椎右侧。腰椎右侧。腰椎右侧。腰椎右侧。2 2. 毗邻：毗邻：vv胃前壁胃前壁胃前壁胃前壁 右侧份邻接肝左叶右侧份邻接肝左叶右侧份邻接肝左叶右侧份邻接肝左叶, , , ,左侧份上部邻接膈，下左侧份上部邻接膈，下左侧份上部邻接膈，下左侧份上部邻接膈，下部接触腹前壁。部接触腹前壁。部接触腹前壁。部接触腹前壁。v
35、v胃后壁胃后壁胃后壁胃后壁 隔网膜囊与胃床隔网膜囊与胃床隔网膜囊与胃床隔网膜囊与胃床( ( ( (胰、左肾上腺、左胰、左肾上腺、左胰、左肾上腺、左胰、左肾上腺、左 肾、脾、横结肠及系膜肾、脾、横结肠及系膜肾、脾、横结肠及系膜肾、脾、横结肠及系膜) ) ) )相邻。相邻。相邻。相邻。 Position and Relationship of stomachOmentum and Ligaments网膜：网膜：大网膜，小网膜大网膜，小网膜 韧带：韧带：肝胃韧带、胃膈韧带、胃脾韧带、肝胃韧带、胃膈韧带、胃脾韧带、 胃结肠韧带、胃胰韧带。胃结肠韧带、胃胰韧带。Blood supply of stoma
36、ch1.动脉：动脉： 胃左胃左胃左胃左 胃右胃右胃右胃右 胃网膜右胃网膜右胃网膜右胃网膜右 胃网膜左胃网膜左胃网膜左胃网膜左 胃短胃短胃短胃短 胃后胃后胃后胃后 Left gastric a.Common hepatic a.Splenic a.Gastroduodenal a.Proper hepatic a.Right gastric a.Left branchRight branchCystic a. Short gastric a. Left gastrioeploic a.Right gastroepiploic a.Superior pancreaticoduodenal a.Sp
37、lemic branches Blood supply of stomach2.静脉回流静脉回流 Venous drainageLymph nodes and lymph drainage of stomach胃的淋巴回流胃的淋巴回流Nerve of stomach神经神经 Nerves Nerves 运动：交感神经运动：交感神经运动：交感神经运动：交感神经-T6T6T6T610 10 10 10 脊髓节段侧角脊髓节段侧角脊髓节段侧角脊髓节段侧角 副交感神经胃前支、后支副交感神经胃前支、后支副交感神经胃前支、后支副交感神经胃前支、后支 感觉：由内脏感觉神经传入脊髓和感觉：由内脏感觉神经传入脊髓和感觉：由内脏感觉神经传入脊髓和感觉：由内脏感觉神经传入脊髓和 延髓延髓延髓延髓CAPD continuous ambulatory peritoneal dialysis
