腹部解剖经典图

1、腹部腹部（1）主要内容主要内容 main content 境境 界界 与与 分分 区区 the boundary and region 表表 面面 解解 剖剖 the surface anatomy 腹腹 前前 外外 侧侧 壁壁 the anterolateral abdominal wall 一、一、境界与分区境界与分区boundary and region1. 腹部的境界腹部的境界上界：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。2. (固有固有)腹腔的境界腹腔的境界 上界：膈上界：膈

2、 下界：骨盆上口下界：骨盆上口3a. 腹腹部部的的分分区区(九分法九分法)3b. 腹腹部部的的分分区区(四分法四分法)二、表二、表 面面 解解 剖剖the surface anatomy 体表标志体表标志 surface landmark 表面投影表面投影 surface projectionxiphoid process剑剑 突突costal arch肋肋 弓弓iliac crest髂嵴髂嵴anterior superior iliac spine髂前上棘髂前上棘pubic tubercle耻骨结节耻骨结节superior edge of pubic symphysis 耻骨联合上缘耻骨联合

3、上缘pubic crest 耻骨嵴耻骨嵴1.骨骨性性标标志志2. 软软 组组 织织 标标 志志location of inguinal ligament3.体体表表投投影影三、三、腹腹 前前 外外 侧侧 壁壁the anterolateral abdominal wall 浅层结构浅层结构 superficial structures 深层结构深层结构 deep structures 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 wall1.skin2.superficial fascia

4、3.deep fascia and muscles4.transverse fascia5.extraperitoneal fascia6.parietal fascia腹横筋膜腹横筋膜 壁腹膜壁腹膜 （一）（一）浅浅 层层 结结 构构the superficial structures 皮肤皮肤 skin 浅筋膜浅筋膜 superficial fascia1. skin: thinner and more elastic 薄而富有弹性2. superficial fascia：主要由脂肪和疏松结缔组织组成。：主要由脂肪和疏松结缔组织组成。camper 筋膜v 在腹壁下部（约在脐平面以下），浅

5、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；v 深层称为深层称为scarpa fascia，是富有弹性纤维的膜性层，在中线附于白线，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（过耻骨联合向下至会阴，与会阴浅筋膜（colles筋膜）相延续。筋膜）相延续。scarpa 筋膜筋膜浅浅 筋筋膜膜skinsuperficial fasica scarpas fasciamu

6、scles of anteriorabdominal campers fasciatransversalis fasciawall2. superficial fasciav superficial fascia consists of a layer of connective tissue that contains a variable amount of fat.v above the level of umbilicus, it is a fatty layer.v in the inferior part of the anterolateral wall, the subcuta

7、neous tissue is composed of two layers, the fatty outer layer, known as campers fascia, and the membranous inner layer, the scarpa fascia. v 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 1.5

8、cm below the inguinal ligament.3) is continuous with the superficial fascia of the perineum (colles fascia).浅浅动动脉、脉、浅浅静静脉、脉、皮皮神神经经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 ilioinguinal and the lower abdominal flaps（二）（二）深层结构深层结构 the deep structures 肌肉层次肌肉层次 muscular layer 血管、淋巴及神经血管、淋巴及神经 vessels, lymph and nerve

9、 腹横筋膜腹横筋膜 transversalis fascia 腹膜下筋膜腹膜下筋膜 extraperitoneal fascia 壁腹膜壁腹膜 parietal peritoneum1. 肌层肌层 the muscular layerv前外侧群 the anterolateral group the three 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

10、（1）腹外腹外斜肌斜肌 external oblique muscle 腹股沟管皮下环腹股沟管皮下环 superficial inguinal ring:内侧脚内侧脚medial crus、外侧脚外侧脚lateral crus、脚间纤维、脚间纤维intercrural fibers.腹外斜肌腹外斜肌external oblique腹外斜肌腱膜腹外斜肌腱膜external oblique，aponeurosisintercrural fibersmedial crusv 腹股沟管皮下环腹股沟管皮下环 superficial inguinal ring:内侧脚内侧脚medial crus、外侧脚外

11、侧脚lateral crus、脚间纤维、脚间纤维intercrural fibers.v返转韧带返转韧带reflected ligament、腹股沟韧带、腹股沟韧带inguinal ligament、腔隙韧带腔隙韧带lacunar ligament、耻骨梳韧带、耻骨梳韧带pectineal ligament 腹股沟韧带腹股沟韧带inguinal ligament、腔隙韧带、腔隙韧带lacunar ligament、耻骨梳韧带、耻骨梳韧带pectineal ligament（2）腹内斜肌及其腱膜）腹内斜肌及其腱膜 internal oblique muscle & aponeurosis

12、 ：参与构成腹直肌鞘前、后层，结合腱：参与构成腹直肌鞘前、后层，结合腱 和提睾肌。和提睾肌。internal oblique muscleinternal oblique m. aponeurosistransversus abdominis, aponeurosistransversus abdominis（3）腹横肌及其腱膜）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）参与构成腹直肌鞘前层（弓状线以下）、后层（弓状线以上） ，结，结合腱合腱 和提睾肌。和提睾肌。 提睾肌提睾肌 cremast

13、er muscle腹股沟镰腹股沟镰inquinal falx联合腱联合腱 conjoined tendon腹横肌下缘腹横肌下缘 腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构 rectus sheath, posterior layer腱腱 划划tendinous intersections rectus abdominis弓状线弓状线arcuate linepyramidal m.（4）腹直腹直肌肌 rectus abdominis（5）锥状肌锥状肌 pyramidal muscletendinous intersectionsrectus sheath

14、, anterior layer腹腹直直肌肌鞘鞘腹直肌鞘腹直肌鞘 rectus sheath 腹直肌鞘腹直肌鞘 rectus sheath 腹直肌鞘腹直肌鞘包绕腹直肌，由腹外侧壁三个扁肌的腱膜构成，分包绕腹直肌，由腹外侧壁三个扁肌的腱膜构成，分为前、后两层。为前、后两层。 在弓状线以上：在弓状线以上：腹直肌鞘前层腹直肌鞘前层 anterior layer of the rectus sheath 由腹由腹外斜肌腱膜和腹内斜肌腱膜前层构成；外斜肌腱膜和腹内斜肌腱膜前层构成；腹直肌鞘后层腹直肌鞘后层 posterior layer of the rectus sheath 由腹由腹内斜肌腱膜的后层

15、和腹横肌腱膜构成。内斜肌腱膜的后层和腹横肌腱膜构成。 在弓状线以下：在弓状线以下：腹直肌鞘前层由三个扁肌的腱膜构成；腹直肌鞘前层由三个扁肌的腱膜构成；腹直肌鞘后层缺如腹直肌鞘后层缺如。2.血管、淋巴及神经血管、淋巴及神经vessels, lymph and nerve(1)(1)动动脉脉(2)(2)静静脉脉(3)(3)神神经经3.腹腹横横筋筋膜膜transversalis fascia腹横筋膜腹横筋膜 transverse fascia 精索内筋膜精索内筋膜internal spermatic fascia 腹股沟深环deep inguinal ring 窝间韧带 interfoveolar

16、ligament腹横筋膜腹横筋膜 transverse fascia腹前壁内面的皱襞及凹窝腹前壁内面的皱襞及凹窝4. 壁腹膜壁腹膜 parietal peritoneum5. 腹腹前前壁壁手手术术常常用用切切口口thoracoabdominal incisionsuperior median incisiontransrectus incisionpararectus incisionparamedian incisionsubcostal incisionsuperior transverse incisionmcburneysincisioninferiormedian incisioni

17、nferiortransverse incisionabove the arcuate linebelow the arcuate line四、腹四、腹 股股 沟沟 区区the inguinal region 境界境界 the boundary 层次与特点层次与特点 the layers and characteristics 腹股沟管腹股沟管 the inguinal canal 腹股沟三角腹股沟三角 the inguinal triangle 疝疝 hernias ：腹股沟直疝：腹股沟直疝 direct inguinal hernias 、腹股沟斜疝、腹股沟斜疝 indirect ingu

18、inal hernias、股疝股疝 femoralhernias（一）境界 boundary1. 皮肤 skin2. 浅筋膜 superficial fascia3. 腹外斜肌 aponeurosis of external obliquus abdominis（二）腹股沟区层次结构（二）腹股沟区层次结构the layers of the inguinal region4. 髂腹下神经 iliohypogastric n. 和髂腹股沟神经 ilioinguinal n.5. 腹内斜肌 obliquus internus abdominis6. 腹横肌 transversus abdominis

19、（二）腹股沟区层次结构腹股沟区层次结构the layers of the inguinal region7. 腹横筋膜腹横筋膜 transverse fascia8. 腹膜外筋膜腹膜外筋膜 extraperitoneal fascia9. 腹璧下动脉腹璧下动脉inferior epigastric a. and 旋髂深动脉旋髂深动脉 deep circumflex iliac a.10.璧腹膜璧腹膜 parietal peritoneum特点：特点：腹外斜肌在此区移行为腱膜，并在下部形成一裂口腹外斜肌在此区移行为腱膜，并在下部形成一裂口(浅环浅环)；腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部

20、，两者间无腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部，两者间无肌层覆盖；肌层覆盖；有精索或子宫圆韧带通过，形成了一潜在性裂隙；有精索或子宫圆韧带通过，形成了一潜在性裂隙；在人体站立时，该区所承受的腹内压力比平卧时高在人体站立时，该区所承受的腹内压力比平卧时高3倍。倍。 因此，腹因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部位。股沟区为腹壁的薄弱区，是腹壁疝的多发部位。 （三）腹股沟管（三）腹股沟管the inguinal canal 位置位置 position 通过的结构通过的结构 structures passing through it 两口、四璧两口、四璧 two opening an

21、d four walls 精索精索 forming of the spermatic cord 腹股沟斜疝腹股沟斜疝 indirect inguinal hernia（三）腹股沟管（三）腹股沟管 inguinal canal1.1.位置位置2.2.内容内容3.3.构成构成4.4.临床意义临床意义 the inguinal canal is an oblique, inferomedially passage(between the superficial and deep inguinial rings) through the inferior part of the anterior ab

22、dominal wall), 35cm long. the inguinal canal lies parallel and just superior to the medial half of the inguinal ligament. the main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. it also contains blood and lymphatic vessels and the ilioi

23、nguinal nerve in both sexes.vthe deep ( internal ) inguinal ring, entrance to inguinal canal , is an outpouching of the transversalis fascia approximately 1.25cm superior to the middle of the inguinal ligament and lateral to the inferior epigastric vessels. v the anterior wall of the inguinal canal

24、is formed by the external oblique aponeurosis throughout the length of the canal, with the anterior wall of the lateral part of the canal being reinforced by fibers of internus oblique. vthe posterior wall of the inguinal canal is formed by the transversalis fascia with the posterior wall of the med

25、ial part of the canal being reinforced the conjoint tendon.vroof ( superior wall) is formed by the arching fibers of the internal oblique and transverse abdominal muscles.vfloor( inferior wall ) is formed by the inguinal ligament.vthe superficial ( external ) inguinal ring-exit from inguinal canal-

26、is a slitlike opening between the diagonal fibers of the aponeurosis fo the external oblique, superolateral to the pubic tubercle. 腹股沟三角腹股沟三角 inguinal triangle （海氏三角海氏三角 hesselbachs triangle）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

27、股沟直疝。腹腹股股沟沟三三角角腹腹股股沟沟直直疝、疝、腹腹股股沟沟斜斜疝、疝、股股疝疝indirect herniadirect hernia股疝股疝 femoral hernia睾睾丸丸下下降降过过程程卵卵巢巢下下降降过过程程睾丸下降过程睾丸下降过程 descending process of the testis 先天性腹股沟斜疝先天性腹股沟斜疝a congenital indirect inguinal hernia 后天性腹股沟斜疝后天性腹股沟斜疝 a acquired indirect inguinal hernia 先天性腹股沟斜疝先天性腹股沟斜疝a congenital indirect inguinal hernia 后天性腹股沟斜疝后天性腹股沟斜疝 a acquired indirect inguinal hernia精索精索的被的被膜与膜与腹前腹前外侧外侧壁层壁层次的次的关系关系精索或睾丸被膜与腹前外侧壁层次的关系精索或睾丸被膜与腹前外侧壁层次的关系解剖与观察dissection