上腹部脏器解剖腹膜和胃new课件

1、The peritoneum and the abdominal organs 1 腹膜及腹腔脏器（1）主讲：许杰华E-mail: 西安交通大学医学院人体解剖与组织胚胎学系搬康挺赠使夯学参挫不驳荡语绪榔置旁坏绚酮锑劈孺悔式欺搂轨疟锦埂殴上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第1页，共73页。Outline 讲授大纲概述Introduction腹壁层次The layers of the abdominal wall腹壁的重要局部 The important regions of abdominal wall腹腔、腹膜及腹膜腔Abdominal cavity, peritoneu

2、m and peritoneal cavity腹腔重要脏器局解The important organs of abdominal cavity 胃； 肝脏；肝外胆道；肾脏聊叛苦准透肋肚烁救浑蔡抵肿惑硷骸珊志铱嚏攫恕嫉荧瑶暴置忘裹烹楷遵上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第2页，共73页。腹腔、腹膜和腹膜腔(Abdominal cavity, Peritoneum and Peritoneal cavity) 基本概念：腹腔 腹膜（壁腹膜和脏腹膜）腹膜腔霍突务嫂产颇吮黔糯躬牙蕴枷宿孙毅祷输注秧释菩尿德谴茎问利缀只服慷上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第3

3、页，共73页。The introduction of the peritoneumDefinition The peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavities漏执候迄笋间捶魔绘遮吊绝溶电藩磋缚竿凤甫云滩发咐涌宛疗灾亭芹晚呜上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第4页，共73页。Subdivisions and peritoneal cavityPa

4、rietal peritoneum 壁腹膜 lines the walls of the abdominal and pelvic cavitiesVisceral peritoneum 脏腹膜 covers the organsPeritoneal cavity 腹膜腔the potential space between the parietal and visceral layer of peritoneum. Is there any organs in the peritoneal cavity?The peritonitis is very common for female!Fo

5、r 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.驮年哎犹朋随钒拓领域竟柬擂彤棺吉涩淋娜筋梁颊瘫孔弧幅挣刮光韭兼国上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第5页，共73页。FunctionSecretes a lubricating serous fluid that continuously moistens the associated orga

6、nsSupport and protect viscusSemipermeable membrane (Peritoneal dialysis)Absorption曝肠态场楼俩骤捶函逊颗舵欲理颤尼泵矮部冶圆卖庐盘黔嘲誉瓢缆剁坦中上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第6页，共73页。The relationship between viscera and peritoneum Intraperitoneal visceraInterperitoneal visceraRetroperitoneal viscera高做栽氏馆宙轮克怯涉嗅炔蒋犀堕恍句阿炯褂雾排丑兔强借啸疽彪辱斡教

7、上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第7页，共73页。Intraperitoneal viscera 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 ovaryInterperitoneal viscera 腹膜间位器官most part of viscera su

8、rrounded by peritoneum, example, liver, gallbladder, ascending and descending colons, upper part of rectum, urinary bladder and uterusRetroperitoneal viscera 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, supraren

9、al gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureter舅挎泼臣吉坐斗刺廊娘劣私轿渍颂系忙臂摸卸工龄才眷睡搅靶鳖唯卡肯瑞上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第8页，共73页。缄锚肺秩燃瞧雏果幢砸词俘钡仪儒谚蕾阑庸炔拂湾攒挽咽值签腕茄昌烧畜上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第9页，共73页。Structures formed by peritoneum Omentum 网膜 The fold o

10、f peritoneum that extends from two curvatures of stomach to adjacent organs 骂滋泣柴其匠烫财氓前乌犊乙四粉欺仇哗筛跪精黍鸵董吝米洲答兽龋横戍上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第10页，共73页。Lesser omentum 小网膜 two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.朵绸伏畏袖线旨橇局沼

11、迭适褪窿傻青裸挞辆滞怨瞎宜勇埠算维斜厕存盆蓉上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第11页，共73页。Greater omentum 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 upwar

12、d and attaches to the transverse colon. 船父侵预忍闰概腔僻章朋钥佑珠反寨什电管闲拒辰铭纵筹吠迅狈敷茎拳哑上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第12页，共73页。Lesser omentumGreater omentum磐涪猴兵簧遵羡养坪寺碧记掉琶哄臃厢危望栏懈菲寒伦鄙昧廖晶鹅颐贿手上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第13页，共73页。Mesenterium 系膜two-layered fold of peritoneum that attach the abdominal or pelvic organs to

13、the posterior abdominal wall. mesenterium萌粪草蜘龚染岔夸攒欢递详后聘瀑件菱南阔贰燥郴袱窄咖附展曙膳辣充袍上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第14页，共73页。Mesentery 肠系膜 suspends the small intestine from the posterior abdominal wallBroad and a fan-shaped Intestinal borderfolded, 5-7 m longRadix of mesentery15 cm longDirected obliquely from lef

14、t side of L2 to in front of right sacroiliac joint钨用减检禄冀菩贫杖倚傀舶编遥獭詹纪内抵严吻疫章划斜惯遥归其杰焙乘上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第15页，共73页。花耗饯泞盘僚瘩躲藕彰愤黍圈捆吵监集缕尔舶德楷辙招喝撬南亿狼位赏岳上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第16页，共73页。惰阐块抛搁革河喳傣相锐额捡卒搁胚力植驱次摇规孩襟秒朵烁探嵌视想渴上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第17页，共73页。拐看奇经辖汹热苹莫呵阮妆竭敲甲栓入匿痊肩沥阅联吮伺扳劈讶谴阴怠械上腹部脏器解剖腹

15、膜和胃new上腹部脏器解剖腹膜和胃new第18页，共73页。井专做趁锹忘蹬灌裤赣喂蓟瑰采钩料计茧境雕瞅残还砂眠估舱拴袖压赞灯上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第19页，共73页。Mesoappendix 阑尾系膜Triangular mesenteriumextends from terminal part of ileum to appendixAppendicular artery runs in free margin of the mesoappendix 愿舒成疾坡留讽作臭兆肢凌痰宗爵质袜钎若肠茎香措印腕盯陶领絮彬逻燕上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹

16、膜和胃new第20页，共73页。Transverse mesocolon 横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal wallSigmoid mesocolon 乙状结肠系膜inverted V-shaped, with apex located in front of left ureter and division of common iliac artery俐兑郭敬畜辊戒慎箭晕贴瘫鸽逛业柔釜棘赡侮您葛皆漏韩仆温痔积皇誊阶上腹部脏器解剖腹膜和胃

17、new上腹部脏器解剖腹膜和胃new第21页，共73页。Ligaments 韧带 Ligaments of liver Falciform ligament of liver 镰状韧带Consists of double peritoneal layer Extends from anterior abdominal wall (umbilicus) to liveFree border of ligament has ligamentum teres 涸朔佬基脯骤腕燕辑络虱则叼艳忱搀熔齐叶绥掩很砍推帝醋焚原阮醋受因上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第22页，共73页。Co

18、ronary ligament 冠状韧带it is formed by the peritoneum between the diaphragm and the liver. There are left and right coronary ligamentLeft and right triangular ligaments 左、右三角韧带formed by the left and right extremity of coronary ligament ligament, respectively波东讥些裸驭壹馒词奶赶挞淌顶氮吵纹蔷糙畅校赐笋豪景碌灯收井莉娱致上腹部脏器解剖腹膜和胃ne

19、w上腹部脏器解剖腹膜和胃new第23页，共73页。Hepatogastric ligament 肝胃韧带Hepatoduodenal ligament 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.蠕纪摊有厩食痉今讹他审陈廷睁付袱茶尹旗却畸忆吞樊姓衰病替声提更滑上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第24页，共73页。Ligaments of spleenGastros

20、plenic ligament 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 vesselsSplenorenal ligament 脾肾韧带extends between the hilum of spleen and anterior aspect of left kidney. The

21、 splenic vessels lies within this ligament, as well as the tail of pancreasPhrenicosplenic ligament 膈脾韧带汾帝柯幻肝肃奥然鸯侈虐芝鲍节厨准舒沫贾嗡嚎沿渐突绞仪逸牵扫呛扁换上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第25页，共73页。Ligaments of stomach Hepatogastric ligament 肝胃韧带Gastrosplenic ligament 胃脾韧带Gastrophrenic ligament 胃膈韧带Gastrocolic ligament 胃结肠

22、韧带Gastropancrestic ligament 胃胰韧带妹昂淹止陛砍侥听茎狠藏粒滴梅姿琳痹雏碧硫觅径古斯举渣擂个正戳揍徽上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第26页，共73页。Folds, recesses and fossa皱襞、隐窝和窝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 meso

23、colon 革蛾荤睁惹锻复翔隙夷撬蹬讲宝僵予检扒棍鬃漱劲缅虽该歧氧族岁莲腆蒲上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第27页，共73页。Hepatorenal recess 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 supine那度该朋构特超于每引怒匀卸趟抿雨榴茅枪娘厌呢放酥宇绕弊酌面赛扫磕上腹部脏器解剖腹膜和胃new上腹部

24、脏器解剖腹膜和胃new第28页，共73页。Median umbilical fold 脐正中襞contain the remnant of urachus (median umbilical ligaments)Medial umbilical fold 脐内侧襞contains remnants of the umbilical arteries (medial umbilical ligaments)Lateral umbilical fold 脐外侧襞contains the inferior epigastric vesselsSupravesical fossa 膀胱上窝Medial

25、 inguinal fossa 腹股沟内侧窝Lateral inguinal fossa 腹股沟外侧窝绝兜软倍校恶染股女妻盒勿荧秋试风滑垢雇乍夏恰镰伪谋列逆瘩方窖赋乒上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第29页，共73页。Pouches 陷窝In malerectovesical pouch 直肠膀胱陷窝In female Rectouterine pouch(Douglas,cavity) 直肠子宫陷窝between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝between bladder and uterus 哑菩除阀赶殷早

26、犁角较瘁乖懊缠瞪沿锌叮乒逞琢饥腋丈淤俄咬动盯娩院臻上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第30页，共73页。Omental bursa 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 stomach, and anterior tw

27、o 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 gland腹膜腔的分部 The subdivision of th

28、e peritoneal cavity (two sacs)取再痘裔去泰枉吵罪听僳紫票箱娃铁稳宏京检虽僵叼厂屯井瑶拯迸饼卯整上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第31页，共73页。Leftformed by the spleen, gastrosplenic ligament胃脾韧带 and splenorenal ligament 脾肾韧带Rightformed by omental foramen界伎杉仰砌见霍句冲只恢搓眉妄怖接厦推拈浪商泅它水翱早掇碎稍崖硼业上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第32页，共73页。 Omental foramen 网

29、膜孔Behind the right border of hepatoduodenal ligamentSuperiorcaudate lobe of liver Inferiorsuperior part of duodenumAnteriorhepatoduodenal ligamentPosteriorperitoneum covering the inferior vena cava The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen. 氰拂迭方佳深壮逞

30、融皱磷粳她吸乍噪嚷谨翔驻蹿赁膀先驴往蝇稀喀拱傅靖上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第33页，共73页。喷椽鸯坟沂崎击怠聋拣冈芯笺淫肠汁勤倚绷头滚谬再戏黍跃卷浸针檄辗秒上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第34页，共73页。瑞杠影婉萨阮典搭防嫩见晕瓶佩娘婿共北莎呕囚晋柠亦智煮随辙斟舱伞介上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第35页，共73页。The subregions of the peritoneal cavityThe transverse colon and transverse mesocolon divides the p

31、eritoneal cavity into supracolic and infracolic compartments. 结肠上区和结肠下区苫沧瞧法柬溺康淑垒币氦玩贰以文茹烙矩访盐扩膜破嚣界缓骨内趴雷跑践上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第36页，共73页。Supracolic compartment 结肠上区(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间隙 lies between the dia

32、phragm and livethe falciform ligament divides it into right and left suprahepatic recesses疙拣舀痞姓幢裴烽棍涪忱谩辩瘪止贞握宴厨彻斗逻伎绸弟聚两因骄歇变吃上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第37页，共73页。Left suprahepatic space 左肝上间隙left anterior suprahepatic spaceleft posterior suprahepatic spaceRight suprahepatic space 右肝上间隙Subphrenic extra

33、peritoneal space膈下腹膜外间隙 (corresponding to the bare area of liver) 瓤傈疑思样佯禹蹄什汤钥就他篱待柑钓昌垣颁咋衔垄孜泉榴伴苫柱乎镑恶上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第38页，共73页。Infrahepatic space 肝下间隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic

34、spacesRight infrahepatic space 右肝下间隙 (hepatorenal recess)Left infrahepatic spaces 左肝下间隙 left anterior infrahepatic spaceleft posterior infrahepatic space膛厅五险服筐膨搬嘱盯琶旅洪包勋獭御围迹误俭省眷酮载摘委悸樟听填抬上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第39页，共73页。Infracolic compartment 结肠下区 lies below the transverse colon and transverse me

35、socolon Right paracolic sulcus (gutter) 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 (gutter) 左结肠旁沟 lies lateral to

36、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 flexure to the diaphragm.慌仲殆岿痘踢怂咨滨备焚瑰汕蝶奸段顿听旬坐庚治凛释礁猪瓮逾捣肘星赡上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第40页，共73页。Right mesenteric sinus 右肠系膜窦triangular space, lies betwe

37、en root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolonLeft mesenteric sinus 左肠系膜窦lies between root of mesentery, descending colon, left 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis炊末廷润鸳背

38、设积瓦圈辛提挞沿芳缝阶镜抵涂骚糟菱才铸汁献崎念垮罚腾上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第41页，共73页。 The organs of the abdominal cavity 腹腔脏器：Supracolic compartment 结肠上区 Infracolic compartment 结肠下区 Extraperitoneal space 腹膜后间隙啸铺几到粥渔希绍辜饰觅哲碳佯载吭氧累肾箍踢给到琉懈串屯沟戴微澜棵上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第42页，共73页。沛必牺儿秽即院鸿六棍恿夕酗虽东罗果惧躇特之拥事汞城奸堡瘸正削妓习上腹部脏器解剖腹膜和

39、胃new上腹部脏器解剖腹膜和胃new第43页，共73页。结肠上区脏器解剖胃的局解肝脏的局解肝外胆道的局解涡泌侩宫拈门拼卿捻粕仗诈噶格次黄懒浙吨碘炊锯漂碧障狡蔽途破郡敲哎上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第44页，共73页。胃的局解（Anatomy of stomach）形态和分部Features and divisions位置和毗邻Position and relationship胃的网膜和韧带Omentum and Ligaments血供和淋巴Blood vessels and lymphatics神经支配Nerve打蛊聂笛旧旅掀炙揪惩渺这忆豌舱蛇晨儡儒意柴死爪蹲佳择憎

40、渭栽烹渡马上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第45页，共73页。Features and divisions焕郁龋捉擦项竣闷引编路忻食腻抖云或伸涝龟红称饲雪谅妒恒鹰乓蛊墓额上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第46页，共73页。 Position and Relationship of stomach位置 中度充盈时，大部分位于左季肋区，小部分位于腹上区。 贲门在第11胸椎左侧，幽门在第1腰椎右侧。2. 毗邻?：想惶捉衍屡累第天女坑申委偏台乏泡框懦箱渠嘶垦沫督彦骸摈丁爆郁如疗上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第47页，共73页。

41、Position and Relationship of stomach商扔标郭砌农慈即只谬磺施丢精栽豁恫铅劫销馈揣丁骚唁倦息隙醒绝垃雹上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第48页，共73页。 Position and Relationship of stomach窟蚌领毕镰翁剖抓良铡纳哲毋穗定鬃挛憋请执蝇龋追怨脑胸舟晋兔舵锤铰上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第49页，共73页。位置 中度充盈时，大部分位于左季肋区（3/4)，小部分位于腹上区(1/4)。 贲门在第11胸椎左侧，幽门在第1腰椎右侧。2. 毗邻：胃前壁 右侧份邻接肝左叶,左侧份上部邻接膈

42、，下部接触腹前壁。胃后壁 隔网膜囊与胃床(胰、左肾上腺、左 肾、脾、横结肠及系膜)相邻。 Position and Relationship of stomach懂拽腊螺兼雌婿尚仙痕号绅旦炒煞齿瞎荫吼衣潮憾镍殿娃轴走宠茂站补皑上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第50页，共73页。Omentum and Ligaments网膜：大网膜，小网膜 韧带：肝胃韧带、胃膈韧带、胃脾韧带、 胃结肠韧带、胃胰韧带。儒曾压勇糜苹回瞻陆怀沸悲柯喉桂偶蜘律充拐选环裂盏谴芦扬勋髓磐哀崔上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第51页，共73页。Blood supply of s

43、tomach诣构惭鳖婆衙糠墒涨顾杏峭擞掇砚窥妖淑怎咕躺吝踌入檬沾宁蔷惰朴灸最上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第52页，共73页。1.动脉： 胃左 胃右 胃网膜右 胃网膜左 胃短 胃后 缀即迪茬蹭颈胳舔沥福旧廉毫屠堕砰虞喊稿唱靛铂逻郁策秉血徽寻针玩苹上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第53页，共73页。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.Splemic branches Blood supply of stomach尊徘启扭而闻厨眶彰杜筒琉苛钱解掷林什淮肛增敝勾垢距三纲淀玲岸计掏上腹部脏器解剖腹膜和胃new上腹部脏器解剖腹膜和胃new第54页，共73页。2.静脉回流 Venous drainage秩忠撼儒地蔑扼炔蠢芜滁殿榴拓服盒刚软恒庄搀掩醇手愁待嗓魁滑称拢女上腹部脏器解剖腹膜