腹壁的解剖课件

Abdominalwall

腹壁

BoundariesoftheabdomenBoundariesSuperiorly－xiphoidprocess,lowerborderofcostalarch,11thand12thribs,vertebraT12Inferiorly－superiorborderofpubicsymphysis,pubiccrest,pubictubercle,foldofinguinalcanal,anteriorsuperioriliacspine,iliaccrest,spinousprocessofL5Theabdominalregions腹部分区

——NineregionsR.hypochondriacregion右季肋区Epigastricregion腹上区L.hypochondriacregion左季肋区R.lateralregions右外区Umbilicalregion脐区L.lateralregions左外侧区R.inguinalregion右腹股沟区L.inguinalregion左腹股沟区Pubicregion耻区LandmarksofabdomenPubicsymphysisPubictubercleIliaccrestUmbiicusLineasemilunarisTranspyloricplaneAnterolateralabdominalwall

Layers

(fromsuperficialtodeep)SkinSuperficialfasciaAnterolateralmusclesTransversefascia腹横筋膜Extraperitonealfascia腹膜下筋膜Parietalperitoneum壁腹膜

Superficialvesselsandcutaneousnerves

Arteries

Superficialepigastrica.Superficialiliaccircumflexa.Veins

Thoracoepigastricv.Superficialepigastricv.CutaneousnervesAnteriorandlateralcutaneousn.oflowersixthoracicIliohypogastricn.(firstlumbnerves)MusclesofabdomenMusclesofabdomenPosteriorgroup

Quadratuslumborum腰方肌Psoasmajor腰大肌Obliquusexternusabsominis腹外斜肌Generaldirectionoffibers:downward,forwardandmedially(rundownandinward)Obliquusexternusabsominis腹外斜肌StructuresInguinalligament

腹股沟韧带Lacunarligament

腔隙韧带Superficialinguinalring

腹股沟管浅环

－triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercleSuperficialinguinalringObliquusinternusabdominis腹内斜肌DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmediallyTransversusabdominis

腹横肌Inguinalfalx

腹股沟镰

Obliquusinternusabdominishasalower,freeborderthatarchesoverspermaticcordInsertedwithtransversusabdominisfiberintomedialpartofpectenofpubisCremaster

提睾肌

DirivedfromthelowerfibersoftheobliquusinternusabdominisandtransversusabdominisAroundthespermaticcordandtestisRectusabdominis腹直肌

Position:lieontoeitherofmidlineOrigin:pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesTendinousintersections

腱划

3-4lineasemiluaris

半月线

Sheathofrectusabdominis腹直肌鞘AnteriorlayerFormedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisSheathofrectusabdominis腹直肌鞘Posteriorlayer

FormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversusabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuateline弓状线BelowthislinerectusabdominisincontactwithtransversefasciaDeepvesselsofabdomenArteriesSuperiorandinferiorepigastricarterisLowerposteriorintercostalaa.Subcostala.Deepiliaccircumflexa.Fourlumbara.DeepnervesofabdomenLowerfiveintercostalsnerves

Subcostalnerve

Runbetweenobliquusinternusandtranversusabdominis.DeepnervesofabdomenIliohypogastricn.

髂腹下神经ArisesfromlumbarplexusPassesforwardintheintervalbetweenobliquusinternusandtranversusabdominisPiecesobliquusinternusabdominis2.5cmmedialtoanteriorsuperioriliacspinePiecesaponeurosisofobliquusexternusabdominisabout2.5cmabovesuperficialinguinalringDeepnervesofabdomenGenitofemoraln.

生殖股神经ArisesfromlumbarplexusEmergesthroughsuperficialinguinalringandsuppliesthecremastermuscleInguinalregion腹股沟区BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolateralmarginofrectusabdominisInguinalcanal腹股沟管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinalligamentBoundariesofinguinalcanalAnteriorwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PosteriorwallTransversefasciaInguinalflaxmediallyRoof－archingfibersofobliquusinternusandtransversusabdominisFloor－inguinalligamentBoundariesofinguinalcanalTwoopeningsSuperficialinguinalring

腹股沟管浅环－atriangular-shapeddefectintheaponeurosisoftheobliquusexternusabdominisandliesimmediatelyaboveandmedialtothepubictubercleBoundariesofinguinalcanalTwoopeningsDeepinguinalring

腹股沟管深环－anovalopeningintransversefasciaandliesapproximately1.5cmabovemidpointofinguinalligamentMechanicsoftheinguinalcanalTheinguinalcanalisasiteofpotentialweaknessinbothsexes.Oncoughingandstraining(asinmicturition,defecation,andparturition),thearchinglowersfibersoftheobliquusinternusandtransversusabdominiscontractandflattenthearch.Inturn,thislowerstheroofofthecanaltowardthefloorandvirtuallyclosesthecanal.Structurespassingthroughtheinguinalcanal

Inmales

Spermaticcord精索

Ilioinguinalnerve髂腹股沟神经Infemales

Roundligamentofuterus子宫圆韧带Ilioinguinalnerve髂腹股沟神经DescentoftestesSeven-weekembryoshowingthetestisbeforeitsdescentfromthedorsalabdominalwallDescentoftestesFetusat28weekthetestispassingthroughtheinguinalcanalDescentoftestesNewbornInguinalTriangle(ofHesselbach)腹股沟三角

Boundaries

Medially:LateralborderofrectusabdominisLaterally:InferiorepigastricarteryInferiorly:InguinalligamentIndirectinguinalherniaand

directinguinalhernia

DirectinguinalherniaIndirectinguinalherniaAnteriorabdominalwallTransversefascia腹横筋膜Extraperitonealfascia腹膜外筋膜Parietalperitoneum壁腹膜

LandmarksandsurfaceanatomyXiphoidprocessCostalarchAnteriorsuperioriliacspineIliaccrestSuperiorborderofpubicsymphysisPubictubercleLandmarksa