局部解剖学复习纲要

猫小黑axsfrom56071第一章头部（head）一、概述1．掌握头部重要的骨性标志。（Landmarkesofhead.）Superciliaryarch(眉弓)Supra-orbitalnotch(眶上切迹)Infra-orbitalforamen（眶下孔）Mentalforamen（颏孔）Pterion（翼点）Zygomaticarch（颧弓）Tragus（耳屏）Condylarprocess（髁突）Angleofmandible（下颌角）Mastoidprocess（乳突）Bregma（前囟点）Lambda（人字点）Externaloccipitalprotuberance（枕外隆凸）Superiornuchalline（上项线）二、面部（face）1．掌握面动脉的行程及面静脉与海绵窦的交通(1)Originandcoursingoffacialartery.Branchofexternalcarotida.Runsforwardoverdigastric(二腹肌)andsubmandibulargland,looparound（inf.borderof）mandibular(whereitispalpable)atant.borderofmasseter（咬肌）toentertheface,（takesthecourse1cmlateraltotheangleofmouth,lateraltoalaofnose,tomedialangleofeye）,followsatortuouscoursetomedialangleofeyeliesdeeptomostfacialmuscles.（2）facialveincommunicatewithcavernoussinus.Throughtheophthalmicvein（眼静脉）.Andalsothroughpterygoidplexus（翼静脉丛）viathedeepfacialvein（面深静脉）.2．掌握腮腺的位置和毗邻，掌握穿经腮腺的结构。(parotidgland)(1)locationSituatedbelowtheexternalauditorymeatus(耳道)andliesinadeephollowbehindtheramusofmandibularandinfrontofthesternocleidomastoid.Superficialpart:triangularinshape,liesbelowandinfrontoftheexternalacousticmeatus,andpartiallycoversthemasseter.Deeppart:liesdeeptomedialpterygoid.(2)relationshipsofparotidglandSuperiorly–externalacosticmeatus(外耳道),pos.marginoftemporomandibularjointAnteromedialy–masseter,ramusofmandible,pos.partofmedialpterygoidPosteromedial–mastoidprocess,sternocleidomastoid,pos.bellyofdigastric,styloidprocessandm.around,internalcarotida.,internaljugularv.,Ⅸ~Ⅻcranialnerves.“parotidbed”--styloidprocessandm.aroundinternalcarotidernaljugularv.Ⅸ~Ⅻcranialnerves.上缘：颧弓、外耳道、颞下颌关节；后缘：乳突前缘及胸锁乳头肌前缘的上份；深部：下颌后窝内及下颌支的深面；腮腺床(3)StructurespassingthroughtheparotidglandVertical:externalcarotida.(纵行)Retromandibularv.（下颌后静脉）Superficialtemporala.andv.（颞浅）Auriculotemporaln.（耳颞神经）Transversal:maxillarya.,v.(横行)tranversefaciala.,v.Branchesoffacialn.3.掌握腮腺管的行程和开口部位。(parotidduct)Arisesfrontant.Borderofgland.Lies1-1.5cmbelowandparalleltozygomaticarch（颧弓）.Runsforwardovermasseter,piercesthebuccinatorandoralmucosatoopenoppositeseconduppermolartooth.三、颅部1．掌握额顶枕区的层次结构特点。（Frontalparietaloccipitalregion）(1)SkinThickandhairbearingandcontainsnumeroussebaceousglands皮厚腺多血运丰富(2)Superficialfascia：containmanyfibroustract,a.,v.,n.DenseconnectivetissuethatbindstheskintotheunderlyingepicranialaponeurosisThevasculatureofthescalprunsprimarilyinthislayer.Itisrichandwidelyanastomosis.Woundsofthescalpbleedprofuselybuthealwell.了解：AnteriorgroupSupratrochleara.v.n.Supraorbitala.v.n.PosteriorgroupOccipitala.v.Greateroccipitaln.炎症不易扩散，肿胀疼痛剧烈，血管吻合多，止血应呈环状，局麻范围要广，切口呈放射状，皮瓣蒂在下方(3)Epicranial(galea)aponeurosisandoccipitofrontalis（帽状腱膜和枕额肌）Itisinterposedbetweenthefrontalis（额）andoccipitalis（枕）portionsoftheoccipitofrontalismuscle（枕额肌）.Thesemusclesplacetheaponeurosisundertensionsothatdeeptransverselacerationsofthescalpgapewidely坚韧致密，前连额腹，后连枕腹，1、2、3层，合称头皮(4)Subaponeuroticspace(腱膜下隙，looseconnectivetissue)Containsarichnetworkofdeeparteriesandveins.Therefore,thislayerhasbeencalledthe“dangerousarea”.Infectionmayspreadtothesubstanceofthebones,tovenouschannelswithinthecranialcavity,ortothebrain.出血化脓，漫及全顶，有导血管，颅内外交通(5)Pericranium(颅骨外膜)Fusesfirmlywithboneatthesuturesandwiththeperiosteumoftheadjacentbone,thuslimitingthesubperiostealspace.薄而致密，易于颅骨分离，如有血肿，与骨一致2．掌握垂体的位置、毗邻及临床意义。(hypophysis)(1)positionPea-sizedorgan,attachedbyinfundibulumtohypothalamus,liesinhypophysialfossa位于颅底蝶鞍的垂体窝内，借漏斗柄与下丘脑相连，周围被硬脑膜形成的海绵间窦包绕。(2)relationshipAnterior-tuberculumsellae（鞍结节）Posterior-dorsumsellae（鞍背）Anterolateraly-opticcanalAbove-diaphragmasellae（鞍膈）,opticchiasma（视交叉）andopticnerveLaterally-cavernoussinus（海绵窦）Below-sphenoidsinus（蝶窦）垂体在神经系统与内分泌腺的相互作用中处于重要地位。远侧部和结节部称垂体前叶，分泌生长激素、催乳激素、促甲状腺激素和促性腺激素（各自作用）；中间部和神经部称垂体后叶，中间部的黑素细胞刺激素细胞分泌黑素细胞刺激素（促黑激素），神经垂体能储存和释放加压素（抗利尿素）及催产素。3．掌握海绵窦的位置及穿经结构。(cavernoussinus)(1)positionLiesoneachsideofsellaturcica(2)traversingthecavernoussinusInternalcarotidarteryAbducentnerve(3)traversingthelateralwallofthecavernoussinusOculomotornerve(动眼神经)Trochlearnerve（滑车神经）Ophthalmicnerve(眼神经)Maxillarynerve(上颌神经)第二章颈部（neck）一、概述1．掌握颈部的体表标志。(landmarksofneck)Hyoidbone（舌骨）Thyroidcartilage(甲状软骨)Cricoidcartilage(环状软骨)Carotidtubercle（颈动脉结节）Sternocleidomastoid(胸锁乳突肌)Suprasternalfossa(胸骨上窝)Greatersupraclavicularfossa(锁骨上大窝)二、颈部浅层结构1．掌握颈筋膜的层次。（cervicalfascia）Superficiallayer(investingfascia封套筋膜)Middlelayer（pretracheallayer气管前层carotidsheath颈动脉鞘）Deeplayer(prevertebrallayerorprevertebralfascia椎前层或椎前筋膜)三、颈前区1．掌握下颌下三角的构成及内容。（submandibulartriangle）(1)boundaries-AnteriorandposteriorbrlliesofdigastricandlowerborderofthebodyofthemandibleCovered-byskin,superficialfascia,platysma（颈阔肌）andinvestingfasciaFloor-mylohyoid（下颌舌骨肌）,hyoglossus（舌骨舌肌）andmiddleconstrictorofpharynx(2)ContentsSubmandibularglandFaciala.,v.Hypoglossaln.，v.Linguala.,v.andn.Submandibularganglionandsubmandibularlymphnodes2．掌握颈动脉三角的境界及内容。（carotidtriangle）(1)BoundariesBoundedbyanteriorborderofsternocleidomastoid,superiorbellyofomohyoid(肩胛舌骨肌)andposteriorbellyofdigastricmuscles（二腹肌）Coveredbyskin,superficialfascia,platysmaandinvestingfasciaFloor－prevertebralfasciaandlateralwallofpharynx（2）Contentscommoncarotida.anditsbranches,internaljugularv.anditstributaries,hypoglossaln.withitsdescendingbranches,theaccessoryandvagusnerves,partofthechainofdeepcervicallymphnodes3．掌握肌三角的境界、层次及内容。(musculartriangle)（1）Boundedbymidlineoftheneck,superiorbellyoftheomohyoidandanteriorborderofthesternocleidomastoid.Floor－prevertebralfascia（2）Coveredbyskin,superficialfascia,platysma,anteriorjugularv.,cutaneousn.（皮神经）andinvestingfascia（3）Contents－sternohyoid(胸骨舌骨肌),superiorbellyofomohyoid（肩胛舌骨肌）,sternothyroid（胸骨甲状肌）,thyrohyoid（甲状舌骨肌）,thyroidgland,parathyroidgland,cervicalpartoftracheaandesophagus4．掌握甲状腺的形态、被膜、位置毗邻以及血管。(thyroidgland)(1)ShapeandlocationH-shapeLeftandrightlobes:lieoneithersideofinferiorpartoflarynxandsuperiorpartoftrachea,extendfrommiddleofthyroidcartilagetolevelofsixthtracheacartilageIsthmus:overlies2ndto4thtrachealcartilagePyramidallobe:sometimesarisesfromisthmus(2)CoveringsofthethyroidglandFibrouscapsule:asheathofpretrachealfasciawhichisattachedtoarchofcricoidandthyroidcartilagestofromthesuspensoryligamentofthyroidgland,hence,thethyroidglandmoveswithlarynxduringswallowingandoscillatesduringspeakingTurecapsule:fibrouscapsuleSpacebetweensheathandcapsuleofthyroidgland:therearelooseconnectivetissue,vessels,nervesandparathyroidglands.(3)RelationsAnteriorly:skinSuperficialfasciaInvestingfasciaInfrahyoidmusclesandpretrachealfasciaPosteropmedially:larynxandtracheaPharynxandesophagusRecurrentlaryngealnervePosterolaterally:carotidsheathwithcommoncarotida.,internaljugularv.andvagusn.Cervicalsympathetictrunk(4)Vessels:Arteries:Superiorthyroida.:branchofexternalcarotida.Inferiorthyroida.:branchofthyrocervicaltrunkofsubclaviana.Arteriesthyroidima:mayarisefromthebrachiocephalica.oraorticarchVenous:Superiorthyroidvein:drainintointernaljugularveinMiddlethyroidvein:drainintointernaljugularveinInferiorthyroidvein:oftwosidesanastomosewithoneanotherastheydescendinfrontofthetracheatoformunpairedthyroidvenousplexus(甲状腺奇静脉丛)Theydrainintobrachiocephalicveins.5．掌握喉上神经的来源、分支、分布及与甲状腺上动脉的关系。(Superiorlaryngealn.)(1)Thebranchofvagusn.(2)Internalbranch:whichpiercesthyrohyoidmembranetoinnervatesmucousmembraneoflarynxabovefissureofglottisExternalbranch:isfinen.,whichdescendsincompanywiththesuperiorthyroida.andsuppliescricothyroid.(3)RelationshipsofarterytothesuperiorlaryngealnervesThesuperiorthyroidarteryiscloselyrelatednearitsorigintothesuperiorlaryngealnerveSectionofthenervewouldanaesthetize（麻醉）thelaryngealmucosaandabolishthecoughreflex,soincreasingtheriskoffoodoraforeignbodyenteringthetrachea.6．掌握喉返神经的来源、行程、分布及与甲状腺下动脉的关系。(Recurrentlaryngealnerves)(1)Thebranchofvagusn.(2)Ascendintracho-esophagealgroovePassdeeptothelobeofthethyroidglandandcomeintocloserelationshipwiththeinferiorthyroidarteryCrosseitherinfrontoforbehindthearteryofmaypassbetweenitsbranchesNervesenterlarynxposteriortocircothyroidjoint,thenerveisnowcalledinferiorlaryngealnerveInnervation:laryngealmucosabelowfissureorglottis,alllaryngealmusclesexceptcircothryoid.(3)RelationshipofarterytotherecurrentlaryngealnervesTheinferiorthyroidarteryrelatedtotherecurrentlaryngealnerveasitentertheglandSectionofthenervewouldresultinparalysisofmusclesthatmovethevocalcordonthatside.7．掌握气管颈部的毗邻及气管切开术的解剖要点。(Cervicalpartoftrachea)(1)RelationsAnteriorlyTheskin,superficialfascia,investingfascia,suprasternalspace（胸骨上间隙）andjugulararch,infrahyoidmuscles（舌骨下肌）andpretrachealfascia,isthmusofthyroidgland(infrontofthe2ndto4thtrachealcartilage),inferiorthyroidv.andunpairedthyroidvenousplexus,arteriathyroidima(ifpresent),andleftbrachiocephalicv.inchildLaterallyThelobesofthethyroidgland(downasfarasthesixthring)andthecarotidsheathPosteriorlyTherightandleftrecurrentlaryngealnerves,theesophagus(2)临床上气管切开术是在气管颈部的前壁作一切口，出入气管套管，另建呼吸道，解除严重喉梗阻的治疗方法，可分为高位气管切开术和低位气管切开术。前者将甲状腺峡稍向下牵拉，切开1、2气管软骨环；后者切开5、6气管软骨环。如果将甲状腺峡切断、结扎，亦可切开3/4气管软骨环。高位气管切开术，由于靠近环状软骨，如损伤该软骨有引起喉狭窄的可能；低位气管切开术有损伤头臂静脉等大血管的可能。目前临床上一般主张切开2、3气管软骨环。气管切开时，应熟知气管颈部的毗邻关系。通常在肩后垫一软枕，严格使头保持正中位，并尽量后仰，使气管接近体表，以利于手术进行。在体表，上为环状软骨，两侧为胸锁乳突肌前缘，尖向颈静脉切迹的三角，为气管切开的安全三角。手术时，自环状软骨向下至胸骨上窝处沿前正中线作垂直切口，依次切开皮肤、浅筋膜和颈深筋膜浅层，向两侧分离、牵拉舌骨下肌群，显露气管颈部，根据需要切开1、2或3、4或5、6气管软骨，插入气管套管，新的呼吸道即可建立。手术中应注意避免损伤胸骨上间隙内的颈静脉弓，必要时可结扎切断；要始终沿气管前正中线进行手术，以免偏离正中线损伤颈部大血管致大出血。幼儿因其胸腺和头臂静脉位于气管颈部下端前面，故在幼儿进行气管切开时应注意这一特点。四、胸锁乳突肌区和颈根部(sternocleidomastoidregionandrootofneck)1.掌握颈动脉鞘的位置和内容。P60(Carotidsheath)(1)Position:insternocleidomastoidregionandcoveredbysternocleidomastoid.上起自颅底，下至颈根部续于纵膈。(2)Contents:InternaljugularveinVagusnerveInternalcarotidarteryorcommoncarotidartery2.掌握斜角肌间隙的构成及穿行结构。Abovethefirstrib,thereisatriangularspacebetweenscalenusanterior（前斜角肌）andmedius.Thebrachialplexusandthesubclavinea.emergefromthisspace.第三章胸部一、概述1．掌握胸部的体表标志。（landmarksofthorax）Jugularnotch(颈静脉切迹)Sternalangle（胸骨角）Xiphoidprocess（剑突）Clavicleandinfraclavicularfossa（锁骨和锁骨下窝）Costalarchandinfrasternalangle(肋弓和胸骨下角)Ribsandintercostalspaces（肋和肋间隙）Inferiorangleofscapula（肩胛骨下角）Mammarypapilla（乳头）二、胸壁1．掌握女性乳房的形态、构造、淋巴回流。(Mamma)(1）ShapeHemispheric(半球形，青春期未授乳女性)(2)StructureContainsskin,mammaryglands,andadiposetissueConsistsof15to20lobesofmammary(乳腺小叶)thatradiateoutwardfromthenippleLactiferousduct(输乳管)Lactiferoussinus(输乳管窦)Suspensoryligamentsofbreast(乳房悬韧带cooper’sligaments)connectivetissueseptathatextendfromtheskintothedeepfascia.(3)LymphaticdrainageofbreastIntopectoralln.fromlateralandcentralpartsofbreastIntoapicalandsupraclavicularln.fromsuperiorpartofbreastIntoparasternalln.frommedialpartofbreastIntointerpectoralln.fromdeeppartofbreastThelymphaticcapillariesofbreastformananastomosingnetworkwhichiscontinuousacrossthemidlinewiththatoftheoppositesideandwiththatoftheabdominalwall2．掌握胸壁的层次、胸部皮神经分布的节段性和重叠性及其意义。(Thoracicwall)(1)LayersSuperficialstructures:skinandsuperficialfascia(superficialn.a.andv.)a.：internalthoracica.posteriorintercostala.thebranchofaxillarya.v.：theperforatingbranchofinternalthoracicv.thebranchofposteriorintercostalv.thoracoepigastricv.(胸腹壁静脉)n.:nervuscutaneous(皮神经)supraclavicularn.（锁骨上静脉）lateralcutaneousbranch（皮支）ofintercostaln.anteriorcutaneousbranchofintercostaln.Deepstructures:deepfasciaandmusclesClavipectoralfascia(锁胸筋膜)Pectoralismajor（胸大肌）PectoralisminorSubclavius（锁骨下肌）Serratusanterior(前锯肌)Intercostalesexterni（肋间外肌）IntercostalesinterniIntercostalesintiniTransversesthoracisa.；posteriorintercostala.(9pairs)supremeintercostala.(肋间最上动脉1、2肋间隙)subcostala.(肋下动脉胸主动脉发出沿第12肋下行Posteriorintercostalv.Intercostaln./subcostaln.(第12胸神经)Endothoracicfascia(胸内筋膜)(2)superaclavicularn.Anteriorandlateralcutaneousbranchesofintercostaln.T2sternalangleT4nippleT6xiphoidprocessT8costalarchT10umbilicusT12midpointbetweenumbilicusandsymphysispubis3．掌握肋间隙结构及血管、神经走行的排列关系及其临床意义。(Intercostalsspace)(1)Structures:Fascia,intercostalmuscles,intercostalarteryandvein,intercostalnervesMuscles:fromlateraltointernalIntercostalesexterniIntercostalesinterniIntercostalesintimiArtery:PosteriorintercostalsarteriesSubcostalarteryNerves:Intercostalnerves(anteriorramiofT1toT11)Subcostalnerve(anteriorramiofT12)Fromsuperiortoinferior:vein,artery,nerve(2)Techniqueforthoracocentesis(inmidaxillaryline)Interclstalnerveblock三、胸膜腔及肺（pleuralcavity）1．掌握胸膜腔的构成、胸膜顶的位置、胸膜隐窝的构成和胸膜下界的体表投影。(1)PleuralcavityPotentialspacebetweenvisceralandparietalpleural.Twopleurallayerscontinuewitheachotheratrootoflungformingclosedpotentialspace－pleuralcavityContainsasmallamountofpleuralfluidSubatmosphericpressureinit脏、壁胸膜在肺根处相互延续共同围成的左、右各一的密闭窄隙，腔内为负压，并有少量浆液。(2)PositionofcupulaofpleuralExtendsupintotheneckovertheapexoflung,2.5cmabovethemedialthirdofclavicle(3)Pleuralrecesses(胸膜隐窝)Potentialspaceofpleuralcavitywhichlungsarenotoccupiedinquietrespiration.Costodiaphragmaticrecess(肋膈隐窝)Slit-likespacebetweencostalanddiaphragmaticpleuraeoneachsideThelowestareaofpleuralcavityintowhichthelungsexpandduringdeepinspiration.Costomediastinalrecess(肋纵隔隐窝)Ontheleftsidebetweenthemediastinalpleural(纵膈胸膜)andcostalpleura(4)Lowermarginsofpleuralcrossthe8th,10th,11th,ribsand12thribsatthemidclavicularlines,themidaxillarylinesmscapularline,andthesidesofthevertebralcolumn,respectively.P882．掌握肺门的位置。掌握肺根的构成、各结构的排列关系及其毗邻。(Hilumoflung)(1)PositionofhilumoflungMiddleofmedialsurface,whichisadepressionwherethebronchi,vessels,andnervesenterthelung(2)ContentsofrootoflungPrincipalbronchusPulmonaryarteryandveinNervesandlymphaticvesselsSurroundbyconnectivetissue(3)OrderofstructuresintherootoflungFrombeforebackward:V.A.B.Fromabovedownward:L:A.B.V.R:B.A.V.由前向后为上肺静脉、肺动脉、主支气管和下肺静脉；自上而下，左肺根依次为肺动脉、主支气管、上肺静脉和下肺静脉；右肺根为上叶支气管、肺动脉，中、下叶支气管，上肺静脉和下肺静脉。(4)Relationsofrootoflung--LeftAnterior:phrenicn.andpericardiacophrenicvessels（心包膈动、静脉）Posterior:thoracicaortaandvagusn.Superior:aorticarchInferior:pulmonaryligament--RightAnterior:phrenicn.,pericardiacophrenicvessels,superiorvenacave,partpericardium,andrightatriumPosterior:vagusn.Superior:azygosv.Inferior:pulmonaryligament两肺根的前方为膈神经和心包膈动、静脉，后方为迷走神经，下方为肺韧带。左肺根的上方尚有主动脉弓跨过，后方为胸主动脉；右肺根的前方有上腔静脉、部分心包和右心房，上方有奇静脉弓。四、纵隔(themediastinum)1．掌握纵隔的概念、境界和分区。(1)Conceptalloforgansbetweentheleftandrightmediastinalpleuraeiscalledmediastinum.(2)Itextendsfromthesternumtothebodiesofthevertebrae,andfromthesuperiorthoracicaperturetothediaphragm.(3)SubdivisionsofmediastinumSuperiormediastinumInferiormediastinumAnteriormediastinumMiddlemediastinumPosteriormidiastinum2．掌握上纵隔内器官结构层次。(Superiormediastinum)Content:Superficiallayer:ThymusThreeveins(leftbrachiocephalicv.rightbrachiocephalicv.superiorvenacave)MiddlelayerAorticarchanditsthreebranchesPhrenicn.Vagusn.PosteriorlayerTracheaEsophagusThoracicduct3．掌握主动脉弓的毗邻。掌握动脉导管三角的围成和内容。(1)RelationsofaorticarchAnteriorlyandtotheleft:PleuraLungPhrenicn.Pericardiacophrenicvessels(心包膈血管)Vagusn.Posteriorlyandtotheright:TracheaEsophagusLeftrecurrentlaryngealnerveThoracicductDeepcardiacplexusSuperior:ItsthreebranchesLeftbranchiocephalicveinThymusInferior:PulmonaryarteryArterialligamentLeftrecurrentnerveLeftprincipalbronchusSuperficialcardiacplexus（2）Triangleofductusarteriosus(动脉导管三角)BoundariesLeftphrenicnerveLeftvagusnerveLeftpulmonaryarteryContentsArterialligamentLeftrecurrentnerveSuperficialcardiacplexuses4．掌握食管胸部的毗邻。(Relationsofesophagus)Anterior:TracheaBifurcationoftrachea(气管杈)LeftprincipalbranchusLeftrecurrentlaryngealnerveAnterioresophagealplexusPericardiumLeftatriumDiaphragm(膈肌)PosteriorPosterioresophagealplexusThoracicaortaThoracicductAzygosveinHemiazygosveinAccessoryhemiazygosveinRightposteriorintercostalarteryLeftleftcommoncarotida.,leftsubclaviana.,aorticarch,thoracicaorta,superiorpartofthoracicductRight:Archofazygosvein第四章腹部(Abdomen)一、概述1．掌握腹部的体表标志。(Landmarksofabdomen)Xiphoidprocess(剑突)CostalarchAnteriorsuperioriliacspineIliaccrestPubicsymphysisPubictubercleUmbilicus（脐）atthelevelofL3~L4Lineaalba(白线)Lineasemilunaris(半月线)inguinalfold（腹股沟）二、腹前外侧壁（Anterolateralabdominalwall）1．掌握腹肌前外侧群的位置、层次、肌纤维方向、形成结构及作用。掌握腹直肌鞘的构成和特点。(1)AnterolateralmusclesObliquusexternusabdominis(腹外斜肌)Generaldirectionoffibers:downward,forwardandmedially(rundownandinward)OriginFromoutersurfaceoflowereightribsInsertionPosteriorfibersextendsverticallydownwardtoanteriorhalfofiliaccrestRemainder（剩余的）extenddownandmediallyintoabroadaponeurosis(腱膜),whichmeetitsfollowatlineaalba(白线)bycrossinganteriortorectusabdomins(腹直肌)Attachestoanteriorsuperioriliacspineandpubictubercletoformafreelowerborder(theinguinalligament腹股沟韧带)betweenthesetwopointsSuperficialinguinalring(腹股沟浅环)Triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercle（耻骨结节）Lacunarligament(腔隙韧带)ExtensionofinguinalligamentcurvingdownwardandposteriorlyfrompubictuberclePectinealligament(Cooper’s)耻骨梳韧带ContinuationoffibersoflacunarligamentalongthepectineallineObliquusinternusabdominis(腹内斜肌)DeeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsandmediallyOrigin:Lateral2/3ofinguinalligamentAnterior2/3ofiliaccrestThoracolumbarfascia(胸腰筋膜)InsertionExtensionofmostfiberupwardsandmediallyTolower3ribsandcostalcartilagesIntobroadaponeurosis,whichsplitsintoanteriorandposteriorleavestoencloserectusabdominis,meetingatlineaalbaFibersfrominguinalligament-archoverspermaticcord,insertedwithtransversusabdominisfibersintopubiccrestandadjacentpectineallinetoforminguinalfalx(腹股沟镰)DerivationofcremastermuscleandfasciaTransversusabdominis(腹横肌)DeeptoobliquusinternusGeneraldirectionoffibers:runhorizontallyforwardOrigin—Lateral1/3ofinguinalligamentAnterior2/3ofiliaccrestThoracolumbarfasciaLowersixribsandcostalcartilagesInsertion—Mostfibers—runhorizontallyintoabroadaponeurosis,mostofwhichpassesposteriortorectusabdominisandmeetsitsfellowatthelineaalbaInguinalfalx(腹股沟镰)Formedbyinsertionofobliquusinternusabdominisandtransversusabdominisfibersintopubiccrestandadjacentpectinealline(耻骨肌线)StrengthensabdominalwallposteriortosuperficialringObliquusinternusabdominishasalower,freeborderthatarchesoverspermaticcordInsertedwithtransversusabdominisfiberintomedialpartofpectenofpubisCremaster(提睾肌)DerivedfromthelowerfibersoftheobliquusinternusabdominisandtransversusabdominisAroundthespermaticcordandtestisRectusabdominis(腹直肌)Position:lieontoeitherofmidlineOrigin-pubiccrestandsymphysisInsertion:xiphoidandanteriorsurfaceof5th~7thcostalcartilagesHas3-4tendinousintersections(腱划)attachedtoanteriorrectussheathLineasemilunaris(半月线)（2）SheathofrectusabdominisEnclosesrectusabdominisAnteriorlayer:FormedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofobliquusinternusabdominisLowest1/4formedbyaponeurosisofallthreemusclesPosteriorlayer:FormedbyfusionofposteriorleafofaponeurosisofobliquusinternusabdominisandtransversusabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayer.Thelowerfreebordernamedarcuateline(弓状线)Belowthislinerectusabdominisincontactwithtransversefascia2．掌握腹前外侧壁的层次结构。Layersofanterolateralabdominalwall(fromsuperficialtodeep)SuperficialstructureskinsuperficialfasciaDeepstructuresanterolateralmusclevessels,lymphaticdrainageandnervesuperiorepigastrica.(腹壁上)，inferiorepigastrica.,deepiliaccircumflexa.(旋髂深)；腹部上部的深淋巴管注入肋间淋巴结或胸骨旁淋巴结，腹壁中部者注入腰淋巴结，腹壁下部者注入髂外淋巴结；iliohypogastricn.(髂腹下)，ilioinguinaln.(髂腹股沟)，genitofemoraln.(生殖股)transversefascia(腹横筋膜)extraperitonealfascia(腹膜外筋膜)parietalperitoneum(壁腹膜)3．掌握腹股沟区的境界。掌握腹股沟区的特点及其与腹股沟疝形成的关系。（Inguinalregion）(1)BoundariesInguinalligamentLateralmarginofrectusabdominisAhorizontallinestretchingfromanterioriliacspinetolateralmargintorectusabdominis（2）腹股沟区为腹壁的薄弱区，其原因在于1)腹外斜肌在此处移行为较薄的腹外斜肌腱膜，其下方还形成一裂口（腹股沟管浅环）；2）腹内斜肌与腹横肌的下缘均未达到腹股沟韧带的内侧部，因而该区域没有肌遮盖；3)男性有精索、女性有子宫圆韧带通过腹股沟管，在此形成解剖上的潜在性裂隙。4）当人体站立时，腹股沟区所承受的腹内压力比平卧时约高3倍。故腹壁疝多发生于此区。P1334.掌握腹股沟管的位置、构成及内容。(Inguinalcanal)(1)Position:obliquepassage,4cmlong,located1.5cmabovemediahalfofinguinalligament位于腹股沟韧带内侧半的上方，由外上斜向内下的肌筋膜裂隙。(2)Boundaries:FourwallsAnteriorwall:aponeurosisofobliquusexternusabdominisandobliquusinternusabdominis(lateralthirdofwall)浅层为腹外斜肌腱膜，深层在管的外侧1/3处有腹内斜肌起自腹股沟韧带的肌纤维加强Posteriorwall:transversefasciaandinguinalflaxmedially后壁为腹横筋膜，在管的内侧1/3处有发育程度不一的联合腱加强Roof:archingfibersofobliquusinternusandtransversusabdominis上壁为腹内斜肌与腹横肌形成的弓状下缘Floor:inguinalligament下壁为腹股沟韧带构成的凹槽。TwoopeningsSuperficialinguinalring(腹股沟浅环)外口Atriangular-shapedefectintheaponeurosisoftheobliquusexternusabdominisLiesimmediatelyaboveandmedialtothepubictubercleDeepinguinalring(腹股沟深环)内口AnovalopeningintransversefasciaLiesapproximately1.5cmabovemidpointofinguinalligament(3)StructurespassingthroughinguinalcanalInmale:Spermaticcord(精索)Ilioinguinalnerve(髂腹股沟神经)InfemalesRoundligamentofuterus(子宫圆韧带)Ilioinguinalnerve(髂腹股沟神经)5．掌握腹股沟三角的构成，腹股沟斜疝与直疝的解剖学鉴别要点。（InguinaltriangleofHesselbach）(1)Boundaries:LateralborderofrectusabdominismediallyInferiorepigastricartery(腹壁下动脉)laterallyInguinalligamentinferiorly(2)TypeindirectinguinalherniaDirectinguinalherniaDescriptionprotrudesthroughtheinguinalringandisultimatelytheresultofthefailureofembryonicclosureoftheinternalinguinalringafterthe

\o"Testicle"testicle

passesthroughitentersthroughaweakpointinthefasciaoftheabdominalwall(\o"Hesselbachtriangle"Hesselbachtriangle)Relationshipto\o"Inferiorepigastricvessels"inferiorepigastricvesselsLateralMedialCoveredby\o"Internalspermaticfascia"internalspermaticfascia?YesNoUsualonsetCongenital/AdultAdult三、腹膜腔1．掌握网膜孔和网膜囊的境界及临床意义。(1)Omentalforamen(网膜孔)Behindtherightborderofhepatoduodenalligament(肝十二指肠韧带)Superior:caudatelobeofliver(肝尾状叶)Inferior：superiorpartofduodenumAnterior:（freeborderof）hepatoduodenalligamentPosterior:peritoneumcoveringtheinferiorvenacava(2)Omentalbursa(网膜囊)Position:liesbehindthelesseromentum(小网膜)andstomachWalls:Superiorly:peritoneum(腹膜)whichcoversthecaudatelobeofliveranddiaphragmAnteriorly:formedbylesseromentum,peritoneumofposteriorwallofstomach,andanteriortwolayersofgreateromentumInferiorly:conjunctiveareaofanteriorandposteriortwolayersofgreatomentumPosteriorly:formedbyposteriortwolayersofgreateromentum,transversecolonandtransversemesocolon,peritoneumcoveringpancreas,leftkidneyandsuprarenalgland.Left－formedbythespleen,gastrosplenicligament（胃脾韧带）andsplenorenalligament（脾肾韧带）Right－formedbyomentalforamen临床意义：TheOmentalbursa(lessersac)communicateswiththegreatersacthroughtheomentalforamen.手术时，遇有外伤性肝破裂或肝门附近动脉出血，可将示指伸入孔内，拇指在小网膜游离缘用力捏压，进行暂时止血。若肠襻经网膜孔突入网膜囊，则形成网膜囊疝。由于网膜孔周边都有重要结构，因此当网膜囊疝发生嵌顿时必须切开胃结肠韧带以接触嵌顿。网膜囊是腹膜腔的一个盲囊，位置较深，局邻关系复杂，相邻器官的病变由此相互影响。当胃后壁穿孔或某些炎症导致网膜囊内积液（脓）时，液体可经网膜孔流到腹膜腔的其他部位，引起炎症扩散。但有时由于网膜孔周缘的腹膜受到刺激发炎而封闭了网膜孔，扩散范围不会太大，感染也很局限，故腹膜刺激症状不甚明显，给诊断带来一定困难。(一)结肠上区(Supracoliccompartment)1．掌握胃的位置与毗邻、胃周围的韧带及胃的动脉供应。(Stomach)(1)Location:Mainlypartsissituatedinthelefthypochondriacregion(季肋区)Smallintheepigastricregion(上腹区)Thecardia(贲门)issituatedtotheleftofT11,thepylorus（幽门）liestotherightofL1（2）Relationship：Anteriorly:Liver(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(lowerpart)Posteriorly:separatedbyperitoneumoflessersacfromthefollowing(“stomach-bed”)PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversemesocolon(3)LigamentsofstomachHepatogastricligament肝胃韧带Gastrocolicligament胃结肠韧带Gastrosplenicligament胃脾韧带Gastropancreaticligament胃胰韧带Gastrophrenicligament胃膈韧带(4)ArteriesofstomachLeftandrightgastricarteries(左右胃动脉)Arisefromceliactrunkandproperhepaticartery,respectively(分别)Runinlesseromentumalonglessercurvature,andanastomose(吻合)end-to-endRightandleftgastroepiploicartery(左右胃网膜动脉)Arisefromthegastroduodenal(胃十二指肠)andsplenicartery,respectivelyThesetwovesselspassintothegreateromentum,runparalleltothegreatercurvature,andanastomoseend-to-endShortgastricarteries(胃短动脉)BranchesofsplenicarteryCoursethroughthegastrosplenicligamentSupplythefundusofstomachPosteriorgastricartery(72%)胃后动脉ArisefromthesplenicarteryCoursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach2．掌握十二指肠的分部及毗