局解-腹腔脏器局部解剖

TheAnatomyofAbdomen(腹部解剖2）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Outline内容大纲概述Introduction腹壁层次Thelayersoftheabdominalwall腹壁的重要局部Theimportantregionsofabdominalwall腹腔、腹膜及腹膜腔Abdominalcavity,peritoneumandperitonealcavity腹腔重要脏器局解Theimportantorgansofabdominalcavity胃；肝；肝外胆道；阑尾；肾肝的局解

Anatomyofliver形态

Externalfeatures位置和毗邻

Positionandrelationship形态和分叶

1sthepaticportaGlission系统

2ndhepaticporta3rdhepaticporta肝静脉系统位置和毗邻位置大部分位于右季肋区和腹上区，小部分位于左季肋区。体表投影123毗邻毗邻

膈面：肝右半部的借膈与右肋膈隐窝和右肺底相邻；肝左半部借膈与心的下面相邻脏面：右叶与右肾上腺、右肾、十二指肠上部及结肠右曲相邻；在右纵沟前方和胆囊相邻；后方则和下腔静脉肝后段相邻；后缘近左纵沟处与食管相接触；左叶脏面与胃前壁小弯侧相邻。毗邻肝脏的临床分叶和分段肝脏分段依据---肝静脉系统和Glisson系统Glisson系统右半肝尾状叶肝左半肝左半肝456肝脏移植病变肝脏摘除及供体肝移植管道吻合示意图1.组成Compositions

gallbladder胆囊(底、体、颈及管）

hepaticduct肝管（左、右和总）commonbileduct胆总管（四段）肝外胆道局解Anatomyofextrahepaticbileduct胆囊三角2.胆总管的分段3.胆总管各段毗邻的结构十二指肠上段

Righttoproperhepatica.Anteriortohepaticportalv.十二指肠后段

AnteriortothevenacavaRighttothehepaticportalv.胰腺段Liesinagroovebetweenposteriorsurfaceofduodenumandtheheadofpancreas十二指肠壁内段

Entersthewallofdescendingpartofduodenumobliquely

wherejoinsthepancreaticducttoformthehepatopancreaticampulla（肝胰壶腹）opensatthemajorduodenalpapilla结肠下区脏器解剖空、回肠的局解结肠的局解阑尾的局解阑尾的局部解剖形态、位置、体表投影及血供不同年龄段阑尾形态结构的变化及其与阑尾炎发病的关系阑尾手术及注意事项阑尾形态、

位置

5-7cm蚓状器官管径0.5-0.6cm阑尾位置

大体位置：右髂窝（有变异）局部位置：回肠前位（变异多）ABCEF体表投影中立点麦氏点兰氏点苏氏点闭孔内肌试验又名obturator征：病人仰卧位，使右髋关节（右大腿）屈曲，然后被动向内旋转，引起右下腹痛者为阳性。提示阑尾靠近闭孔内肌腰大肌试验左侧卧位将右下肢向后过伸，引起右下腹痛为阳性。表明阑尾炎患者阑尾位置深在盲肠后近腰大肌前方、盲肠后位或腹膜后位。罗氏征（又称间接压痛）：病人仰卧位，检查者用手掌按压左下腹部，或沿降结肠向上腹用力推挤，如右下腹疼痛加重即为阳性阑尾的血供阑尾切除术暴露并分离腹内斜肌切开皮肤、皮下组织，暴露腹外斜肌腱膜并沿纤维走行方向切开暴露并分离腹横肌斜肌，暴露腹横筋膜，腹膜外脂肪及壁腹膜血管钳钳夹提起腹横筋膜，腹膜外脂肪及壁腹膜，打开腹膜腔剪刀扩大腹膜腔切口寻找阑尾并拉出切口处理阑尾系膜，结扎血管结扎阑尾预置荷包缝合线切除阑尾一并残端消毒处理（注意事项）收紧预留荷包缝合线包埋阑尾残端清点器械，关腹（连续缝合腹膜）间断缝合肌层间断缝合腹外斜肌腱膜间断缝合皮肤皮下组织（必要时置引流）不同年龄段的阑尾解剖特点及阑尾炎特点腹膜后间隙解剖肾脏肾上腺输尿管腹段腹部大血管和神经肾脏的局解

Anatomyofthekidney大体形态GeneralfeaturesBeanshaped,reddish-brownorgansSuperiorextremity－broadandthinInferiorextremity－narrowandthickAnteriorsurface－convexPosteriorsurface－flatLateralborder－convexMedialborder－concaveRenalhilum肾门－averticalslitonthemedialborderofkidney,thestructureswhichenterandleavetherenalhilumiscalledrenalpedicle肾蒂,includingtherenalvein,renalartery,renalpelvis,lymphaticvesselsandnervesOrderofstructuresintherenalpediclefromanteriortoposterior－V.A.P.;fromsuperiortoinferior－A.V.P.Renalsinus肾窦－whichistherenalhilumleadsintoaspacewithinthekidney,therenalsinusisoccupiedbytherenalvessels,minorrenalcalices,majorrenalcalices,renalpelvisandsomeadiposetissue结构Structureofthekidney

Renalcortex肾皮质renalcolumns肾柱Renalmedulla

肾髓质

Renalpyramids肾锥体:15～20Renalpapilla肾乳头Papillaryforamina乳头孔Minorrenalcalices

肾小盏(7－8)Majorrealcalices

肾大盏

(2～3)Renalpelvis

肾盂位置Position

位于腹膜后间隙脊柱两侧，左右各一。左肾Leftkidney

位于T11-L2椎体下缘之间;第12肋斜行跨过其后面中部右肾Rightkidney

较左肾略低,位于T12-L3椎体上缘之间;第12肋斜行跨过其后面上部肾门Renalhilum

位于L1高度,距后正中线约5cm肾角Renalregion－theareabetween12thribandthelateralmarginoferectorspinae肾脏的体表投影2.5cm7.5cm-8.5cm肾脏变异被膜Coverings

Fibrouscapsule

纤维囊－astrongfibrouscapsulewhichstripseasilyfromanormalkidneysurfacebutadheresfirmlytoanorganthathasbeeninflamedFattyrenalcapsule脂肪囊

－athickadiposeconnectivetissuecapsule.ItactsasashockabsorbertoprotectthekidneyfromjoltingandjarringRenalfascia肾筋膜－onoutside,surroundsboththekidneyandsuprarenalgland,holdingtheseorgansinplaceSuperiorly－superarenalglandPosteriorlyThreemusclesDiaphragm(pleuralcavity),Psoasmajor腰大肌

Quadratuslumborum腰方肌ThreenervesSubcostal肋下NIliohypogastric髂腹下NIlioinguinal髂腹股沟NMedialLeftkidney－abdominalaortaRightkidney－inferiorcevavana肾脏的毗邻RelationshipsofkidneysAnteriorlyLeftkidneyStomach&spleen(superior),Pancreas(middle),leftcolicflexure(inferiorly)jejunumRightkidneyRightlobeofliver(superior)Rightcolicflexure(inferior)Descendingpartofduodenum(medially)肾段RenalsegmentsThekidneyisdividedintofivevascularsegmentsandeachissuppliedbyabranchoftherenalartery;betweenthesegmentsthereisn