人体形态科学学习资料：PBL重点终结版

PBL重点考点----99K82B138211朱浩Case11.McBureny’spoint麦氏点Thesurfaceprojectionoftherootofappendixisthelateral1/3pointofthelinebetweenumbilicus脐andtherightanteriorsuperioriliacspine.右髂前上棘脐右髂前上棘在脐至右髂前上棘连线的中外1/3交界处。2.麦氏切口Atthelateral1/3pointofthelinebetweenumbilicusandtherightanteriorsuperioriliacspine,maketheincisionwhichisperpendiculartothisline.About5to7cmlong.从脐到右髂前上棘连线的中外1/3处，所作的垂直于此线的切口，长约5到7厘米3.WhichlayerswillyoumeetwhenyouchoosetheMcBureny’sincision?阑尾交错切口所经过的层次(1)skin皮肤(2)superficialfascia浅筋膜(3)aponeurosisofexternalabdominalobliquemuscle腹外斜肌腱膜(4)obliquusinternusabdominis腹内斜肌(5)transversusabdominis腹横肌(6)transversalisfasciaortransversefascia腹横筋膜(7)extraperitonealfascia腹膜外筋膜(8)parietalperitoneum壁腹膜4.Duringtheoperation,howtofindvermiformappendix?如何在手术中寻找阑尾Firstfindcecum盲肠intherightiliacfossa右髂窝,andthentrackdowntherootsofappendixalongwithcolicbandsofcecum.Namely,wecanputoutthewholeappendix.盲肠右髂窝先在右髂窝内找到盲肠，再沿盲肠的结肠带往下追踪找到阑尾根部，即可将整条阑尾牵出。Case21.Recognizeanddefinetheinguinalregion?什么是腹股沟区？（P53）Thetriangleareasurroundedbythelateralborderofrectusabdominis,Theinguinalligamentandthehorizontallinefromanterioriliacspinetothelateralborderofrectusabdominis.Itisaweakregionofabdominalwall.腹腹股沟区为下腹部两侧的三角形区域，其内界是腹直肌的外缘，上界为髂前上棘至腹直肌外缘的水平线，下界为腹股沟韧带。是腹膜的薄弱部位。2.Recognizeanddefinetheinguinaltriangle(Hesselbanch’sTriangle)?.什么是腹股沟三角（海氏三角）？Thetriangleareasurroundedbyinferiorepigastricartery腹壁下动脉,inguinalligament腹股沟韧带andthelateralborderoftherectusabdominis腹直肌.腹壁下动脉腹股沟韧带腹直肌腹壁下动脉与腹股沟韧带及同侧腹直肌外缘围成的三角形区域。3.The4wallsand2openingsofinguinalcanal腹股沟管四壁两口Fourwalls:1).thesuperiorwall（上壁）:thearcuatelateralbordermadebytheobliquusinternusabdominis腹内斜肌andthetransversesabdominis腹横肌腹内斜肌腹横肌上壁为腹内斜肌和腹横肌的弓形下缘2).theinferiorwall（下壁）:isformedbyinguinalligament腹股沟韧带腹股沟韧带下壁为腹股沟韧带3).theanteriorwall（前壁）:aponeurosisoftheobliquusexternusabdominis腹外斜肌腱膜andlaterallyisreinforcedbymusclefibersofobliquusinternusabdominis腹内斜肌inthedeeplayercuttheouter1/3ofthecanal.腹外斜肌腱膜腹内斜肌前壁为腹外斜肌腱膜，其外1/3份有腹内斜肌参与构成。4).theposteriorwall（后壁）:transversalisfascia腹横筋膜,腹横筋膜Twoopenings:Thedeepinguinalring腹股沟深环Thesuperficialinguinalring腹股沟浅环2.Howtodistinguishthedirectandindirecthernia?如何鉴别直疝和斜疝？p56indirecthernia斜疝directhernia直疝Positonthedeepinguinalring腹股沟深环theinguinaltriangle腹股沟三角inferiorepigastricartery腹壁下动脉fromoutsidefrominsideperitonealfossa腹膜窝fromlateralinguinalfossa

腹股沟外侧窝frommedialinguinalfossa腹股沟内侧窝DirectionfromhighoutsidetolowinsideanteriorAnswer1: Youcanalsopushtheabdominalcontentsbackintotheabdominalcavityandthenpressthedeepringontheconditionthattheabdominalpressureisincreased.Iftheherniaappearedagain,thenwecanconcludethatitisdirectinguinalhernia,oritwillbeindirectinguinalhernia.也可以把腹腔内容物推回到腹腔,然后在腹部压力增大的条件下按深环，如果疝气再次出现，可以下结论是直疝，否则是斜疝。Answer2:Indirecthernia:herniasacneckgoesthroughdeepinguinalringthengoesmedialanddownwardthroughinguinalcanal,andfinallydropsoutfromsuperficialinguinalring.Theherniasacneckcanevendropintoscrotum阴囊.阴囊斜疝：疝囊腹壁下动脉外侧的腹股沟深环突出，向内，向前斜行经过腹股沟管，在穿出腹股沟管浅环，并可以进入阴囊，称为腹股沟斜疝。Directhernia:herniasacneckdropsoutdirectlyfromtheinguinaltriangle腹股沟三角，anditdoesn’tgothroughinternalringordropintoscrotum.腹股沟三角直疝：疝囊经腹壁下动脉的腹股沟三角区由后向前突出，不经过内环，也不进入阴囊，为腹股沟直疝。Inaword,directherniadoesn’tgothroughinguinalcanalandtheindirectherniaismorelikelytohappenonthemalesthanthefemales.Directherniahappensjustdirectlythroughtheweaknessofepigastricandatthemedialofinferiorepigastricartery腹壁下动脉.Theindirectherniahappensmorelikelyonoldmentoo.腹壁下动脉直疝不经过腹股沟管，斜疝男性多于女性，直疝为有腹壁的薄弱部位直接向前突出，位于腹壁下动脉的内侧，斜疝老年人多见。Case31. Whicharteriessupplythestomach?胃的血供leftgastricartery胃左动脉rightgastricartery胃右动脉rightgastroepiploicartery胃网膜右动脉leftgastroepiploicartery胃网膜左动脉shortgastricartery胃短动脉posteriorgastricartery胃后动脉2.omentalbursa网膜囊，epiploicforamen网膜孔（概念）Theomentalbursaisanarrowandirregularspacethatexistsbetweenthestomachandtheposteriorwalloftheabdominalcavity.网膜囊是小网膜和胃后壁与腹后壁的腹膜之间的一个偏窄而不规则的间隙。Theboundariesoftheomentalbursaareasfollows:网膜囊的边界superior（上壁）:caudatelobeofliver肝尾状叶ventral:thestomachposterior（后壁）:posteriorabdominalwallinferior（下壁）:theduodenumepiploicforamen网膜孔:Theonlywaytoperitonealsacandperitonealcavity.腹膜囊与腹膜腔的唯一通道。3.迷走神经切除术的解剖基础Parietalcells’excessivesecretionofgastricacidisthemainreasonforgastriculcerandduodenalulcer.Highlyselectivevagotomycancutoffthebranchesofvagusnerveongastricbody,lessercurvatureandfundus,reducingthesecretionofacidofparetalcells.Meanwhile,highlyselectivevagotomypreservetheliverbranch,abdominalbranch,andthe"RavenClaw"-shapedbranchoftheanteriorandposteriorgastricbranch.Thus,itcanpreserveemptyingfunctionofstomachandavoiddysfunctionofliver,gallbladder,pancreasandintestines.壁细胞分泌的胃酸过多是引起胃、十二指肠溃疡的主要原因。高选择性迷走神经切断术切断迷走神经至胃体、胃小弯和胃底的分支，降低了壁细胞的泌酸功能，达到治疗溃疡的目的，同时，高选择性迷走神经切断术保留肝支、腹腔支和胃前、后支的“鸦爪”形分支，从而保留胃的排空功能，避免肝、胆、胰、肠的功能障碍。）Case41.门静脉吻合支(1)esophagealvenousofloweresophagus食管下段静脉丛(2)rectalvenousplexus直肠静脉丛(3)venousnetworkaroundumbilic脐周静脉网(4)RetziusveinRetzius静脉Case51.Thethreenarrowingsitesoftheureters.输尿管的三个狭窄(1)thepelviuretericjunction(肾盂输尿管移行处)d=0.2cm(2)crossingthepelvicbrim(跨越髂血管处)d=0.3cm(3)traversingthebladderwall(进入膀胱壁内)depands2.HowtolocatetheureterintheX-ray?影像学中如何定位输尿管？YoucanfindthatthereisashadowwithhighdensityinfrontofthetransverseprocessofL3andL4.Thepathoftheureteristhelinemakesbetweenthe2points.Weusuallycant’tfindtheureterintheX-