腹部概述腹前外側(cè)壁解剖課件

1、 腹 部 ABDOMEN2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹 部 ABDOMEN2021/7/22Copyrigh境界分區(qū)內(nèi)容概述2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 境界概述2021/7/22Copyr

2、ight Depart境界上界：劍突、肋弓、第11肋前端、第12肋下緣和第12胸椎下界:恥骨聯(lián)合上緣、恥骨嵴、恥骨結(jié)節(jié)、腹股溝韌帶、髂嵴至第5腰椎下緣的連線。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 境界上界：劍突、肋弓、第11肋前端、第12肋下緣和第12胸椎分區(qū)九分法四分法2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou Un

3、iversity. All right reserved by YP HOU and YF SONG 分區(qū)九分法四分法2021/7/22Copyright De內(nèi)容腹壁結(jié)腸上區(qū)結(jié)腸下區(qū)、腹膜后隙2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 內(nèi)容腹壁2021/7/22Copyright Depart腹前外側(cè)壁層次局部結(jié)構(gòu)睪丸下降與腹股溝疝的關(guān)系2021/7/22Copyright Depart. Anatomy

4、, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹前外側(cè)壁層次2021/7/22Copyright Dep層次1、皮膚2、淺筋膜3、肌層4、腹橫筋膜5、腹膜外組織6、壁腹膜2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 層次1、皮膚2021/7/22Copyright Depa1、皮膚 腹前外側(cè)

5、壁的皮膚 薄而富有彈性, 臨床常選擇為游離皮瓣的供皮區(qū)。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 1、皮膚 腹前外側(cè)壁的皮膚 薄而富有彈性, 臨床常選擇為 腹前外側(cè)壁淺筋膜較厚，在臍平面以下分淺、深兩層。 淺層：為含大量脂肪組織的Camper筋膜(脂肪層)，向下與股部的淺筋膜相續(xù) 。 深層：為富含彈性纖維的Scarpa筋膜(膜性層)，中線處附于白線，向下在腹股溝韌帶下方約一橫指處附于闊筋膜，向內(nèi)下與陰囊肉

6、膜及會(huì)陰淺筋膜相續(xù) 。2、淺筋膜2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹前外側(cè)壁淺筋膜較厚，在臍平面以下分淺、深兩層。2、淺筋 淺筋膜內(nèi)含有豐富的淺血管、淋巴管和皮神經(jīng)。淺動(dòng)脈：有三組腹側(cè)壁淺動(dòng)脈：來(lái)自肋間后動(dòng)脈、肋下動(dòng)脈及腰動(dòng)脈。正中線附近淺動(dòng)脈：來(lái)自腹壁上、下動(dòng)脈的分支。腹前壁下半部淺動(dòng)脈：腹壁淺動(dòng)脈、旋髂淺動(dòng)脈，為股動(dòng)脈分支。2021/7/22Copyright Depart. Anatomy,

7、 School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淺筋膜內(nèi)含有豐富的淺血管、淋巴管和皮神經(jīng)。淺動(dòng)脈：有三組2臍以下的淺靜脈匯入股靜脈。淺靜脈：豐富, 吻合成臍周靜脈網(wǎng)。臍以上的淺靜脈匯入腋靜脈。 在臍區(qū)，淺靜脈與深部的附臍靜脈吻合，并借此靜脈溝通肝門靜脈，從而構(gòu)成肝門靜脈系統(tǒng)與上、下腔靜脈系統(tǒng)的溝通。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserv

8、ed by YP HOU and YF SONG 臍以下的淺靜脈匯入股靜脈。淺靜脈：豐富, 吻合成臍周靜脈網(wǎng)。 淺淋巴管：與淺血管伴行。臍以上入腋淋巴結(jié)；臍以下入腹股溝淺淋巴結(jié)；臍部淋巴管可經(jīng)肝圓韌帶與肝的淋巴管交通。 2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淺淋巴管：與淺血管伴行。臍以上入腋淋巴結(jié)；臍以下入腹股溝皮神經(jīng)：呈節(jié)段性分布第7肋間神經(jīng)劍突平面 第10肋間神經(jīng)臍平面第12肋間神經(jīng)髂前上棘平面第

9、1腰神經(jīng)腹股溝平面2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 皮神經(jīng)：呈節(jié)段性分布2021/7/22Copyright 3、肌層腹直肌腹外斜肌腹內(nèi)斜肌腹橫肌2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 3、肌層腹直肌腹外斜

10、肌腹內(nèi)斜肌腹橫肌2021/7/22Cop腹直肌鞘腹直肌腹直肌腱劃2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹直肌鞘腹直肌腹直肌腱劃2021/7/22Copyright腹外斜肌腱膜形成的主要結(jié)構(gòu)：腹直肌鞘前層皮下環(huán)(淺環(huán)) 腹股溝韌帶腔隙韌帶恥骨梳韌帶2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All

11、 right reserved by YP HOU and YF SONG 腹外斜肌腱膜形成的主要結(jié)構(gòu)：腹直肌鞘前層皮下環(huán)(淺環(huán)) 腹內(nèi)斜?。杭±w維起自腹股溝韌帶外側(cè)1/2-1/3、髂棘及胸腰筋膜，呈扇形斜向內(nèi)上，后部纖維止于下3對(duì)肋，余纖維在腹直肌外側(cè)移行為腱膜，并分兩層包裹腹直肌，止于腹白線。 腹內(nèi)斜肌2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹內(nèi)斜?。杭±w維起自腹股溝韌帶外側(cè)1/2-1/3、髂棘及胸

12、腹橫?。杭±w維起自下6對(duì)肋骨內(nèi)面、髂棘、胸腰筋膜及腹股溝韌帶外側(cè)1/3，自后向前內(nèi)側(cè)橫行，在腹直肌外側(cè)移行為腱膜。 腹橫肌2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹橫?。杭±w維起自下6對(duì)肋骨內(nèi)面、髂棘、胸腰筋膜及腹股溝韌腹橫肌與腹內(nèi)斜肌共同形成的結(jié)構(gòu)：弓狀下緣腹股溝鐮（聯(lián)合腱）提睪肌2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzh

13、ou University. All right reserved by YP HOU and YF SONG 腹橫肌與腹內(nèi)斜肌共同形成的結(jié)構(gòu)：弓狀下緣腹股溝鐮（聯(lián)合腱4、腹橫筋膜 腹橫筋膜為腹內(nèi)筋膜的一部分，位于腹橫肌深面，形成的結(jié)構(gòu)有：凹間韌帶腹股溝管深環(huán)精索內(nèi)筋膜2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 4、腹橫筋膜 腹橫筋膜為腹內(nèi)筋膜的一部分，位于腹橫肌深5、腹膜外組織 腹膜外組織又稱腹膜外脂肪，

14、是位于腹橫筋膜與壁腹膜之間的疏松結(jié)締組織，向后與腹膜后隙的疏松結(jié)締組織相續(xù)。在腹股溝區(qū)此層含脂肪較多。輸精管、腹壁下動(dòng)脈等均行于此層內(nèi)，臨床行泌尿外科和婦產(chǎn)科手術(shù)，盡量避免進(jìn)入腹膜腔，經(jīng)腹膜外組織入路進(jìn)行。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 5、腹膜外組織 腹膜外組織又稱腹膜外脂肪，是位6、壁腹膜皺襞臍正中襞臍內(nèi)側(cè)襞臍外側(cè)襞隱窩腹股溝內(nèi)側(cè)窩膀胱上窩腹股溝外側(cè)窩2021/7/22Copyright D

15、epart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 6、壁腹膜皺襞臍正中襞臍內(nèi)側(cè)襞臍外側(cè)襞隱窩腹股溝內(nèi)側(cè)窩膀胱上腹前外側(cè)壁的血管、神經(jīng) 1.血管 腹壁上、下動(dòng)脈 下5對(duì)肋間后動(dòng)脈 肋下動(dòng)脈 4對(duì)腰動(dòng)脈 旋髂深動(dòng)脈 2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹前外側(cè)壁

16、的血管、神經(jīng) 1.血管 2021/7/22Cop腹壁下動(dòng)脈 腹壁下動(dòng)脈是髂外動(dòng)脈經(jīng)過(guò)腹股溝韌帶深面時(shí)發(fā)出的分支，其體表投影為腹股溝韌帶中內(nèi)1/3交點(diǎn)與臍的連線。故腹膜腔穿刺應(yīng)在此線的外上方，以免損傷腹壁下動(dòng)脈。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹壁下動(dòng)脈 腹壁下動(dòng)脈是髂外動(dòng)脈經(jīng)過(guò)腹股溝韌帶深 旋髂深動(dòng)脈：與腹壁下動(dòng)脈同一水平發(fā)自髂外動(dòng)脈，經(jīng)髂前上棘內(nèi)側(cè)，行向髂棘前部的上緣，在此分支入髂棘內(nèi)唇，臨床

17、上常取其為營(yíng)養(yǎng)動(dòng)脈的帶血管蒂髂骨移植。旋髂深動(dòng)脈2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 旋髂深動(dòng)脈：與腹壁下動(dòng)脈同一水平發(fā)自髂外動(dòng)脈， 2. 神經(jīng) 第7-12胸神經(jīng)前支 髂腹下神經(jīng) 髂腹股溝神經(jīng) 生殖股神經(jīng)2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP

18、 HOU and YF SONG 2. 神經(jīng) 2021/7/22Copyright De第7-12胸神經(jīng)前支2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 第7-12胸神經(jīng)前支2021/7/22Copyright 髂腹下神經(jīng)：髂前上棘內(nèi)側(cè)cm處穿入腹內(nèi)斜肌，腹股溝管淺環(huán)上方3 4 cm處穿出。分布于恥骨聯(lián)合上方皮膚和腹壁下部的肌肉。闌尾手術(shù)麥?zhǔn)锨锌趶?qiáng)調(diào)鈍性分離腹內(nèi)外肌，以避免損傷。 髂腹股溝神經(jīng)：在髂腹下神經(jīng)的

19、下方，進(jìn)入腹股溝管，行于精索上方，出腹股溝管淺環(huán)。分布于陰囊或大陰唇皮膚，肌支支配腹壁下部的肌肉。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 髂腹下神經(jīng)：髂前上棘內(nèi)側(cè)cm處穿入腹內(nèi)斜肌，腹股溝管淺生殖股神經(jīng)：在髂總血管附近分為生殖支和股支。生殖支進(jìn)入腹股溝管，隨精索下行，出腹股溝管淺環(huán)。手術(shù)處理腹股溝管時(shí)應(yīng)注意。2021/7/22Copyright Depart. Anatomy, School of Me

20、dicine, Lanzhou University. All right reserved by YP HOU and YF SONG 生殖股神經(jīng)：在髂總血管附近分為生殖支和股支。生殖支進(jìn)入腹股溝局部結(jié)構(gòu)1、腹直肌鞘2、腹白線3、腹股溝管4、腹股溝三角2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 局部結(jié)構(gòu)1、腹直肌鞘2021/7/22Copyright 腹直肌鞘：是包裹腹直肌和錐狀肌的纖維組織，由腹外側(cè)壁三

21、層闊肌的腱膜構(gòu)成，分前層、后層。在弓狀線上、下，前、后兩層結(jié)構(gòu)不同。 臍以上弓狀線以下腹外斜肌腹內(nèi)斜肌腹橫肌腹橫肌腹內(nèi)斜肌腹外斜肌白線后層后層前層前層2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹直肌鞘：是包裹腹直肌和錐狀肌的纖維組織，由腹外側(cè)壁三層闊肌 腹直肌鞘后層在臍下4-5cm處缺如，而形成一凹向下方的弓形線，稱弓狀線或半環(huán)線。弓狀線2021/7/22Copyright Depart. Anatomy

22、, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹直肌鞘后層在臍下4-5cm處缺如，而形成一凹向下方的腹白線：由兩側(cè)腹直肌鞘纖維腹前正中線上彼此交織而成。厚而堅(jiān)韌，血管少。腹白線腹白線2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹白線：由兩側(cè)腹直肌鞘纖維腹前正中線上彼此交織而成。厚而堅(jiān)韌 腹

23、股溝管：是位于腹股韌帶內(nèi)側(cè)半上方約1.5cm處由肌和筋膜形成的潛在性裂隙，長(zhǎng)約45cm。男性有精索、女性有子宮圓韌帶通過(guò)。是腹前外側(cè)壁的薄弱部位，有兩口四壁。 精索腹股溝管2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹股溝管：是位于腹股韌帶內(nèi)側(cè)半上方約1.5cm處由肌和腹股溝管二口： 外口（皮下環(huán)）：來(lái)自腹外斜肌腱膜。內(nèi)口（腹環(huán)）：來(lái)自腹橫筋膜。2021/7/22Copyright Depart. Anat

24、omy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 腹股溝管二口： 外口（皮下環(huán)）：來(lái)自腹外斜肌腱膜。內(nèi)口（腹 前壁：是腹外斜肌腱膜和腹內(nèi)斜肌。后壁：是腹橫筋膜和腹股溝鐮。下壁：是腹股溝韌帶上壁：是腹內(nèi)斜肌和腹橫肌的弓狀下緣。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 前壁：是腹外斜肌腱膜

25、和腹內(nèi)斜肌。后壁：是腹橫筋膜和腹凡器官或結(jié)構(gòu)從先天或后天形成的裂口或薄弱區(qū)脫出者，稱為疝。器官或結(jié)構(gòu)從腹股溝管突出為腹股溝斜疝，臟器包在精索的3層被膜內(nèi)。2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 凡器官或結(jié)構(gòu)從先天或后天形成的裂口或薄弱區(qū)脫出者，稱為疝。器腹股溝三角(hesselbach三角):腹直肌外側(cè)緣，腹股溝韌帶和腹壁下動(dòng)脈圍成的三角區(qū)。如腹腔內(nèi)容經(jīng)海氏三角處膨出，則為腹股溝直疝，疝囊在精索被膜之外。腹股溝韌帶腹股溝管深環(huán)腹直肌腹壁下動(dòng)脈精索股靜脈 股動(dòng)脈 2021/7/22Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG