腹前外侧壁解剖.ppt

腹前外侧壁腹前外侧壁内容：内容：一、浅层结构一、浅层结构 二、深层结构二、深层结构 三、腹股沟区三、腹股沟区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 一、浅层结构一、浅层结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 皮皮肤肤:薄薄而而富富有有弹弹性性,伸伸展展性性和和移移动动性性都都相相当当大大,故故临临床床常常选选择择为为游游离离皮皮瓣的供皮区。瓣的供皮区。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅浅筋筋膜膜:在在脐脐平平面面以以下下腹腹壁浅筋膜分浅、深两层。壁浅筋膜分浅、深两层。浅浅层层为为Camper筋筋膜膜(脂肪层脂肪层)。深深层层为为Scarpa筋筋膜膜(膜膜性层性层)。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅浅筋筋膜膜的的脂脂肪肪层层和和膜膜性性层层之之间间有有浅浅血血管管、淋淋巴巴管管和皮神经。和皮神经。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅动脉：浅动脉：腹腹前前壁壁下下半半部部有有二二条条起起自自股股动动脉脉的的浅浅动脉，较粗大：动脉，较粗大：腹壁浅动脉腹壁浅动脉 旋髂浅动脉旋髂浅动脉January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 由由于于行行于于浅浅筋筋膜膜的的浅浅、深深二二层层之之间间的的浅浅动动脉脉与与同同名名静静脉脉伴伴行行，故故临临床床上上常在腹下部切取带蒂或游离皮瓣。常在腹下部切取带蒂或游离皮瓣。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅静脉：浅静脉：腹腹前前壁壁的的浅浅静静脉脉较较丰丰富富,彼彼此吻合成网。此吻合成网。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 脐脐以以上上的的浅浅静静脉脉经经汇汇入入腋腋静静脉脉，脐脐以以下下的的浅浅静静脉脉汇汇入入大大隐隐静静脉脉。脐脐区区的的浅浅静静脉脉还还与与附附脐脐静脉相吻合。静脉相吻合。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅淋巴管：浅淋巴管：脐脐以以上上的的浅浅淋淋巴巴管管注注入入腋腋淋淋巴巴结结，脐脐以以下下浅浅淋淋巴巴管管注注入入腹腹股沟浅淋巴结。股沟浅淋巴结。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 皮神经：皮神经：第第7-127-12胸神经前支胸神经前支 第第1 1腰神经腰神经January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 二、深层结构二、深层结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（一）肌层（一）肌层腹直肌腹直肌腹外斜肌腹外斜肌腹内斜肌腹内斜肌腹横肌腹横肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.腹直肌腹直肌 abdominal rectus m.腹直肌作用腹直肌作用：使脊柱前屈使脊柱前屈January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在在腹直肌表腹直肌表面包有面包有腹直肌鞘腹直肌鞘。腹直肌鞘腹直肌鞘January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直腹直肌鞘的构成：肌鞘的构成：由腹外侧壁由腹外侧壁三层阔肌的腱膜三层阔肌的腱膜构成。构成。腹直腹直肌鞘分肌鞘分为前、后二层。为前、后二层。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘前层：腹直肌鞘前层：由由腹外斜肌腹外斜肌腱膜和腹内斜腱膜和腹内斜肌腱膜的前层肌腱膜的前层愈合而成。愈合而成。腹直肌鞘前层腹直肌鞘前层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘后层：腹直肌鞘后层：由腹内斜肌腱膜的后层和腹横肌腱膜愈合而成。腹直肌腹直肌鞘后层鞘后层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘腹直肌鞘前层前层包被整个包被整个腹直肌。腹直肌。腹直肌鞘腹直肌鞘 前层前层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘后腹直肌鞘后层层在脐下在脐下45cm处处缺如，缺如，而形成而形成一凸向上方的弓一凸向上方的弓形线称形线称弓状线弓状线。弓状线弓状线January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 弓状线以弓状线以下，三层阔肌下，三层阔肌的腱膜全部转的腱膜全部转到到腹直肌的前腹直肌的前面构成腹直肌面构成腹直肌鞘前层鞘前层。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 弓弓状状线线以以下下的的腹腹直直肌肌 后后面面直直接接与与腹腹横横筋筋膜膜相贴。相贴。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘的前、后腹直肌鞘的前、后二层在腹直肌的外二层在腹直肌的外侧缘互相融合构成侧缘互相融合构成一半月形的凸向外一半月形的凸向外侧的弧形称侧的弧形称半月线半月线半月线：半月线：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 由两侧腹直肌由两侧腹直肌鞘纤维腹前正鞘纤维腹前正中线上彼此交中线上彼此交织而成。厚而织而成。厚而坚韧，血管少。坚韧，血管少。腹白线：腹白线：腹白线腹白线January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.腹外斜肌腹外斜肌 肌纤维方向：肌纤维方向：腹外斜肌腱膜：腹外斜肌腱膜：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹外斜肌腱膜形成的主要结构：腹外斜肌腱膜形成的主要结构：腹直肌鞘前层腹直肌鞘前层皮下环皮下环(浅环浅环)腹股沟韧带腹股沟韧带腔隙韧带腔隙韧带耻骨梳韧带耻骨梳韧带髂耻弓髂耻弓January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘前层腹直肌鞘前层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 皮下环皮下环(浅环浅环)内侧脚内侧脚外侧脚外侧脚 脚间纤维脚间纤维January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟韧带腹股沟韧带January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腔隙韧带腔隙韧带耻骨梳韧带耻骨梳韧带(Cooper韧带韧带)January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 髂耻弓髂耻弓January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肌纤维方向肌纤维方向:腹内斜肌腱膜腹内斜肌腱膜:3.腹腹内斜内斜肌肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 4.腹横肌腹横肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹内斜肌、腹横腹内斜肌、腹横肌及其腱膜形成肌及其腱膜形成的主要结构：的主要结构：腹直肌鞘腹直肌鞘 提睾肌提睾肌 腹股沟镰腹股沟镰January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹直肌鞘腹直肌鞘January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟镰（联合腱）腹股沟镰（联合腱）提睾肌提睾肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹横肌深面的层次：腹横肌深面的层次：腹横筋膜腹横筋膜 腹膜下筋膜腹膜下筋膜腹横筋膜腹横筋膜腹膜下筋膜腹膜下筋膜腹膜壁层腹膜壁层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹横筋膜腹横筋膜贴于贴于腹横肌深面，在腹横肌深面，在腹股沟管深环处腹股沟管深环处呈漏斗状突出，呈漏斗状突出，延续为精索内筋延续为精索内筋膜。膜。腹横筋膜腹横筋膜 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹膜下筋膜腹膜下筋膜 为一疏松结缔组织为一疏松结缔组织层，在腹股沟区此层，在腹股沟区此层含脂肪较多。输层含脂肪较多。输精管、腹壁下动脉精管、腹壁下动脉等均行于此层内。等均行于此层内。腹膜下筋膜腹膜下筋膜 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹膜壁层腹膜壁层腹膜壁腹膜壁层层是腹前壁是腹前壁的最内层。的最内层。腹膜壁层腹膜壁层January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹前壁下部的腹膜皱襞及隐窝腹前壁下部的腹膜皱襞及隐窝 腹膜皱襞腹膜皱襞:脐正中襞脐正中襞 5条条 脐内侧襞脐内侧襞 脐外侧襞脐外侧襞（腹壁下动脉襞）（腹壁下动脉襞）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹膜隐窝：腹膜隐窝：腹股沟内侧窝腹股沟内侧窝腹股沟外侧窝腹股沟外侧窝 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹腔脏器经腹腔脏器经腹股沟内侧窝突腹股沟内侧窝突出为腹股沟出为腹股沟直疝直疝，经腹股沟外侧窝经腹股沟外侧窝突出为腹股沟突出为腹股沟斜斜疝疝。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（二）腹前壁的血管、神经（二）腹前壁的血管、神经 1.血管血管 腹壁上、下动脉腹壁上、下动脉 下下5对肋间后动脉对肋间后动脉 肋下动脉肋下动脉 4对腰动脉对腰动脉 旋髂深动脉旋髂深动脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹壁下动脉：腹壁下动脉：腹腹壁壁下下动动脉脉是是髂髂外外动动脉脉经经过过腹腹股股沟沟韧韧带带深深面面时发出的分支时发出的分支。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹壁下动脉的体表投影：腹壁下动脉的体表投影：腹腹股股沟沟韧韧带带中中内内1/3交交点点与与脐脐的的连连线线。故故腹腹膜膜腔腔穿穿刺刺应应在在此此线线的的外外上上方方，以以免免损损伤腹壁下动脉。伤腹壁下动脉。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟三角腹股沟三角 inguinal triangle（Hessebach三角、直疝三角）三角、直疝三角）腹壁下动脉、腹直肌外侧缘和腹股沟韧带内腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧段所围成的侧段所围成的 三角形区域。三角形区域。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 临床意义：临床意义：腹腹腔腔脏脏器器经经此此三三角角（腹腹壁壁下下动动脉脉内内侧侧）突突出出为为腹股沟直疝腹股沟直疝。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.腹前壁的神经腹前壁的神经 第第712胸神经前支胸神经前支 髂腹下神经髂腹下神经 髂腹股沟神经髂腹股沟神经 生殖股神经生殖股神经January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 三、腹股沟区三、腹股沟区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟区由腹直肌外侧缘、腹股沟韧带和髂前上棘至腹直肌外侧缘的水平线围成。此区腹壁男性有精索、女性有子宫圆韧带等通过的腹股沟管，是腹壁的薄弱区之一，是疝的好发部位。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.腹股沟管腹股沟管 位置：位于腹位置：位于腹股沟韧带内侧股沟韧带内侧半上方，长约半上方，长约45cm。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 通过通过腹股沟管的腹股沟管的内容：内容：精索（男）精索（男）子宫圆韧带（女）子宫圆韧带（女）精索精索January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 皮下环（浅环）皮下环（浅环）腹环（深环）腹环（深环）腹股沟管有二口：腹股沟管有二口：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 前壁：前壁：腹内斜肌腹内斜肌腹外斜肌腱膜腹外斜肌腱膜 腹股沟管有四壁腹股沟管有四壁：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 后壁：后壁：腹股沟镰腹股沟镰 腹横筋膜腹横筋膜 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 上壁：上壁：腹内斜肌和腹横肌的弓状下缘腹内斜肌和腹横肌的弓状下缘 腹股沟韧带腹股沟韧带下壁：下壁：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.腹股沟疝腹股沟疝 凡器官或结构从先天或后天形凡器官或结构从先天或后天形成的裂口或薄弱区脱出者，称为成的裂口或薄弱区脱出者，称为疝疝。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟腹股沟韧带上方脱韧带上方脱出者，称为出者，称为腹股沟疝腹股沟疝。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹股沟疝又分为：腹股沟疝又分为：斜疝斜疝直直 疝疝January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 以以腹壁下动脉腹壁下动脉为为标志。脏器经腹壁下标志。脏器经腹壁下动脉的外侧（深环）动脉的外侧（深环）突出者为突出者为斜疝斜疝。脏器。脏器经腹壁下动脉的内侧经腹壁下动脉的内侧（直疝三角）突出者（直疝三角）突出者为为直疝直疝。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 斜疝：脏器包在精索的斜疝：脏器包在精索的3层被膜内层被膜内January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 直疝：疝囊在精索被膜之外直疝：疝囊在精索被膜之外January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 睾丸下降至腹股沟管腹环时，向前睾丸下降至腹股沟管腹环时，向前推顶腹膜壁层形成腹膜鞘突。推顶腹膜壁层形成腹膜鞘突。睾丸下降与腹膜的关系：睾丸下降与腹膜的关系：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 睾丸降入阴囊以后，包绕睾丸表睾丸降入阴囊以后，包绕睾丸表面的腹膜鞘突，形成睾丸固有鞘膜，面的腹膜鞘突，形成睾丸固有鞘膜，鞘突的其余部分则闭锁形成鞘韧带。鞘突的其余部分则闭锁形成鞘韧带。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 睾丸下降后，如腹膜鞘突未闭，仍与腹膜腔睾丸下降后，如腹膜鞘突未闭，仍与腹膜腔相通，则可形成先天性腹股沟斜疝或交通性鞘膜相通，则可形成先天性腹股沟斜疝或交通性鞘膜积液。由于右侧睾丸下降慢于左侧，鞘韧带闭锁积液。由于右侧睾丸下降慢于左侧，鞘韧带闭锁时间也较晚，故右侧斜疝多于左侧。时间也较晚，故右侧斜疝多于左侧。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 小结：小结：1.Camper筋膜筋膜、Scarpa筋膜筋膜 2.腹直肌鞘腹直肌鞘3.经腹白线切口、腹直肌切口、阑尾经腹白线切口、腹直肌切口、阑尾手术切口分别经过的层次。手术切口分别经过的层次。4.4.Hessebach三角、三角、腹股沟管腹股沟管5.如何鉴别腹股沟斜疝与直疝？如何鉴别腹股沟斜疝与直疝？January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG