腹前外侧壁的解剖

1. 腹前外侧壁的解剖 易西南 201.3

2. 一、目的要求 1、掌握腹部的标志线及体表标志和腹部的分区。 2、掌握腹膜腔及腹膜与腹、盆腔脏器的关系。 3、掌握腹前外側壁层次结构及外科手术切口与腹壁 层次的关系。 4、掌握腹股沟三角的位置、构成和临床意义.。 5 、掌握腹股沟管的位置、 构成及内容物。 二、思考题 1、试述腹股沟管的位置、 构成和通行结构。 2、腹股沟直疝和斜疝的疝囊各通过哪些途径到达阴囊或大阴唇皮下? 3、 阑尾切除术可选择什么切口?经过哪些层次可到达阑尾?

3. 一、概 述 界域Boundaries of the abdomen Boundaries • Superiorly－ xiphoid process, lower border of costal arch, 11th and 12th ribs, vertebra T12 • Inferiorly－superior border of pubic symphysis, pubic crest, pubic tubercle, fold of inguinal canal, anterior superior iliac spine, iliac crest, spinous process of L5

4. 腹部分区The abdominal regions ——Nine regions Epigastric region 腹上区 R. hypochondriac region 右季肋区 L. hypochondriac region 左季肋区 R. lateral regions 右外区 L. lateral regions 左外侧区 R. inguinal region右腹股沟区 Umbilical region 脐区 L. inguinal region 左腹股沟区 Pubic region 耻区

5. Left and right upper quadrants Left and right lower quadrants The abdominal regions 腹部分区——Four quadrants

6. 表面标志Landmarks of abdomen • Pubic symphysis • Pubic tubercle • Iliac crest • Umbiicus • Linea semilunaris • Transpyloric plane

9. 二、腹前外侧壁Anterolateral abdominal wall Layers( from superficial to deep) • Skin • Superficial fascia • Anterolateral muscles • Transverse fascia 腹横筋膜 • Extraperitoneal fascia 腹膜下筋膜 • Parietal peritoneum 壁腹膜

10. 一、层次 （一）皮肤： 　　　浅层(Camper筋膜) （二）浅筋膜 深层(Scarpa筋膜) 1.浅动脉：腹壁浅动脉和旋髂浅动脉 2.浅静脉：“海蛇头”

11. 肋间神经前皮支 肋间神经外侧皮支 腹壁浅静脉 旋髂浅静脉

12. 皮下血管和神经Superficial vessels and cutaneous nerves • Arteries • Superficial epigastric a. • Superficial iliac circumflex a. • Veins • Thoracoepigastric v. • Superficial epigastric v. • Cutaneous nerves • Anterior and lateral cutaneous n. of lower six thoracic • Iliohypogastric n. (first lumb nerves)

13. 肋下动脉 旋髂浅动脉 腹壁浅动脉 腹壁下动脉

14. Superficial vessels and cutaneous nerves • 淋巴引流Lymph drainge • Superficial lymph vessels above the level of the umbilicus grain upward into the pectoral Ln. • The vessels below this level drain downward into the superficial inguinal Ln.

15. 腹肌Muscles of abdomen Anterolateral group • Obliquus externus abdominis 腹外斜肌 • Obliquus internus abdominis 腹内斜肌 • Transversus abdominis 腹横肌 • Rectus abdominis 腹直肌

16. Obliquus externus absominis 腹外斜肌 • General direction of fibers: downward, forward and medially (run down and inward)

17. Obliquus externus absominis 腹外斜肌 Relative Structures • Inguinal ligament腹股沟韧带 • Lacunar ligament腔隙韧带 • Superficial inguinal ring腹股沟管浅环－triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle

18. 腹股沟浅环Superficial inguinal ring

19. Obliquus internus abdominis 腹内斜肌 • Deep to obliquus externus abdominis • General direction of fibres: upwards, forwards and medially

20. Transversus abdominis 腹横肌 • Deep to obliquus internus • General direction of fibers: run horizontally forward.

21. Transversus abdominis腹横肌 • Inguinal falx腹股沟镰 • Obliquus internus abdominis has a lower, free border that arches over spermatic cord • Inserted with transversus abdominis fiber into medial part of pecten of pubis • Cremaster提睾肌 • Dirived from the lower fibers of the obliquus internus abdominis and transversus abdominis • Around the spermatic cord and testis

22. Rectus abdominis 腹直肌 • Position: lie on to either of midline • Origin: pubic crest and symphysis • Insertion: xiphoid and 5th-7th costal cartilages • Tendinous intersections腱划3-4 • linea semiluaris半月线

23. Similar functions for above four pairs of muscles • Support and compress the abdominal viscera • Increase intra-abdominal pressure, aid in expulsive efforts-vomiting, coughing, sneezing, defecation, urination and childbirth. • Depress ribs, assist in (the act of force(4)expiration. • Flex, lateral flex, and rotate vertebral column

24. Sheath of rectus abdominis 腹直肌鞘 Anterior layer • Formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis

25. Sheath of rectus abdominis 腹直肌鞘 Posterior layer • Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transversus abdominis • Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line 弓状线 • Below this line rectus abdominis in contact with transverse fascia

26. Muscles of abdomen Linea alba白线 －tendinous raphe between right and left recti from xiphoid to pubic symphysis

27. 深层血管Deep vessels of abdomen Arteries • Superior and inferior epigastric arteris • Lower posterior intercostal aa. • Subcostal a. • Deep iliac circumflex a. • Four lumbar a.

28. 深层神经Deep nerves of abdomen • Lower five intercostals nerves • Subcostal nerve • Run between obliquus internus and tranversus abdominis.

29. Deep nerves of abdomen Iliohypogastric n.髂腹下神经 • Arises from lumbar plexus • Passes forward in the interval between obliquus internus and tranversus abdominis • Pieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spine • Pieces aponeurosis of obliquus externus abdominisabout 2.5 cm above superficial inguinal ring

30. Deep nerves of abdomen Ilioinguinal n.髂腹股沟神经 • Arises from lumbar plexus • Runs parallel with iliohypogastric n. at a lower level • Enters inguinal canal and exits through superficial inguinal ring • Supplies the transversus abdominis, obliquus internus, and obliquuse externus abdiminis. It also supplies the skin just above the symphysis pubis and the scrotum or greater lip of pudendum.

31. Deep nerves of abdomen Genitofemoral n.生殖股神经 • Arises from lumbar plexus • Emerges through superficial inguinal ring and supplies the cremaster muscle

32. 白线 弓状线

33. Inguinal region 腹股沟区 Boundaries界域 • Inguinal ligament • Lateral margin of rectus abdominis • A horizontal line stretching from anterior iliac spine to lateral margin of rectus abdominis

34. Inguinal canal 腹股沟管 Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal ligament

35. Ligaments in inguinal region腹股沟区的韧带 Inguinal ligament 腹股沟韧带 Lacunar ligament 腔隙韧带 Superficial inguinal ring腹股沟管浅环

36. Boundaries of inguinal canal腹股沟管构成 Anterior wall- Aponeurosis of obliquus externus abdominis

37. Roof－arching fibers of obliquus internus and transversus abdominis上壁 Floor－inguinal ligament下壁

38. Posterior wall-Transverse fascia • Inguinal flax medially后壁及内环

39. 后壁凹间韧带及腹横筋膜

40. 腹股沟管inguinal canal ： 两口Two openings： 外口（浅环，皮下环） 内口（深环，腹环） 四壁four walls： 前壁：皮肤、皮下组织、和腹外斜肌腱膜 后壁：腹横筋膜，内侧1/3处有腹股沟镰 上壁：腹内斜肌与腹横肌形成的弓状下缘 下壁：腹股沟韧带和腔隙韧带

41. 腹股沟三角

42. 腹股沟三角inguinal triangle (海氏三角Hesselbach triangle）： 腹壁下动脉inferior epigastric arteris 腹直肌外侧缘lateral border of rectus abdominis 腹股沟韧带内侧段inguinal ligament

43. Femoral ring股环

45. Descent of testes 睾丸下降及 鞘膜腔的形成

46. Descent of testes Seven-week embryo showing the testis before its descent from the dorsal abdominal wall

47. Descent of testes Fetus at 28 week the testis passing through the inguinal canal

48. Descent of testes Newborn

49. 精索的结构与腹壁的关系 精索结构层次 皮肤 阴囊皮肤 皮下 阴囊肉膜及中隔 腹外斜肌腱膜 精索外筋膜 腹横肌及腹内斜肌 提睾肌 腹横筋膜 精索内筋膜膜 腹膜 腹膜鞘突及睾丸鞘膜 睾丸A、V及输精管 精索外筋膜 提睾肌 精索内筋膜

50. 睾丸a.v.L输精管 精索内筋膜 提睾肌 精索外筋膜 皮下（阴囊肉膜） 皮肤