腹前外侧壁解剖.ppt

腹前外侧壁解剖.ppt

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January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹前外侧壁,内容：

一、浅层结构二、深层结构三、腹股沟区,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,一、浅层结构,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,皮肤:

薄而富有弹性,伸展性和移动性都相当大,故临床常选择为游离皮瓣的供皮区。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,浅筋膜:

在脐平面以下腹壁浅筋膜分浅、深两层。

浅层为Camper筋膜（脂肪层）。

深层为Scarpa筋膜（膜性层）。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,浅筋膜的脂肪层和膜性层之间有浅血管、淋巴管和皮神经。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,浅动脉：

腹前壁下半部有二条起自股动脉的浅动脉，较粗大：

腹壁浅动脉旋髂浅动脉,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,由于行于浅筋膜的浅、深二层之间的浅动脉与同名静脉伴行，故临床上常在腹下部切取带蒂或游离皮瓣。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,浅静脉：

腹前壁的浅静脉较丰富,彼此吻合成网。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,脐以上的浅静脉经汇入腋静脉，脐以下的浅静脉汇入大隐静脉。

脐区的浅静脉还与附脐静脉相吻合。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,浅淋巴管：

脐以上的浅淋巴管注入腋淋巴结，脐以下浅淋巴管注入腹股沟浅淋巴结。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,皮神经：

第7-12胸神经前支第1腰神经,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,二、深层结构,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,

（一）肌层腹直肌腹外斜肌腹内斜肌腹横肌,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,1.腹直肌abdominalrectusm.,腹直肌作用：

使脊柱前屈,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,在腹直肌表面包有腹直肌鞘。

腹直肌鞘,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘的构成：

由腹外侧壁三层阔肌的腱膜构成。

腹直肌鞘分为前、后二层。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘前层：

由腹外斜肌腱膜和腹内斜肌腱膜的前层愈合而成。

腹直肌鞘前层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,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。

腹直肌鞘后层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘前层包被整个腹直肌。

腹直肌鞘前层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘后层在脐下45cm处缺如，而形成一凸向上方的弓形线称弓状线。

弓状线,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,弓状线以下，三层阔肌的腱膜全部转到腹直肌的前面构成腹直肌鞘前层。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,弓状线以下的腹直肌后面直接与腹横筋膜相贴。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘的前、后二层在腹直肌的外侧缘互相融合构成一半月形的凸向外侧的弧形称半月线,半月线：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,由两侧腹直肌鞘纤维腹前正中线上彼此交织而成。

厚而坚韧，血管少。

腹白线：

腹白线,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,2.腹外斜肌,肌纤维方向：

腹外斜肌腱膜：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹外斜肌腱膜形成的主要结构：

腹直肌鞘前层皮下环（浅环）腹股沟韧带腔隙韧带耻骨梳韧带髂耻弓,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘前层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,皮下环（浅环）,内侧脚,外侧脚,脚间纤维,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹股沟韧带,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腔隙韧带,耻骨梳韧带（Cooper韧带）,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,髂耻弓,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,肌纤维方向:

腹内斜肌腱膜:

3.腹内斜肌,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,4.腹横肌,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹内斜肌、腹横肌及其腱膜形成的主要结构：

腹直肌鞘提睾肌腹股沟镰,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹直肌鞘,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹股沟镰（联合腱）,提睾肌,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹横肌深面的层次：

腹横筋膜,腹膜下筋膜,腹横筋膜腹膜下筋膜腹膜壁层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹横筋膜贴于腹横肌深面，在腹股沟管深环处呈漏斗状突出，延续为精索内筋膜。

腹横筋膜,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹膜下筋膜为一疏松结缔组织层，在腹股沟区此层含脂肪较多。

输精管、腹壁下动脉等均行于此层内。

腹膜下筋膜,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹膜壁层,腹膜壁层是腹前壁的最内层。

腹膜壁层,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹前壁下部的腹膜皱襞及隐窝,腹膜皱襞:

脐正中襞5条脐内侧襞脐外侧襞（腹壁下动脉襞）,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹膜隐窝：

腹股沟内侧窝,腹股沟外侧窝,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹腔脏器经腹股沟内侧窝突出为腹股沟直疝，经腹股沟外侧窝突出为腹股沟斜疝。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,

（二）腹前壁的血管、神经,1.血管腹壁上、下动脉下5对肋间后动脉肋下动脉4对腰动脉旋髂深动脉,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹壁下动脉：

腹壁下动脉是髂外动脉经过腹股沟韧带深面时发出的分支。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹壁下动脉的体表投影：

腹股沟韧带中内1/3交点与脐的连线。

故腹膜腔穿刺应在此线的外上方，以免损伤腹壁下动脉。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹股沟三角inguinaltriangle（Hessebach三角、直疝三角）,腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧段所围成的三角形区域。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,临床意义：

腹腔脏器经此三角（腹壁下动脉内侧）突出为腹股沟直疝。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,2.腹前壁的神经第712胸神经前支髂腹下神经髂腹股沟神经生殖股神经,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,三、腹股沟区,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,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,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,1.腹股沟管,位置：

位于腹股沟韧带内侧半上方，长约45cm。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,通过腹股沟管的内容：

精索（男）子宫圆韧带（女）,精索,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,皮下环（浅环）,腹环（深环）,腹股沟管有二口：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,前壁：

腹内斜肌,腹外斜肌腱膜,腹股沟管有四壁：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,后壁：

腹股沟镰,腹横筋膜,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,上壁：

腹内斜肌和腹横肌的弓状下缘,腹股沟韧带,下壁：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,2.腹股沟疝,凡器官或结构从先天或后天形成的裂口或薄弱区脱出者，称为疝。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹股沟韧带上方脱出者，称为腹股沟疝。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,腹股沟疝又分为：

斜疝,直疝,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,以腹壁下动脉为标志。

脏器经腹壁下动脉的外侧（深环）突出者为斜疝。

脏器经腹壁下动脉的内侧（直疝三角）突出者为直疝。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,斜疝：

脏器包在精索的3层被膜内,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,直疝：

疝囊在精索被膜之外,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,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。

睾丸下降与腹膜的关系：

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,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，鞘突的其余部分则闭锁形成鞘韧带。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,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。

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.Al