1、Outline 讲授大纲讲授大纲 v 概述概述 Introduction v 腹壁层次腹壁层次 The layers of the abdominal wall v 腹壁的重要局部腹壁的重要局部 The important regions of abdominal wall v 腹腔、腹膜及腹膜腔腹腔、腹膜及腹膜腔 Abdominal cavity, peritoneum and peritoneal cavity v 腹腔重要脏器局解腹腔重要脏器局解 The important organs of abdominal cavity 胃；胃； 肝脏；肝外胆道；肾脏肝脏；肝外胆道；肾脏 腹腔、腹
2、膜和腹膜腔腹腔、腹膜和腹膜腔 (Abdominal cavity, Peritoneum and Peritoneal cavity) 基本概念：基本概念： 腹腔腹腔 腹膜（腹膜（ 壁腹膜和脏腹膜）壁腹膜和脏腹膜） 腹膜腔腹膜腔 The introduction of the peritoneum uDefinition The peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cav
3、ities uSubdivisions and peritoneal cavity Parietal peritoneum 壁腹 膜 lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹 膜 covers the organs Peritoneal cavity 腹膜腔 the potential space between the parietal and visceral layer of peritoneum. Is there any organs in the peritoneal ca
4、vity? The peritonitis is very common for female! For male, it is a closed sac. But for female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina. uFunction Secretes a lubricating serous fluid that continuously moistens the associated organs Support and
5、protect viscus Semipermeable membrane (Peritoneal dialysis) Absorption The relationship between viscera and peritoneum Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera v Intraperitoneal viscera 腹膜内位器官 viscera completely surrounded by peritoneum, example, stomach, superior part
6、 of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovary v Interperitoneal viscera 腹膜间位器官 most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colons, upper part of rectum, urinary bladder and uterus v Re
7、troperitoneal viscera 腹膜外位器官 some organs lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureter Structures formed by peri
8、toneum Omentum 网膜 The fold of peritoneum that extends from two curvatures of stomach to adjacent organs l Lesser omentum 小网膜 two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum. l Greater omentum 大网膜 four-layered fold of perito
9、neum, the anterior two layers descend from the greater curvature of stomach and inferior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. Lesser omentum Greater omentum Mesenterium 系膜 two-layered fold of p
10、eritoneum that attach the abdominal or pelvic organs to the posterior abdominal wall. mesenterium lMesentery 肠系膜 suspends the small intestine from the posterior abdominal wall v Broad and a fan-shaped v Intestinal border folded, 5-7 m long v Radix of mesentery 15 cm long Directed obliquely from left
11、 side of L2 to in front of right sacroiliac joint lMesoappendix 阑尾 系膜 v Triangular mesenterium extends from terminal part of ileum to appendix v Appendicular artery runs in free margin of the mesoappendix lTransverse mesocolon 横结肠系 膜 a double fold of peritoneum which connects the transverse colon to
12、 the posterior abdominal wall lSigmoid mesocolon 乙状结肠系膜 inverted V- shaped, with apex located in front of left ureter and division of common iliac artery Ligaments 韧带 lLigaments of liver v Falciform ligament of liver 镰状韧带 Consists of double peritoneal layer Extends from anterior abdominal wall (umbi
13、licus) to live Free border of ligament has ligamentum teres v Coronary ligament 冠状韧带 it is formed by the peritoneum between the diaphragm and the liver. There are left and right coronary ligament v Left and right triangular ligaments 左、右三角韧带 formed by the left and right extremity of coronary ligamen
14、t ligament, respectively vHepatogastric ligament 肝胃韧带 vHepatoduodenal ligament 肝十二指 肠韧带 Extends from porta hepatis to superior part of duodenum Contains common bile duct, proper hepatic a. and hepatic portal v. lLigaments of spleen v Gastrosplenic ligament 胃脾韧带 a double layer of peritoneum that conn
15、ects the fundus of stomach to hilum of spleen. In this double layer of peritoneum, there are the short gastric and left gastroepiploic vessels v Splenorenal ligament 脾肾韧带 extends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as
16、 the tail of pancreas v Phrenicosplenic ligament 膈脾韧带 lLigaments of stomach v Hepatogastric ligament 肝胃韧带 v Gastrosplenic ligament 胃脾韧带 v Gastrophrenic ligament 胃膈韧带 v Gastrocolic ligament 胃结肠韧带 v Gastropancrestic ligament 胃胰韧带 Folds, recesses and fossa 皱襞、隐窝和窝 lSuperior duodenal fold and recess 十二指
17、肠上襞和上隐窝 lInferior duodenal fold and recess 十二指肠下襞和下隐窝 lIntersigmoid recess 乙状结肠间隐窝 formed by the inverted V attachment of sigmoid mesocolon lHepatorenal recess 肝肾隐窝 lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the
18、subject is supine l Median umbilical fold 脐正中襞 contain the remnant of urachus (median umbilical ligaments) l Medial umbilical fold 脐内侧襞 contains remnants of the umbilical arteries (medial umbilical ligaments) l Lateral umbilical fold 脐外侧襞 contains the inferior epigastric vessels l Supravesical fossa
19、 膀胱上窝 l Medial inguinal fossa 腹股沟内侧窝 l Lateral inguinal fossa 腹股沟外侧窝 Pouches 陷窝 lIn male rectovesical pouch 直肠膀胱陷窝 lIn female Rectouterine pouch(Douglas,cavit y) 直肠子宫陷窝 between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝 between bladder and uterus lOmental bursa 网膜囊 Position situated behind the les
20、ser omentum and stomach Walls v Superior peritoneum which covers the caudate lobe of liver and diaphragm v Anterior formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum v Inferior conjunctive area of anterior and posterior two layers of greate
21、r omentum v Posterior formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland 腹膜腔的分部 The subdivision of the peritoneal cavity (two sacs) v Left formed by the spleen, gastrosplenic ligament胃脾韧带 and sp
22、lenorenal ligament 脾肾韧带 v Right formed by omental foramen Omental foramen 网膜孔 v Behind the right border of hepatoduodenal ligament v Superior caudate lobe of liver v Inferior superior part of duodenum v Anterior hepatoduodenal ligament v Posterior peritoneum covering the inferior vena cava The Oment
23、al bursa (lesser sac) communicates with the greater sac through the omental foramen. The subregions of the peritoneal cavity vThe transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments. 结肠 上区和结肠下区 Supracolic compartment 结肠上区 (subphrenic sp
24、ace) lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间 隙 lies between the diaphragm and live the falciform ligament divides it into right and left suprahepatic recesses v Left suprahepatic space 左肝上间隙 left anterior suprahepatic space left posterior suprahep
25、atic space v Right suprahepatic space 右肝上间隙 v Subphrenic extraperitoneal space 膈下腹膜外间隙 (corresponding to the bare area of liver) Infrahepatic space 肝下间隙 lies between the live and transverse colon and transverse mesocolon the ligamentum teres hepatic divides it into right and left infrahepatic spaces
26、 v Right infrahepatic space 右肝 下间隙 (hepatorenal recess) v Left infrahepatic spaces 左肝 下间隙 left anterior infrahepatic space left posterior infrahepatic space Infracolic compartment 结肠下区 lies below the transverse colon and transverse mesocolon v Right paracolic sulcus (gutter) 右结肠旁沟 lies lateral to th
27、e ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal region. v Left paracolic sulcus (gutter) 左结肠旁沟 lies lateral to the descending colon. It is separated from the area around t
28、he spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm. vRight mesenteric sinus 右肠系膜窦 triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon vLeft mesenteric sinus 左肠系膜窦 lies
29、 between root of mesentery, descending colon, left 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis u The organs of the abdominal cavity 腹腔脏器： Supracolic compartment 结肠上区结肠上区 Infracolic compartment 结肠下区结肠下区 Extraperitoneal space
30、腹膜后间隙腹膜后间隙 结肠上区脏器解剖结肠上区脏器解剖 v胃的局解胃的局解 v肝脏的局解肝脏的局解 v肝外胆道的局解肝外胆道的局解 胃的局解（ Anatomy of stomach） v形态和分部形态和分部 Features and divisions v位置和毗邻位置和毗邻 Position and relationship v胃的网膜和韧带胃的网膜和韧带 Omentum and Ligaments v血供和淋巴血供和淋巴 Blood vessels and lymphatics v神经支配神经支配 Nerve Features and divisions Position and Rela
31、tionship of stomach 位置位置 中度充盈时，大部分位于左季肋区，小部分位于腹中度充盈时，大部分位于左季肋区，小部分位于腹 上区。上区。 贲门在第贲门在第 11胸椎左侧，幽门在第胸椎左侧，幽门在第 1腰椎右侧。腰椎右侧。 2. 毗邻毗邻 ?： Position and Relationship of stomach Position and Relationship of stomach 位置位置 中度充盈时，大部分位于左季肋区（中度充盈时，大部分位于左季肋区（ 3/4)，小部分，小部分 位于腹上区位于腹上区 (1/4)。 贲门在第贲门在第 11胸椎左侧，幽门在第胸椎左侧，幽门
32、在第 1腰椎右侧。腰椎右侧。 2. 毗邻：毗邻： v 胃前壁胃前壁 右侧份邻接肝左叶右侧份邻接肝左叶 ,左侧份上部邻接膈，下左侧份上部邻接膈，下 部接触腹前壁。部接触腹前壁。 v 胃后壁胃后壁 隔网膜囊与胃床隔网膜囊与胃床 (胰、左肾上腺、左胰、左肾上腺、左 肾、脾、横结肠及系膜肾、脾、横结肠及系膜 )相邻。相邻。 Position and Relationship of stomach Omentum and Ligaments 网膜：网膜： 大网膜，小网膜大网膜，小网膜 韧带：韧带： 肝胃韧带、胃膈韧带、胃脾韧带、肝胃韧带、胃膈韧带、胃脾韧带、 胃结肠韧带、胃胰韧带。胃结肠韧带、胃胰韧带。
33、 Blood supply of stomach 1.动脉：动脉： 胃左胃左 胃右胃右 胃网膜右胃网膜右 胃网膜左胃网膜左 胃短胃短 胃后胃后 Left gastric a. Common hepatic a. Splenic a. Gastroduodenal a. Proper hepatic a. Right gastric a. Left branch Right branch Cystic a. Short gastric a. Left gastrioeploic a. Right gastroepiploic a. Superior pancreaticoduodenal a. Splemic branches Blood supply of stomach 2.静脉回流 Venous drainage Lymph nodes and lymph drainage of stomach 胃的淋巴回流 Nerve of stomach 神经神经 Nerves 运动：交感神经运动：交感神经 -T6 10 脊髓节段侧角脊髓节段侧角 副交感神经胃前支、后支副交感神经胃前支、后支 感觉：由内脏感觉神经传入脊髓和感觉：由内脏感觉神经传入脊髓和 延髓延髓 CAPD continuous ambulatory peritoneal dialysis
