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1、上腹部脏器解剖腹膜和胃new(1),1,The peritoneum and the abdominal organs 1 腹膜及腹腔脏器（1）,主讲：许杰华E-mail: 西安交通大学医学院人体解剖与组织胚胎学系,上腹部脏器解剖腹膜和胃new(1),2,Outline 讲授大纲,概述Introduction腹壁层次The layers of the abdominal wall腹壁的重要局部 The important regions of abdominal wall腹腔、腹膜及腹膜腔Abdominal cavity, peritoneum and peritoneal cavity腹腔重
2、要脏器局解The important organs of abdominal cavity 胃； 肝脏；肝外胆道；肾脏,上腹部脏器解剖腹膜和胃new(1),3,腹腔、腹膜和腹膜腔(Abdominal cavity, Peritoneum and Peritoneal cavity) 基本概念：腹腔 腹膜（壁腹膜和脏腹膜）腹膜腔,上腹部脏器解剖腹膜和胃new(1),4,The introduction of the peritoneum,Definition The peritoneum is a thin serous membrane that lines the walls of the
3、abdominal and pelvic cavities and cover the organs within the two cavities,上腹部脏器解剖腹膜和胃new(1),5,Subdivisions and peritoneal cavityParietal peritoneum 壁腹膜 lines the walls of the abdominal and pelvic cavitiesVisceral peritoneum 脏腹膜 covers the organsPeritoneal cavity 腹膜腔the potential space between the p
4、arietal and visceral layer of peritoneum.,Is there any organs in the peritoneal cavity?,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.,上腹部脏器解剖腹膜和胃new(1),6,Funct
5、ionSecretes a lubricating serous fluid that continuously moistens the associated organsSupport and protect viscusSemipermeable membrane (Peritoneal dialysis)Absorption,上腹部脏器解剖腹膜和胃new(1),7,The relationship between viscera and peritoneum,上腹部脏器解剖腹膜和胃new(1),8,Intraperitoneal viscera 腹膜内位器官viscera comple
6、tely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovaryInterperitoneal viscera 腹膜间位器官most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending col
7、ons, upper part of rectum, urinary bladder and uterusRetroperitoneal 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
8、 parts of rectum, and ureter,上腹部脏器解剖腹膜和胃new(1),9,上腹部脏器解剖腹膜和胃new(1),10,Structures formed by peritoneum,Omentum 网膜 The fold of peritoneum that extends from two curvatures of stomach to adjacent organs,上腹部脏器解剖腹膜和胃new(1),11,Lesser omentum 小网膜 two-layered fold of peritoneum which extends from porta hepat
9、is to lesser curvature of stomach and superior part of duodenum.,上腹部脏器解剖腹膜和胃new(1),12,Greater omentum 大网膜 four-layered fold of peritoneum, 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 intes
10、tine, and then turns upward and attaches to the transverse colon.,上腹部脏器解剖腹膜和胃new(1),13,上腹部脏器解剖腹膜和胃new(1),14,Mesenterium 系膜two-layered fold of peritoneum that attach the abdominal or pelvic organs to the posterior abdominal wall.,mesenterium,上腹部脏器解剖腹膜和胃new(1),15,Mesentery 肠系膜 suspends the small intes
11、tine from the posterior abdominal wallBroad and a fan-shaped Intestinal borderfolded, 5-7 m longRadix of mesentery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac joint,上腹部脏器解剖腹膜和胃new(1),16,上腹部脏器解剖腹膜和胃new(1),17,上腹部脏器解剖腹膜和胃new(1),18,上腹部脏器解剖腹膜和胃new(1),19,上腹部脏器解剖腹膜和胃new
12、(1),20,Mesoappendix 阑尾系膜Triangular mesenteriumextends from terminal part of ileum to appendixAppendicular artery runs in free margin of the mesoappendix,上腹部脏器解剖腹膜和胃new(1),21,Transverse mesocolon 横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal wallSigmo
13、id mesocolon 乙状结肠系膜inverted V-shaped, with apex located in front of left ureter and division of common iliac artery,上腹部脏器解剖腹膜和胃new(1),22,Ligaments 韧带 Ligaments of liver Falciform ligament of liver 镰状韧带Consists of double peritoneal layer Extends from anterior abdominal wall (umbilicus) to liveFree bo
14、rder of ligament has ligamentum teres,上腹部脏器解剖腹膜和胃new(1),23,Coronary ligament 冠状韧带it is formed by the peritoneum between the diaphragm and the liver. There are left and right coronary ligamentLeft and right triangular ligaments 左、右三角韧带formed by the left and right extremity of coronary ligament ligame
15、nt, respectively,上腹部脏器解剖腹膜和胃new(1),24,Hepatogastric ligament 肝胃韧带Hepatoduodenal ligament 肝十二指肠韧带Extends from porta hepatis to superior part of duodenumContains common bile duct, proper hepatic a. and hepatic portal v.,上腹部脏器解剖腹膜和胃new(1),25,Ligaments of spleenGastrosplenic ligament 胃脾韧带a double layer
16、of peritoneum that connects the fundus of stomach to hilum of spleen. In this double layer of peritoneum, there are the short gastric and left gastroepiploic vesselsSplenorenal ligament 脾肾韧带extends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this l
17、igament, as well as the tail of pancreasPhrenicosplenic ligament 膈脾韧带,上腹部脏器解剖腹膜和胃new(1),26,Ligaments of stomach Hepatogastric ligament 肝胃韧带Gastrosplenic ligament 胃脾韧带Gastrophrenic ligament 胃膈韧带Gastrocolic ligament 胃结肠韧带Gastropancrestic ligament 胃胰韧带,上腹部脏器解剖腹膜和胃new(1),27,Folds, recesses and fossa皱襞、隐
18、窝和窝,Superior duodenal fold and recess 十二指肠上襞和上隐窝Inferior duodenal fold and recess 十二指肠下襞和下隐窝Intersigmoid recess 乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon,上腹部脏器解剖腹膜和胃new(1),28,Hepatorenal recess 肝肾隐窝lies between the right lobe of liver, right kidney, and right colic flexure, and
19、 is the lowest parts of the peritoneal cavity when the subject is supine,上腹部脏器解剖腹膜和胃new(1),29,Median umbilical fold 脐正中襞contain the remnant of urachus (median umbilical ligaments)Medial umbilical fold 脐内侧襞contains remnants of the umbilical arteries (medial umbilical ligaments)Lateral umbilical fold
20、脐外侧襞contains the inferior epigastric vesselsSupravesical fossa 膀胱上窝Medial inguinal fossa 腹股沟内侧窝Lateral inguinal fossa 腹股沟外侧窝,上腹部脏器解剖腹膜和胃new(1),30,Pouches 陷窝In malerectovesical pouch 直肠膀胱陷窝In female Rectouterine pouch(Douglas,cavity) 直肠子宫陷窝between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝between b
21、ladder and uterus,上腹部脏器解剖腹膜和胃new(1),31,Omental bursa 网膜囊,Positionsituated behind the lesser omentum and stomachWallsSuperiorperitoneum which covers the caudate lobe of liver and diaphragmAnteriorformed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater ome
22、ntumInferiorconjunctive area of anterior and posterior two layers of greater omentumPosteriorformed 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 (t
23、wo sacs),上腹部脏器解剖腹膜和胃new(1),32,Leftformed by the spleen, gastrosplenic ligament胃脾韧带 and splenorenal ligament 脾肾韧带Rightformed by omental foramen,上腹部脏器解剖腹膜和胃new(1),33,Omental foramen 网膜孔Behind the right border of hepatoduodenal ligamentSuperiorcaudate lobe of liver Inferiorsuperior part of duodenumAnte
24、riorhepatoduodenal ligamentPosteriorperitoneum covering the inferior vena cava The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen.,上腹部脏器解剖腹膜和胃new(1),34,上腹部脏器解剖腹膜和胃new(1),35,上腹部脏器解剖腹膜和胃new(1),36,The subregions of the peritoneal cavity,The transverse colon and
25、 transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments. 结肠上区和结肠下区,上腹部脏器解剖腹膜和胃new(1),37,Supracolic compartment 结肠上区(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间隙 lies between the diaphragm and li
26、vethe falciform ligament divides it into right and left suprahepatic recesses,上腹部脏器解剖腹膜和胃new(1),38,Left suprahepatic space 左肝上间隙left anterior suprahepatic spaceleft posterior suprahepatic spaceRight suprahepatic space 右肝上间隙Subphrenic extraperitoneal space膈下腹膜外间隙 (corresponding to the bare area of li
27、ver),上腹部脏器解剖腹膜和胃new(1),39,Infrahepatic space 肝下间隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic spacesRight infrahepatic space 右肝下间隙 (hepatorenal recess)Left infrahepatic spaces 左肝下间隙 left anterior infrahep
28、atic spaceleft posterior infrahepatic space,上腹部脏器解剖腹膜和胃new(1),40,Infracolic compartment 结肠下区 lies below the transverse colon and transverse mesocolon Right paracolic sulcus (gutter) 右结肠旁沟lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provid
29、es a route for the spread of infection between the pelvic and the upper abdominal region.Left paracolic sulcus (gutter) 左结肠旁沟 lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure t
30、o the diaphragm.,上腹部脏器解剖腹膜和胃new(1),41,Right mesenteric sinus 右肠系膜窦triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolonLeft mesenteric sinus 左肠系膜窦lies between root of mesentery, descending colon, left 1/3 of transverse colon and tra
31、nsverse mesocolon, its widens below where it is continuous with the cavity of the pelvis,上腹部脏器解剖腹膜和胃new(1),42,The organs of the abdominal cavity 腹腔脏器：,Supracolic compartment 结肠上区 Infracolic compartment 结肠下区 Extraperitoneal space 腹膜后间隙,上腹部脏器解剖腹膜和胃new(1),43,上腹部脏器解剖腹膜和胃new(1),44,结肠上区脏器解剖,胃的局解肝脏的局解肝外胆道的
32、局解,上腹部脏器解剖腹膜和胃new(1),45,胃的局解（Anatomy of stomach）,形态和分部Features and divisions位置和毗邻Position and relationship胃的网膜和韧带Omentum and Ligaments血供和淋巴Blood vessels and lymphatics神经支配Nerve,上腹部脏器解剖腹膜和胃new(1),46,Features and divisions,上腹部脏器解剖腹膜和胃new(1),47,Position and Relationship of stomach,位置 中度充盈时，大部分位于左季肋区，小部
33、分位于腹上区。 贲门在第11胸椎左侧，幽门在第1腰椎右侧。2. 毗邻?：,上腹部脏器解剖腹膜和胃new(1),48,Position and Relationship of stomach,上腹部脏器解剖腹膜和胃new(1),49,Position and Relationship of stomach,上腹部脏器解剖腹膜和胃new(1),50,位置 中度充盈时，大部分位于左季肋区（3/4)，小部分位于腹上区(1/4)。 贲门在第11胸椎左侧，幽门在第1腰椎右侧。2. 毗邻：胃前壁 右侧份邻接肝左叶,左侧份上部邻接膈，下部接触腹前壁。胃后壁 隔网膜囊与胃床(胰、左肾上腺、左 肾、脾、横结肠及系
34、膜)相邻。,Position and Relationship of stomach,上腹部脏器解剖腹膜和胃new(1),51,Omentum and Ligaments,网膜：大网膜，小网膜 韧带：肝胃韧带、胃膈韧带、胃脾韧带、 胃结肠韧带、胃胰韧带。,上腹部脏器解剖腹膜和胃new(1),52,Blood supply of stomach,上腹部脏器解剖腹膜和胃new(1),53,1.动脉： 胃左 胃右 胃网膜右 胃网膜左 胃短 胃后,上腹部脏器解剖腹膜和胃new(1),54,Blood supply of stomach,上腹部脏器解剖腹膜和胃new(1),55,2.静脉回流 Venou
35、s drainage,上腹部脏器解剖腹膜和胃new(1),56,上腹部脏器解剖腹膜和胃new(1),57,Lymph nodes and lymph drainage of stomach胃的淋巴回流,上腹部脏器解剖腹膜和胃new(1),58,上腹部脏器解剖腹膜和胃new(1),59,Nerve of stomach,神经 Nerves 运动：交感神经-T610 脊髓节段侧角 副交感神经胃前支、后支 感觉：由内脏感觉神经传入脊髓和 延髓,上腹部脏器解剖腹膜和胃new(1),60,上腹部脏器解剖腹膜和胃new(1),61,上腹部脏器解剖腹膜和胃new(1),62,上腹部脏器解剖腹膜和胃new(1),63,上腹部脏器解剖腹膜和胃new(1),64,谢谢！,上腹部脏器解剖腹膜和胃new(1),65,CAPD continuous ambulatory peritoneal dialysis,上腹部脏器解剖腹膜和胃new(1),66,上腹部脏器解剖腹膜和胃new(1),67,上腹部脏器解剖腹膜和胃new(1),68,上腹部脏器解剖腹膜和胃new(1),69,上腹部脏器解剖腹膜和胃new(1),70,上腹部脏器解剖腹膜和胃new(1),71,上腹部脏器解剖腹膜和胃new(1),72,上腹部脏器解剖腹膜和胃new(1),73,