腹部概述、腹前外侧壁解剖

January, 2007
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腹横肌与腹内斜肌 共同形成的结构： ①弓状下缘
②腹股沟镰（联合 腱） ③提睾肌
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
旋髂深动脉
旋髂深动脉：与腹壁下
动脉同一水平发自髂外动
脉，经髂前上棘内侧，行 向髂棘前部的上缘，在此
分支入髂棘内唇，临床上
常取其为营养动脉的带血 管蒂髂骨移植。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
浅筋膜内含有丰富的浅血管、
淋巴管和皮神经。
浅动脉：有三组
①腹侧壁浅动脉：来自肋间后 动脉、肋下动脉及腰动脉。
②正中线附近浅动脉：来自腹 壁上、下动脉的分支。 ③腹前壁下半部浅动脉：腹壁 浅动脉、旋髂浅动脉，为股 动脉分支。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
浅静脉：丰富 , 吻合成脐周 静脉网。 脐以上的浅静脉汇入腋静脉。 脐以下的浅静脉汇入股静脉。 在脐区，浅静脉与深部的附 脐静脉吻合，并借此静脉沟
通肝门静脉，从而构成肝门 静脉系统与上、下腔静脉系 统的沟通。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
6、壁腹膜
脐正中ห้องสมุดไป่ตู้ 皱 脐内侧襞 襞 脐外侧襞 膀胱上窝 隐 腹股沟内 窝 侧窝 腹股沟外 侧窝
腹
部
ABDOMEN
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
概述
• 境界
• 分区 • 内容
January, 2007
2. 神经 第7-12胸神经前支 髂腹下神经 髂腹股沟神经 生殖股神经
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
第 712 胸 神 经 前 支
January, 2007
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髂腹下神经：髂前上棘内侧 ２～３cm处穿入腹内斜肌， 腹股沟管浅环上方3 ～4 cm 处穿出。分布于耻骨联合上 方皮肤和腹壁下部的肌肉。 阑尾手术麦氏切口强调钝性 分离腹内外肌，以避免损伤。 髂腹股沟神经：在髂腹下神 经的下方，进入腹股沟管， 行于精索上方，出腹股沟管 浅环。分布于阴囊或大阴唇 皮肤，肌支支配腹壁下部的 肌肉。
• 层次 • 局部结构 • 睾丸下降与腹股沟疝的关系
January, 2007
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层次
3、肌层
腹 外 斜 肌
腹 内 斜 肌
腹 直 肌
腹 横 肌
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
④4对腰动脉
⑤旋髂深动脉
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
腹壁下动脉 腹壁下动脉是髂外动脉
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
腹内斜肌：肌纤维起自腹 股沟韧带外侧1/2-1/3、髂 棘及胸腰筋膜，呈扇形斜 向内上，后部纤维止于下3 对肋，余纤维在腹直肌外 侧移行为腱膜，并分两层 包裹腹直肌，止于腹白线。 腹 内 斜 肌
• • • • • • 1、皮肤 2、浅筋膜 3、肌层 4、腹横筋膜 5、腹膜外组织 6、壁腹膜
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
分区
九 分 法
四 分 法
January, 2007
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凹间韧带
腹股沟管深环
精索内筋膜
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
5、腹膜外组织
腹膜外组织又称腹 膜外脂肪，是位于腹 横筋膜与壁腹膜之间 的疏松结缔组织，向 后与腹膜后隙的疏松 结缔组织相续。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， 临床行泌尿外科和妇 产科手术，尽量避免 进入腹膜腔，经腹膜 外组织入路进行。
浅淋巴管：与浅血管 伴行。脐以上入腋淋 巴结；脐以下入腹股 沟浅淋巴结；脐部淋 巴管可经肝圆韧带与 肝的淋巴管交通。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
内容
• 腹壁
• 结肠上区 • 结肠下区、腹膜后隙
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
腹前外侧壁
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
4、腹横筋膜
腹横筋膜为腹内筋膜的一 部分，位于腹横肌深面， 形成的结构有：
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
腹前外侧壁的血管、神经
1.血管
①腹壁上、下动脉
②下5对肋间后动脉 ③肋下动脉
腹 直 肌
腹 直 肌
腹 直 肌 鞘
腱划
January, 2007 Copyright© 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： ①腹直肌鞘前层 ②皮下环(浅环) ③腹股沟韧带 ④腔隙韧带 ⑤耻骨梳韧带
January, 2007
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腹横肌：肌纤维起自下6
对肋骨内面、髂棘、胸腰 腹 筋膜及腹股沟韧带外侧1/3， 横 肌 自后向前内侧横行，在腹 直肌外侧移行为腱膜。
皮神经：呈节段性分布 第7肋间神经—剑突平面 第10肋间神经—脐平面 第12肋间神经—髂前上 棘平面
第1腰神经—腹股沟平面
January, 2007
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1、皮肤
腹前外侧壁 的皮肤 薄而
富有弹性,
临床常选择 为游离皮瓣
的供皮区。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
境界
上界：剑突、肋弓、 第11肋前端、第12肋 下缘和第12胸椎
下界:耻骨联合上缘、 耻骨嵴、耻骨结节、 腹股沟韧带、髂嵴至 第5腰椎下缘的连线。
经过腹股沟韧带深面时发
出的分支，其体表投影为 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 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
2、浅筋膜
腹前外侧壁浅筋膜较厚，在脐平面 以下分浅、深两层。 ① 浅层：为含大量脂肪组织的
Camper筋膜(脂肪层)，向下与股部的
浅筋膜相续 。 ②深层：为富含弹性纤维的Scarpa筋
膜(膜性层)，中线处附于白线，向下
在腹股沟韧带下方约一横指处附于阔 筋膜，向内下与阴囊肉膜及会阴浅筋 膜相续 。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG