疝解剖学.ppt

腹股沟区的临床应用解剖学 丁文龙 上海交通大学医学院 2009.8.21 浅 筋膜及腹 壁 Skin Superficial fasica Scarpa’s fascia Muscles of anterior abdominal Camper’s fascia Transversalis fascia wall 一. The Muscles of Abdomen (The Anterolateral Group) 腹肌(前外侧群) obliquus externus abdominis 腹外斜肌 linea alba 腹白线 inguinal ligament 腹股沟韧带 superficial inguinal ring 腹股沟管浅环 （1）腹外斜肌 external oblique muscle 腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral crus、脚间纤维intercrural fibers. 腹外斜肌 External oblique 腹外斜肌腱膜 External oblique，aponeurosis Intercrural fibers Medial crus 腹股沟管皮下环 superficial inguinal ring:内侧脚medial crus、外侧脚lateral crus、脚间纤维intercrural fibers. 返转韧带reflected ligament、腹股沟韧带inguinal ligament、 腹股沟韧带inguinal ligament、腔隙韧带lacunar ligament、耻骨梳韧带pectineal ligament ☆提睾肌 Cremaster muscle ☆腹股沟镰Inguinal falx 联合腱 Conjoined tendon ☆腹横肌下缘 腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构 腹横筋膜 Transverse fascia 精索内筋膜internal spermatic fascia 腹股沟深环deep inguinal ring 窝间韧带 interfoveolar ligament 腹横筋膜 Transverse fascia 腹前壁内面的皱襞及凹窝 4. 壁腹膜 Parietal peritoneum 二. The Inguinal Region腹股沟区 The boundary 境界 The layers and characteristics 层次与特点 The inguinal canal 腹股沟管 The inguinal triangle 腹股沟三角 hernias 疝 ： Direct inguinal hernias 腹股沟直疝、 indirect inguinal hernias 腹股沟斜疝 、 femoral hernias 股疝 （一）Boundary 1. The skin 2. Superficial fascia 3. Aponeurosis of external obliquus abdominis （二）The Layers of the Inguinal Region 4. Iliohypogastric nerve and ilioinguinal nerve 5. Obliquus internus abdominis 6. Transversus abdominis （二）The Layers of the Inguinal Region 7. Transverse fascia 8. Extraperitoneal fascia 9. Inferior epigastric artery and deep circumflex artery 10.Parietal peritoneum 三. 腹股沟区的特点 ①腹外斜肌在此区移行为腱膜，并在下部形成一裂口(浅环)； ②腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部，两者间无肌层覆盖； ③有精索或子宫圆韧带通过，形成了一潜在性裂隙； ④在人体站立时，该区所承受的腹内压力比平卧时高3倍。 因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部位。 四. The inguinal canal腹股沟管 Position Structures passing through it Two opening and four walls Forming of