腹股沟区的临床应用解剖学课件.ppt

1、腹股沟区的临床应用解剖学1浅浅 筋筋膜膜及及腹腹 壁壁SkinSuperficial fasica Scarpas fasciaMuscles of anteriorabdominal Campers fasciaTransversalis fasciawall2一.The Muscles of Abdomen(The Anterolateral Group)腹肌(前外侧群)obliquus externus abdominis 腹外斜肌腹外斜肌linea alba 腹白线 inguinal ligament 腹股沟韧带 superficial inguinal ring 腹股沟管浅环 3（1

2、）腹外斜肌腹外斜肌 external oblique muscle 腹股沟管皮下环腹股沟管皮下环 superficial inguinal ring:内侧脚内侧脚medial crus、外侧脚、外侧脚lateral crus、脚间纤维、脚间纤维intercrural fibers.腹外斜肌腹外斜肌External oblique腹外斜肌腱膜腹外斜肌腱膜External oblique，aponeurosisIntercrural fibersMedial crus4v 腹股沟管皮下环腹股沟管皮下环 superficial inguinal ring:内侧脚内侧脚medial crus、外侧脚、

3、外侧脚lateral crus、脚间纤维、脚间纤维intercrural fibers.v返转韧带返转韧带reflected ligament、腹股沟韧带、腹股沟韧带inguinal ligament、5 腹股沟韧带腹股沟韧带inguinal ligament、腔隙韧带、腔隙韧带lacunar ligament、耻骨梳韧带、耻骨梳韧带pectineal ligament6obliquus internus abdominis腹内斜肌腹内斜肌Cremaster 提睾肌 transversus abdominis 腹横肌腹横肌inguinal falx腹股沟镰(conjoined tendon)7

4、 腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构腹内斜肌及其腱膜和腹横肌及其腱膜形成的结构 8腹横筋膜腹横筋膜 Transverse fascia 精索内筋膜精索内筋膜internal spermatic fascia9 腹股沟深环deep inguinal ring 窝间韧带 interfoveolar ligament腹横筋膜腹横筋膜 Transverse fascia10腹前壁内面的皱襞及凹窝腹前壁内面的皱襞及凹窝4.壁腹膜壁腹膜 Parietal peritoneum11二二.The Inguinal Region腹股沟区腹股沟区 The boundary 境界境界 The layers

5、and characteristics 层次与特点层次与特点 The inguinal canal 腹股沟管腹股沟管 The inguinal triangle 腹股沟三角腹股沟三角 hernias 疝疝：Direct inguinal hernias 腹股沟直疝、腹股沟直疝、indirect inguinal hernias 腹股沟斜疝腹股沟斜疝、femoral hernias 股疝股疝12（一）Boundary1.The skin2.Superficial fascia3.Aponeurosis of external obliquus abdominis（二）The Layers of

6、the Inguinal Region134.Iliohypogastric nerve and ilioinguinal nerve5.Obliquus internus abdominis6.Transversus abdominis（二）The Layers of the Inguinal Region147.Transverse fascia8.Extraperitoneal fascia9.Inferior epigastric artery and deep circumflex artery10.Parietal peritoneum15三三.腹股沟区的特点腹股沟区的特点 腹外斜

7、肌在此区移行为腱膜，并在下部形成一裂口腹外斜肌在此区移行为腱膜，并在下部形成一裂口(浅环浅环)；腹内斜肌与腹横肌的下缘未达腹股沟韧带的内侧部，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；两者间无肌层覆盖；有精索或子宫圆韧带通过，形成了一潜在性裂隙；有精索或子宫圆韧带通过，形成了一潜在性裂隙；在人体站立时，该区所承受的腹内压力比平卧时高在人体站立时，该区所承受的腹内压力比平卧时高3倍。倍。因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部因此，腹股沟区为腹壁的薄弱区，是腹壁疝的多发部位。位。16四.The inguinal canal腹股沟管 Position Structure

8、s passing through it Two opening and four walls Forming of the spermatic cord Indirect inguinal hernia17The Inguinal Canal 腹股沟管腹股沟管1.1.位置位置2.2.内容内容3.3.构成构成4.4.临床意义临床意义 18 The inguinal canal is an oblique,inferomedially passage(between the superficial and deep inguinial rings)through the inferior par

9、t of the anterior abdominal wall),35cm long.位于腹股沟带内侧半的上方，是由外上斜向内下的肌筋膜裂隙。The inguinal canal lies parallel and just superior to the medial half of the inguinal ligament.The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females.It also contai

10、ns blood and lymphatic vessels and the ilioinguinal nerve in both sexes.有精索（男性）或子宫圆韧带（女性）、髂腹股沟神经通过。19vThe deep(internal)inguinal ring,entrance to inguinal canal,is an outpouching of the transversalis fascia approximately 1.25cm superior to the middle of the inguinal ligament and lateral to the infer

11、ior epigastric vessels.内口：即腹股沟深环，位于腹股沟韧带内口：即腹股沟深环，位于腹股沟韧带中点上方约一横指处、腹壁下动脉外侧，是腹横筋膜在向外突形成中点上方约一横指处、腹壁下动脉外侧，是腹横筋膜在向外突形成的一个卵圆形孔。的一个卵圆形孔。vThe superficial(external)inguinal ring-exit from inguinal canal-is a slitlike opening between the diagonal fibers of the aponeurosis fo the external oblique,superolater

12、al to the pubic tubercle.v 外口：即腹股沟管浅环外口：即腹股沟管浅环，是腹外斜肌腱膜在耻骨结节外上方形，是腹外斜肌腱膜在耻骨结节外上方形成的三角形裂隙。成的三角形裂隙。20v The anterior wall of the inguinal canal is formed by the external oblique aponeurosis throughout the length of the canal,with the anterior wall of the lateral part of the canal being reinforced by fi

13、bers of internus oblique.前壁前壁：为浅层：为浅层的腹外斜肌腱膜和深层的腹内斜肌（在管的外侧的腹外斜肌腱膜和深层的腹内斜肌（在管的外侧1/3处）。处）。vThe posterior wall of the inguinal canal is formed by the transversalis fascia with the posterior wall of the medial part of the canal being reinforced the conjoint tendon.v后壁后壁：为腹横筋膜和腹股沟镰（在管的内侧：为腹横筋膜和腹股沟镰（在管的内侧

14、1/3处）。处）。Roof(superior wall)is formed by the arching fibers of the internal oblique and transverse abdominal muscles.上壁上壁：为腹内斜肌和腹横肌的弓状下缘。：为腹内斜肌和腹横肌的弓状下缘。vFloor(inferior wall)is formed by the inguinal ligament.v下壁下壁：为腹股沟韧带。：为腹股沟韧带。21腹股沟三角腹股沟三角 Inguinal Triangle （海氏三角海氏三角 Hesselbachs triangle）构成：腹壁下动脉

15、、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。域。临床意义：由腹股沟三角突出的疝，称腹股沟直疝。临床意义：由腹股沟三角突出的疝，称腹股沟直疝。22五.腹股沟直疝、腹股沟斜疝、股疝23闭孔支或异常的闭孔动脉24Indirect HerniaDirect Hernia股疝股疝 femoral hernia25睾睾丸丸下下降降过过程程26The descending process of the testis27精索的被膜与腹前外侧壁层次的关系精索的被膜与腹前外侧壁层次的关系28精索或睾丸被膜与腹前外侧壁层次的关系精索或睾丸被膜与腹前外侧壁层次的关系29The EndThe EndThe End30