1、主讲：许杰华主讲：许杰华E-mail:西安交通大学医学院西安交通大学医学院人体解剖与组织胚胎学系人体解剖与组织胚胎学系The introduction of the peritoneumuDefinition The peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavitiesuSubdivisions and peritoneal cavity Parietal periton
2、eum 壁腹壁腹膜膜 lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹脏腹膜膜 covers the organs Peritoneal cavity 腹膜腔腹膜腔the potential space between the parietal and visceral layer of peritoneum.Is there any organs in the peritoneal cavity?The peritonitis is very common for female!For ma
3、le,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 protect viscus Semipermeable membrane(Peritoneal dialysis)Abs
4、orptionThe relationship between viscera and peritoneum Intraperitoneal visceraInterperitoneal visceraRetroperitoneal visceravIntraperitoneal viscera 腹膜内位器官腹膜内位器官viscera completely surrounded by peritoneum,example,stomach,superior part of duodenum,jejunum,ileum,cecum,vermiform appendix,transverse and
5、 sigmoid colons,spleen and ovaryvInterperitoneal viscera 腹膜间位器官腹膜间位器官most part of viscera surrounded by peritoneum,example,liver,gallbladder,ascending and descending colons,upper part of rectum,urinary bladder and uterusvRetroperitoneal viscera 腹膜外位器官腹膜外位器官some organs lie on the posterior abdominal
6、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 ureterStructures formed by peritoneum Omentum 网膜网膜 The fold of peritoneum that extends from two curvatures of s
7、tomach to adjacent organs l Lesser omentum 小网膜小网膜 two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.l Greater omentum 大网膜大网膜 four-layered fold of peritoneum,the anterior two layers descend from the greater curvature of stomac
8、h 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 omentumGreater omentumMesenterium 系膜系膜two-layered fold of peritoneum that attach the abdominal or pelvic organs to the posterior abdomin
9、al wall.mesenteriuml Mesentery 肠系膜肠系膜 suspends the small intestine from the posterior abdominal wallvBroad and a fan-shaped vIntestinal borderfolded,5-7 m longvRadix of mesentery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac jointlMesoappendix 阑尾阑尾系膜系膜vTriangular m
10、esenteriumextends from terminal part of ileum to appendixvAppendicular artery runs in free margin of the mesoappendix lTransverse mesocolon 横结肠系横结肠系膜膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal walllSigmoid mesocolon 乙状结肠系膜乙状结肠系膜inverted V-shaped,with a
11、pex located in front of left ureter and division of common iliac arteryLigaments 韧带韧带 lLigaments of liver vFalciform ligament of liver 镰状韧带镰状韧带Consists of double peritoneal layer Extends from anterior abdominal wall(umbilicus)to liveFree border of ligament has ligamentum teres vCoronary ligament 冠状韧
12、带冠状韧带it is formed by the peritoneum between the diaphragm and the liver.There are left and right coronary ligamentvLeft and right triangular ligaments 左、右三角韧带左、右三角韧带formed by the left and right extremity of coronary ligament ligament,respectivelyvHepatogastric ligament 肝胃韧带肝胃韧带vHepatoduodenal ligame
13、nt 肝十二指肝十二指肠韧带肠韧带Extends from porta hepatis to superior part of duodenumContains common bile duct,proper hepatic a.and hepatic portal v.lLigaments of spleenvGastrosplenic ligament 胃脾韧带胃脾韧带a double layer of peritoneum that connects the fundus of stomach to hilum of spleen.In this double layer of peri
14、toneum,there are the short gastric and left gastroepiploic vesselsvSplenorenal ligament 脾肾韧带脾肾韧带extends between the hilum of spleen and anterior aspect of left kidney.The splenic vessels lies within this ligament,as well as the tail of pancreasvPhrenicosplenic ligament 膈脾韧带膈脾韧带lLigaments of stomach
15、vHepatogastric ligament 肝胃韧带肝胃韧带vGastrosplenic ligament 胃脾韧带胃脾韧带vGastrophrenic ligament 胃膈韧带胃膈韧带vGastrocolic ligament 胃结肠韧带胃结肠韧带vGastropancrestic ligament 胃胰韧带胃胰韧带Folds,recesses and fossa皱襞、隐窝和窝皱襞、隐窝和窝l Superior duodenal fold and recess 十二指肠上襞和上隐窝十二指肠上襞和上隐窝l Inferior duodenal fold and recess 十二指肠下襞和
16、下隐窝十二指肠下襞和下隐窝l Intersigmoid recess 乙状结肠间隐窝乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon l Hepatorenal recess 肝肾隐窝肝肾隐窝lies between the right lobe of liver,right kidney,and right colic flexure,and is the lowest parts of the peritoneal cavity when the subject is supinel Median umbilic
17、al fold 脐正中襞脐正中襞contain the remnant of urachus(median umbilical ligaments)l Medial umbilical fold 脐内侧襞脐内侧襞contains remnants of the umbilical arteries(medial umbilical ligaments)l Lateral umbilical fold 脐外侧襞脐外侧襞contains the inferior epigastric vesselsl Supravesical fossa 膀胱上窝膀胱上窝l Medial inguinal fos
18、sa 腹股沟内侧窝腹股沟内侧窝l Lateral inguinal fossa 腹股沟外侧窝腹股沟外侧窝Pouches 陷窝陷窝l In malerectovesical pouch 直肠膀胱陷窝直肠膀胱陷窝l In female Rectouterine pouch(Douglas,cavity)直肠子宫陷窝直肠子宫陷窝between rectum and uterus Vesicouterine pouch 膀胱子宫陷窝膀胱子宫陷窝between bladder and uterus lOmental bursa 网膜囊网膜囊Positionsituated behind the less
19、er omentum and stomachWallsvSuperiorperitoneum which covers the caudate lobe of liver and diaphragmvAnteriorformed by lesser omentum,peritoneum of posterior wall of stomach,and anterior two layers of greater omentumvInferiorconjunctive area of anterior and posterior two layers of greater omentumvPos
20、teriorformed by posterior two layers of greater omentum,transverse colon and transverse mesocolon,peritoneum covering pancreas,left kidney and suprarenal gland腹膜腔的分部腹膜腔的分部 The subdivision of the peritoneal cavity(two sacs)vLeftformed by the spleen,gastrosplenic ligament胃脾韧带胃脾韧带 and splenorenal ligam
21、ent 脾肾韧带脾肾韧带vRightformed by omental foramen Omental foramen 网膜孔网膜孔vBehind the right border of hepatoduodenal ligamentvSuperiorcaudate lobe of liver vInferiorsuperior part of duodenumvAnteriorhepatoduodenal ligamentvPosteriorperitoneum covering the inferior vena cava The Omental bursa(lesser sac)comm
22、unicates with the greater sac through the omental foramen.The subregions of the peritoneal cavityvThe transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments.结肠结肠上区和结肠下区上区和结肠下区Supracolic compartment 结肠上区结肠上区(subphrenic space)lies between di
23、aphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间肝上间隙隙 lies between the diaphragm and livethe falciform ligament divides it into right and left suprahepatic recessesvLeft suprahepatic space 左肝上间隙左肝上间隙left anterior suprahepatic spaceleft posterior suprahepatic spacevRight
24、suprahepatic space 右肝上间隙右肝上间隙vSubphrenic extraperitoneal space膈下腹膜外间隙膈下腹膜外间隙(corresponding to the bare area of liver)Infrahepatic space 肝下间隙肝下间隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic spacesvRight in
25、frahepatic space 右肝右肝下间隙下间隙(hepatorenal recess)vLeft infrahepatic spaces 左肝左肝下间隙下间隙 left anterior infrahepatic spaceleft posterior infrahepatic spaceInfracolic compartment 结肠下区结肠下区 lies below the transverse colon and transverse mesocolon vRight paracolic sulcus(gutter)右结肠旁沟右结肠旁沟lies lateral to the a
26、scending 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.vLeft paracolic sulcus(gutter)左结肠旁沟左结肠旁沟 lies lateral to the descending colon.It is separated from the area around the sp
27、leen by the phrenicocolic ligament,a fold of peritoneum that passes from the colic flexure to the diaphragm.vRight mesenteric sinus 右肠系膜窦右肠系膜窦triangular space,lies between root of mesentery,ascending colon,right 2/3 of transverse colon and transverse mesocolonvLeft mesenteric sinus 左肠系膜窦左肠系膜窦lies be
28、tween 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 pelvisu The organs of the abdominal cavity 腹腔脏器：腹腔脏器：Supracolic compartmentInfracolic compartmentExtraperitoneal space 胃的局解（胃的局解（Anatomy of st
29、omach）Position and Relationship of stomach Position and Relationship of stomach Position and Relationship of stomach.Position and Relationship of stomachBlood supply of stomach Left gastric a.Common hepatic a.Splenic a.Gastroduodenal a.Proper hepatic a.Right gastric a.Left branchRight branchCystic a.Short gastric a.Left gastrioeploic a.Right gastroepiploic a.Superior pancreaticoduodenal a.Splemic branches Blood supply of stomach2.静脉回流静脉回流 Venous drainageLymph nodes and lymph drainage of stomach胃的淋巴回流胃的淋巴回流Nerve of stomach CAPD continuous ambulatory peritoneal dialysis
