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第1页，共73页。第2页，共73页。第3页，共73页。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 cavities第4页，共73页。uSubdivisions an
2、d peritoneal cavity Parietal peritoneum 壁腹膜壁腹膜 lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹膜脏腹膜 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 peritoni
3、tis 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.第5页，共73页。uFunction Secretes a lubricating serous fluid that continuously moistens the associated organs Support and protect viscus S
4、emipermeable membrane(Peritoneal dialysis)Absorption第6页，共73页。The relationship between viscera and peritoneum Intraperitoneal visceraInterperitoneal visceraRetroperitoneal viscera第7页，共73页。Intraperitoneal viscera 腹膜内位器官腹膜内位器官viscera completely surrounded by peritoneum,example,stomach,superior part of
5、duodenum,jejunum,ileum,cecum,vermiform appendix,transverse and sigmoid colons,spleen and ovaryInterperitoneal 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 uterusRetroperitoneal vis
6、cera 腹膜外位器官腹膜外位器官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 parts of rectum,and ureter第8页，共73页。第9页，共73页。Structures formed by perito
7、neum Omentum 网膜网膜 The fold of peritoneum that extends from two curvatures of stomach to adjacent organs 第10页，共73页。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.第11页，共73页。l Greater omentum 大网膜大网膜 fo
8、ur-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 intestine,and then turns upward and attaches to the transverse colon.第12页，共73页。Lesser omentumGreater omentum第13页，共
9、73页。Mesenterium 系膜系膜two-layered fold of peritoneum that attach the abdominal or pelvic organs to the posterior abdominal wall.mesenterium第14页，共73页。l Mesentery 肠系膜肠系膜 suspends the small intestine from the posterior abdominal wallBroad and a fan-shaped Intestinal borderfolded,5-7 m longRadix of mesent
10、ery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac joint第15页，共73页。第16页，共73页。第17页，共73页。第18页，共73页。第19页，共73页。l Mesoappendix 阑尾系阑尾系膜膜Triangular mesenteriumextends from terminal part of ileum to appendixAppendicular artery runs in free margin of the mesoappendix 第20页，共73
11、页。l Transverse mesocolon 横结肠系膜横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal walll Sigmoid mesocolon 乙状结肠系膜乙状结肠系膜inverted V-shaped,with apex located in front of left ureter and division of common iliac artery第21页，共73页。Ligaments 韧带韧带 l Ligaments of liv
12、er Falciform ligament of liver 镰状韧镰状韧带带Consists of double peritoneal layer Extends from anterior abdominal wall(umbilicus)to liveFree border of ligament has ligamentum teres 第22页，共73页。Coronary ligament 冠状冠状韧带韧带it is formed by the peritoneum between the diaphragm and the liver.There are left and righ
13、t coronary ligamentLeft 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,respectively第23页，共73页。Hepatogastric ligament 肝胃韧带肝胃韧带Hepatoduodenal ligament 肝十二指肠肝十二指肠韧带韧带Extends from porta hepatis to superior part of duodenumContains common
14、bile duct,proper hepatic a.and hepatic portal v.第24页，共73页。l Ligaments of spleenGastrosplenic 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 peritoneum,there are the short gastric and left gastroepiploic vesselsSplenorenal
15、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 pancreasPhrenicosplenic ligament 膈脾韧带膈脾韧带第25页，共73页。l Ligaments of stomach Hepatogastric ligament 肝胃韧带肝胃韧带Gastrosplenic ligament 胃脾韧带胃脾韧带Gastrop
16、hrenic ligament 胃膈韧带胃膈韧带Gastrocolic ligament 胃结肠韧带胃结肠韧带Gastropancrestic ligament 胃胰韧带胃胰韧带第26页，共73页。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 i
17、nverted V attachment of sigmoid mesocolon 第27页，共73页。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 supine第28页，共73页。l Median umbilical fold 脐正中襞脐正中襞contain the remnant of urach
18、us(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 vesselslSupravesical fossa 膀胱上窝膀胱上窝lMedial inguinal fossa 腹股沟腹股沟内侧窝内侧窝lLateral inguinal fossa 腹股沟腹股沟外
19、侧窝外侧窝第29页，共73页。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 第30页，共73页。lOmental bursa 网膜囊网膜囊Positionsituated behind the lesser omentum and stomachWalls
20、Superiorperitoneum which covers the caudate lobe of liver and diaphragmAnteriorformed by lesser omentum,peritoneum of posterior wall of stomach,and anterior two layers of greater omentumInferiorconjunctive area of anterior and posterior two layers of greater omentumPosteriorformed by posterior two l
21、ayers 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)第31页，共73页。Leftformed by the spleen,gastrosplenic ligament胃脾韧带胃脾韧带 and splenorenal ligament 脾肾韧带脾肾韧带Rightforme
22、d by omental foramen第32页，共73页。Omental foramen 网膜孔网膜孔Behind the right border of hepatoduodenal ligamentSuperiorcaudate lobe of liver Inferiorsuperior part of duodenumAnteriorhepatoduodenal ligamentPosteriorperitoneum covering the inferior vena cava The Omental bursa(lesser sac)communicates with the g
23、reater sac through the omental foramen.第33页，共73页。第34页，共73页。第35页，共73页。The subregions of the peritoneal cavityThe transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments.结肠上结肠上区和结肠下区区和结肠下区第36页，共73页。Supracolic compartment 结肠上区结肠上区(subphrenic s
24、pace)lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间隙肝上间隙 lies between the diaphragm and livethe falciform ligament divides it into right and left suprahepatic recesses第37页，共73页。Left suprahepatic space 左肝上间隙左肝上间隙left anterior suprahepatic spaceleft poster
25、ior suprahepatic spaceRight suprahepatic space 右肝上间隙右肝上间隙Subphrenic extraperitoneal space膈下腹膜外间隙膈下腹膜外间隙(corresponding to the bare area of liver)第38页，共73页。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
26、and left infrahepatic spacesRight infrahepatic space 右肝下间隙右肝下间隙(hepatorenal recess)Left infrahepatic spaces 左肝下间左肝下间隙隙 left anterior infrahepatic spaceleft posterior infrahepatic space第39页，共73页。Infracolic compartment 结肠下区结肠下区 lies below the transverse colon and transverse mesocolon Right paracolic s
27、ulcus(gutter)右右结肠旁沟结肠旁沟lies lateral to the ascending 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.Left paracolic sulcus(gutter)左左结肠旁沟结肠旁沟 lies lateral to the descending colon.
28、It is separated from the area around the spleen by the phrenicocolic ligament,a fold of peritoneum that passes from the colic flexure to the diaphragm.第40页，共73页。Right 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 transver
29、se mesocolon Left mesenteric sinus 左肠系膜窦左肠系膜窦lies between 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 pelvis第41页，共73页。u The organs of the abdominal cavity 腹腔脏器：腹腔脏器：Supracolic compartmentInfra
30、colic compartmentExtraperitoneal space 第42页，共73页。第43页，共73页。第44页，共73页。胃的局解（胃的局解（Anatomy of stomach）第45页，共73页。第46页，共73页。Position andRelationship of stomach第47页，共73页。Position andRelationship of stomach第48页，共73页。Position andRelationship of stomach第49页，共73页。.Position and Relationship of stomach第50页，共73页。
31、第51页，共73页。Blood supply of stomach第52页，共73页。第53页，共73页。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
32、 stomach第54页，共73页。2.静脉回流静脉回流 Venous drainage第55页，共73页。第56页，共73页。Lymph nodes and lymph drainage of stomach胃的淋巴回流胃的淋巴回流第57页，共73页。第58页，共73页。Nerve of stomach 第59页，共73页。第60页，共73页。第61页，共73页。第62页，共73页。第63页，共73页。第64页，共73页。CAPD continuous ambulatory peritoneal dialysis 第65页，共73页。第66页，共73页。第67页，共73页。第68页，共73页。第69页，共73页。第70页，共73页。第71页，共73页。第72页，共73页。第73页，共73页。
