1、The peritoneum and the abdominal organs 1 腹膜及腹腔脏器（1）,主讲：许杰华 E-mail: 西安交通大学医学院 人体解剖与组织胚胎学系,Outline 讲授大纲,概述Introduction 腹壁层次The layers of the abdominal wall 腹壁的重要局部 The important regions of abdominal wall 腹腔、腹膜及腹膜腔Abdominal cavity, peritoneum and peritoneal cavity 腹腔重要脏器局解The important organs of abdo
2、minal cavity胃； 肝脏；肝外胆道；肾脏,腹腔、腹膜和腹膜腔(Abdominal cavity, Peritoneum and Peritoneal cavity)基本概念： 腹腔 腹膜（壁腹膜和脏腹膜） 腹膜腔,The introduction of the peritoneum,DefinitionThe peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavities
3、,Subdivisions and peritoneal cavity Parietal peritoneum 壁腹膜 lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹膜 covers the organs Peritoneal cavity 腹膜腔the potential space between the parietal and visceral layer of peritoneum.,Is there any organs inthe peritoneal cavity?,The
4、peritonitis is very commonfor 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.,Function Secretes a lubricating serous fluid that continuously moistens the associated organs Support and protect visc
5、us Semipermeable membrane (Peritoneal dialysis) Absorption,The relationship between viscera and peritoneum,Intraperitoneal viscera 腹膜内位器官viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons,
6、 spleen and ovary Interperitoneal viscera 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 uterus Retroperitoneal viscera 腹膜外位器官some organs lie on the posterior abdominal wall and are covered
7、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,Structures formed by peritoneum,Omentum 网膜The fold of peritoneum that extends from two curvatures of stomach to adjace
8、nt organs,Lesser omentum 小网膜 two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.,Greater omentum 大网膜four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and inferior part of du
9、odenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon.,Mesenterium 系膜 two-layered fold of peritoneum that attach the abdominal or pelvic organs to the posterior abdominal wall.,mesenterium,Mesentery 肠系膜 suspends the small
10、 intestine from the posterior abdominal wall Broad and a fan-shaped Intestinal borderfolded, 5-7 m long Radix of mesentery 15 cm long Directed obliquely from left side of L2 to in front of right sacroiliac joint,Mesoappendix 阑尾系膜Triangular mesenteriumextends from terminal part of ileum to appendix A
11、ppendicular artery runs in free margin of the mesoappendix,Transverse mesocolon 横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall Sigmoid mesocolon 乙状结肠系膜inverted V-shaped, with apex located in front of left ureter and division of common iliac arter
12、y,Ligaments 韧带Ligaments of liver Falciform ligament of liver 镰状韧带 Consists of double peritoneal layer Extends from anterior abdominal wall (umbilicus) to live Free border of ligament has ligamentum teres,Coronary ligament 冠状韧带it is formed by the peritoneum between the diaphragm and the liver. There
13、are left and right coronary ligament Left and right triangular ligaments 左、右三角韧带formed by the left and right extremity of coronary ligament ligament, respectively,Hepatogastric ligament 肝胃韧带 Hepatoduodenal ligament 肝十二指肠韧带 Extends from porta hepatis to superior part of duodenum Contains common bile
14、duct, proper hepatic a. and hepatic portal v.,Ligaments of spleen Gastrosplenic ligament 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 vessels Splenorenal ligament 脾肾韧带e
15、xtends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas Phrenicosplenic ligament 膈脾韧带,Ligaments of stomach Hepatogastric ligament 肝胃韧带 Gastrosplenic ligament 胃脾韧带 Gastrophrenic ligament 胃膈韧带 Gastrocolic lig
16、ament 胃结肠韧带 Gastropancrestic ligament 胃胰韧带,Folds, recesses and fossa 皱襞、隐窝和窝,Superior duodenal fold and recess 十二指肠上襞和上隐窝 Inferior duodenal fold and recess 十二指肠下襞和下隐窝 Intersigmoid recess 乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon,Hepatorenal recess 肝肾隐窝lies between the right lob
17、e of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the subject is supine,Median umbilical fold 脐正中襞contain the remnant of urachus (median umbilical ligaments) Medial umbilical fold 脐内侧襞contains remnants of the umbilical arteries (medial umbilical
18、 ligaments) Lateral umbilical fold 脐外侧襞contains the inferior epigastric vessels Supravesical fossa 膀胱上窝 Medial inguinal fossa 腹股沟内侧窝 Lateral inguinal fossa 腹股沟外侧窝,Pouches 陷窝 In malerectovesical pouch 直肠膀胱陷窝 In female Rectouterine pouch(Douglas,cavity) 直肠子宫陷窝between rectum and uterus Vesicouterine po
19、uch 膀胱子宫陷窝between bladder and uterus,Omental bursa 网膜囊,Positionsituated behind the lesser omentum and stomach Walls Superiorperitoneum which covers the caudate lobe of liver and diaphragm Anteriorformed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater om
20、entum Inferiorconjunctive area of anterior and posterior two layers of greater omentum Posteriorformed 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 The subdivision of the peritoneal cavity
21、 (two sacs),Leftformed by the spleen, gastrosplenic ligament胃脾韧带 and splenorenal ligament 脾肾韧带 Rightformed by omental foramen,Omental foramen 网膜孔 Behind the right border of hepatoduodenal ligament Superiorcaudate lobe of liver Inferiorsuperior part of duodenum Anteriorhepatoduodenal ligament Posteri
22、orperitoneum covering the inferior vena cavaThe Omental bursa (lesser sac) communicates with the greater sac through the omental foramen.,The subregions of the peritoneal cavity,The transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments. 结
23、肠上区和结肠下区,Supracolic compartment 结肠上区(subphrenic space)lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess 肝上间隙 lies between the diaphragm and livethe falciform ligament divides it into right and left suprahepatic recesses,Left suprahepatic space 左肝上间隙 left anteri
24、or suprahepatic space left posterior suprahepatic space Right suprahepatic space 右肝上间隙 Subphrenic extraperitoneal space膈下腹膜外间隙 (corresponding to the bare area of liver),Infrahepatic space 肝下间隙 lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it
25、into right and left infrahepatic spaces Right infrahepatic space 右肝下间隙 (hepatorenal recess) Left infrahepatic spaces 左肝下间隙 left anterior infrahepatic space left posterior infrahepatic space,Infracolic compartment 结肠下区 lies below the transverse colon and transverse mesocolon Right paracolic sulcus (g
26、utter) 右结肠旁沟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) 左结肠旁沟 lies lateral to the descending colon. It is sepa
27、rated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm.,Right mesenteric sinus 右肠系膜窦triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon Left me
28、senteric sinus 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,The organs of the abdominal cavity 腹腔脏器：,Supracolic compartment 结肠上区Infracolic compartment 结肠下区Extraperit
29、oneal space 腹膜后间隙,结肠上区脏器解剖,胃的局解 肝脏的局解 肝外胆道的局解,胃的局解（Anatomy of stomach）,形态和分部Features and divisions 位置和毗邻Position and relationship 胃的网膜和韧带Omentum and Ligaments 血供和淋巴Blood vessels and lymphatics 神经支配Nerve,Features and divisions,Position and Relationship of stomach,位置中度充盈时，大部分位于左季肋区，小部分位于腹上区。贲门在第11胸椎左侧
30、，幽门在第1腰椎右侧。 2. 毗邻?：,Position and Relationship of stomach,Position and Relationship of stomach,位置中度充盈时，大部分位于左季肋区（3/4)，小部分位于腹上区(1/4)。贲门在第11胸椎左侧，幽门在第1腰椎右侧。 2. 毗邻： 胃前壁 右侧份邻接肝左叶,左侧份上部邻接膈，下部接触腹前壁。 胃后壁 隔网膜囊与胃床(胰、左肾上腺、左 肾、脾、横结肠及系膜)相邻。,Position and Relationship of stomach,Omentum and Ligaments,网膜：大网膜，小网膜 韧带：
31、肝胃韧带、胃膈韧带、胃脾韧带、 胃结肠韧带、胃胰韧带。,Blood supply of stomach,1.动脉：胃左 胃右 胃网膜右 胃网膜左 胃短 胃后,Blood supply of stomach,2.静脉回流 Venous drainage,Lymph nodes and lymph drainage of stomach 胃的淋巴回流,Nerve of stomach,神经 Nerves 运动：交感神经-T610 脊髓节段侧角副交感神经胃前支、后支感觉：由内脏感觉神经传入脊髓和延髓,谢谢！,CAPD continuous ambulatory peritoneal dialysis,
