局部解剖学（十四）
? 腹部的局部解剖与操作（ 1）
主要内容 Main Content
? 境 界 与 分 区
The boundary and region
? 表 面 解 剖
The surface anatomy
? 腹 前 外 侧 壁
The Anterolateral Abdominal Wall
一,境界与分区
Boundary and Region
1,腹部的境界
?上界：为胸廓下口，
即剑突、肋弓、第
11肋前端、第 12肋
下缘和第 12胸椎围
成；
? 下界：为耻骨联合
上缘、耻骨嵴、耻
骨结节、腹股沟韧
带、髂嵴至第 5腰椎
下缘的连线。
2,(固有 )腹腔的境界
? 上界：膈
? 下界：骨盆上口
3A,
腹
部
的
分
区
(九分法 )
3B,
腹
部
的
分
区
(四分法 )
二、表 面 解 剖
The Surface Anatomy
? 体表标志 Surface landmark
? 表面投影 Surface projection
Xiphoid process
剑 突
Costal arch
肋 弓
Iliac crest
髂嵴
Anterior superior
iliac spine
髂前上棘 Pubic tubercle
耻骨结节
Superior edge of pubic symphysis 耻骨联合上缘
Pubic crest 耻骨嵴
1.
骨
性
标
志
2,软 组 织 标 志
Location of inguinal ligament
3.
体
表
投
影
三,腹 前 外 侧 壁
The Anterolateral Abdominal Wall
? 浅层结构 Superficial structures
? 深层结构 Deep structures
皮肤
浅筋膜
腹膜下筋膜
深筋膜和肌肉
The layers of the anterolateral abdominal wall
1.Skin
2.Superficial fascia
3.Deep fascia and muscles
4.Transverse fascia
5.Extraperitoneal fascia
6.Parietal fascia 腹横筋膜
壁腹膜
（一） 浅 层 结 构
The superficial structures
? 皮肤 Skin
? 浅筋膜 Superficial fascia
1,Skin,thinner and more elastic 薄而富有弹性
2,Superficial fascia：主要由脂肪和疏松结缔组织组成。
Camper 筋膜
? 在腹壁下部（约在脐平面以下），浅筋膜分为两层：浅层称为 Camper`s
fascia,含有丰富的脂肪组织，又称脂肪层，向下与股部的浅筋膜相互延续；
?深层称为 Scarpa` fascia,是富有弹性纤维的膜性层，在中线附于白线，
向下在腹股沟下方约一横指处，紧附于股部的深筋膜，在耻骨结节之间，越
过耻骨联合向下至会阴，与会阴浅筋膜（ Colles筋膜）相延续。
Scarpa 筋膜
浅
筋
膜
Skin
Superficial fasica
Scarpa’s fascia
Muscles of
anterior
abdominal
Camper’s fascia
Transversalis
fascia
wall
2,Superficial fascia
?Superficial fascia consists of a layer of connective tissue that
contains a variable amount of fat,
?Above the level of umbilicus,it is a fatty layer,
?In the inferior part of the anterolateral wall,the subcutaneous
tissue is composed of two layers,the fatty outer layer,known
as Camper`s fascia,and the membranous inner layer,the
Scarpa` fascia,
?The Scarpa` fascia,
1) is attached to linea alba medially,
2) continuse downwards cross the inguinal ligament to
blend with the fascia lata of the thigh about 1.5cm below
the inguinal ligament,
3) is continuous with the superficial fascia of the perineum
(Colles’ fascia),
浅
动
脉
、
浅
静
脉
、
皮
神
经
髂腹股沟区和下腹部的皮瓣
The ilioinguinal and the lower abdominal flaps
（二） 深层结构
The Deep Structures
? 肌肉层次 Muscular layer
? 血管、淋巴及神经
Vessels,lymph and nerve
? 腹横筋膜 Transversalis fascia
? 腹膜下筋膜 Extraperitoneal fascia
? 壁腹膜 Parietal peritoneum
1,肌层 The Muscular layer
?前外侧群 The Anterolateral Group The
three flat muscles are the,
– 腹外斜肌 external oblique muscle
– 腹内斜肌 internal oblique muscle
– 腹横肌 transversus abdominis,
– 腹直肌 rectus abdominis
– 锥状肌 pyramidalis
（ 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、
腔隙韧带 lacunar ligament、耻骨梳韧带 pectineal ligament
? 腹股沟韧带 inguinal ligament、腔隙韧带 lacunar
ligament、耻骨梳韧带 pectineal ligament
（ 2）腹内斜肌及其腱膜 internal oblique muscle & aponeurosis
,参与构成腹直肌鞘前、后层，结合腱 和提睾肌。
Internal oblique
muscle
Internal oblique m,
aponeurosis
Transversus
abdominis,
aponeurosis
Transversus
abdominis
（ 3）腹横肌及其腱膜 transversus muscle & aponeurosis：
参与构成腹直肌鞘前层（弓状线以下）、后层（弓状线以上）,
结合腱 和提睾肌。
☆ 提睾肌
Cremaster muscle ☆ 腹股沟镰 Inquinal 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
Rectus sheath,
posterior layer
腱 划
tendinous intersections
Rectus abdominis
弓状线
Arcuate line
Pyramidal m,
（ 4） 腹直肌 rectus abdominis
（ 5） 锥状肌 pyramidal muscle
tendinous intersections
Rectus sheath,
anterior layer
腹
直
肌
鞘
☆ 腹直肌鞘 rectus sheath
☆ 腹直肌鞘 Rectus sheath
? 腹直肌鞘 包绕腹直肌，由腹外侧壁三个扁肌的腱膜构成，分
为前、后两层。
? 在弓状线以上,
– 腹直肌鞘前层 anterior layer of the rectus sheath 由腹
外斜肌腱膜和腹内斜肌腱膜前层构成；
– 腹直肌鞘后层 posterior layer of the rectus sheath 由腹
内斜肌腱膜的后层和腹横肌腱膜构成。
? 在弓状线以下,
– 腹直肌鞘前层由三个扁肌的腱膜构成；
– 腹直肌鞘后层缺如。
2.血管、淋巴及神经
Vessels,Lymph and Nerve
(1)
动
脉
(2)
静
脉
(3)
神
经
3.
腹
横
筋
膜 Transversalis Fascia
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
5,
腹
前
壁
手
术
常
用
切
口
Thoracoabdominal
incision
Superior
median incision
Transrectus incision
Pararectus
incision
Paramedian
incision
Subcostal incision
Superior
transverse incision
McBurney’s
incision
Inferior
median incision
Inferior
transverse incision
Above the arcuate line
Below the arcuate line
四、腹 股 沟 区
The Inguinal Region
? 境界 The boundary
? 层次与特点 The layers and characteristics
? 腹股沟管 The inguinal canal
? 腹股沟三角 The inguinal triangle
? 疝 hernias,腹股沟直疝 Direct inguinal
hernias,腹股沟斜疝 indirect inguinal hernias、
股疝 femoralhernias
（一） 境界 Boundary
1,皮肤 skin
2,浅筋膜 superficial fascia
3,腹外斜肌 aponeurosis of external obliquus abdominis
（二）腹股沟区层次结构
The Layers of the Inguinal Region
4,髂腹下神经 Iliohypogastric n,和髂腹股沟神经 ilioinguinal n,
5,腹内斜肌 Obliquus internus abdominis
6,腹横肌 Transversus abdominis
（二） 腹股沟区层次结构
The Layers of the Inguinal Region
7,腹横筋膜 Transverse fascia
8,腹膜外筋膜 Extraperitoneal fascia
9,腹璧下动脉 Inferior epigastric a,and 旋髂深动脉 deep circumflex iliac a,
10.璧腹膜 Parietal peritoneum
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。
（三）腹股沟管
The inguinal canal
? 位置 Position
? 通过的结构 Structures passing through it
? 两口、四璧 Two opening and four walls
? 精索 Forming of the spermatic cord
? 腹股沟斜疝 Indirect inguinal hernia
（三）腹股沟管 Inguinal Canal
1.位置
2.内容
3.构成
4.临床意义
? The inguinal canal is an oblique,inferomedially
passage(between the superficial and deep inguinial rings) through
the inferior part of the anterior abdominal wall),3~5cm long,
? 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
contains blood and lymphatic vessels and the ilioinguinal nerve in
both sexes,
?The 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
inferior epigastric vessels,
? The anterior wall of the inguinal canal is formed by the
external oblique aponeurosis throughout the length of the
canal,with the anteri r wall of the lateral part of the canal
being einforced by fibers of internus oblique,
?The 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,
Roof ( uperior wall) is formed by the arching fibers of the
internal ob que and transv rse abd minal muscles,
?Floor( i fe ior wall ) is formed by the inguinal ligament,
?The superficial ( external ) inguinal ring-exit from inguinal canal-
is a slitlike opening between the diagonal fibers of the aponeurosis
fo the external oblique,superolateral to the pubic tubercle,
腹股沟三角 Inguinal Triangle
（ 海氏三角 Hesselbach’s triangle）
① 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。
②临床意义,由腹股沟三角突出的疝，称腹股沟直疝。
腹
股
沟
三
角
腹
股
沟
直
疝
、
腹
股
沟
斜
疝
、
股
疝
Indirect Hernia
Direct Hernia
股疝 femoral hernia
睾
丸
下
降
过
程
卵
巢
下
降
过
程
睾丸下降过程 descending process of the testis
? 先天性腹股沟斜疝
A congenital indirect inguinal
hernia
? 后天性腹股沟斜疝
A acquired indirect inguinal
hernia
? 先天性腹股沟斜疝
A congenital indirect inguinal hernia ? 后天性腹股沟斜疝 A acquired indirect inguinal hernia
精索
的被
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
解剖与观察
Dissection and Observation
? 浅层结构 superficial structures
? 三层阔肌、血管和神经
Three flat muscles,vessels and nerves
? 腹直肌 rectus abdominis
– 腹直肌 rectus sheath
? 腹股沟区 inguinal region
– 腹股沟管 inguinal canal
– 腹股沟三角 inguinal triangle
1.切口 Incision
2.将皮瓣翻向外侧 reflect skin flaps laterally,
3,Identify the fatty layer of the superificial fascia,
4.Identify the superficial epigastric vessels,
5.Remove the superficial fascia,
6,Identify the membranous layer of the superficial fascia,
7,Identify several anterior cutaneous branches of the lowest
five intercostal nerves (T7~T11)and the subcostal nerve (T12),
8,Identify the terminal branches of the iliohypogastric nerve
(L1) and the ilioinguinal nerve (L1),
9,Remove deep investing covering the external abdominal oblique
muscle,
10.Identify the direction of the fibers and the aponeurosis of the external
abdominal oblique muscle,
11.Identify the inguinal ligament,the superficial inguinal ring,
the medial crus,the lateral crus and the intercrural fibers,
12.Reflect the external abdominal oblique and expose the internal
abdominal oblique,Reflect the internal abdominal oblique and expose
the transversalis muscle,
13.Identify the vessels and nerves,
14.Cut through the anterior layer of the rectus abdominis,
15.Identify the muscular part and tendinous part of the rectus abdominis,
and the pyramidal muscle,
16.Free the lateral edge of rectus abdominis,and make a horizontal incision
through the entire width of the rectus abdominis muscle at the level of the
umbilicus,Reflect the segments of transected muscle superiorly and inferiorly,
17,Identify the superior and inferior epigastric vessels,the intercostal
and subcostal nerves,the posterior layer of the rectus sheath and the
arcuate line,
18,Dissect the inguinal region,Identify the iliohygogastric nerve,the
ilioinguinal nerve,the transverse fascia and the inferior epigastric
artery,
19,Identify the two openings and four walls of the inguinial canal,
20,Dissect the spermatic cord and identify its components,
21,Identify five folds of the peritoneum and fossae located on
the inner surface of the anterior abdominal wall,
The End
? 腹部的局部解剖与操作（ 1）
主要内容 Main Content
? 境 界 与 分 区
The boundary and region
? 表 面 解 剖
The surface anatomy
? 腹 前 外 侧 壁
The Anterolateral Abdominal Wall
一,境界与分区
Boundary and Region
1,腹部的境界
?上界：为胸廓下口，
即剑突、肋弓、第
11肋前端、第 12肋
下缘和第 12胸椎围
成；
? 下界：为耻骨联合
上缘、耻骨嵴、耻
骨结节、腹股沟韧
带、髂嵴至第 5腰椎
下缘的连线。
2,(固有 )腹腔的境界
? 上界：膈
? 下界：骨盆上口
3A,
腹
部
的
分
区
(九分法 )
3B,
腹
部
的
分
区
(四分法 )
二、表 面 解 剖
The Surface Anatomy
? 体表标志 Surface landmark
? 表面投影 Surface projection
Xiphoid process
剑 突
Costal arch
肋 弓
Iliac crest
髂嵴
Anterior superior
iliac spine
髂前上棘 Pubic tubercle
耻骨结节
Superior edge of pubic symphysis 耻骨联合上缘
Pubic crest 耻骨嵴
1.
骨
性
标
志
2,软 组 织 标 志
Location of inguinal ligament
3.
体
表
投
影
三,腹 前 外 侧 壁
The Anterolateral Abdominal Wall
? 浅层结构 Superficial structures
? 深层结构 Deep structures
皮肤
浅筋膜
腹膜下筋膜
深筋膜和肌肉
The layers of the anterolateral abdominal wall
1.Skin
2.Superficial fascia
3.Deep fascia and muscles
4.Transverse fascia
5.Extraperitoneal fascia
6.Parietal fascia 腹横筋膜
壁腹膜
（一） 浅 层 结 构
The superficial structures
? 皮肤 Skin
? 浅筋膜 Superficial fascia
1,Skin,thinner and more elastic 薄而富有弹性
2,Superficial fascia：主要由脂肪和疏松结缔组织组成。
Camper 筋膜
? 在腹壁下部（约在脐平面以下），浅筋膜分为两层：浅层称为 Camper`s
fascia,含有丰富的脂肪组织，又称脂肪层，向下与股部的浅筋膜相互延续；
?深层称为 Scarpa` fascia,是富有弹性纤维的膜性层，在中线附于白线，
向下在腹股沟下方约一横指处，紧附于股部的深筋膜，在耻骨结节之间，越
过耻骨联合向下至会阴，与会阴浅筋膜（ Colles筋膜）相延续。
Scarpa 筋膜
浅
筋
膜
Skin
Superficial fasica
Scarpa’s fascia
Muscles of
anterior
abdominal
Camper’s fascia
Transversalis
fascia
wall
2,Superficial fascia
?Superficial fascia consists of a layer of connective tissue that
contains a variable amount of fat,
?Above the level of umbilicus,it is a fatty layer,
?In the inferior part of the anterolateral wall,the subcutaneous
tissue is composed of two layers,the fatty outer layer,known
as Camper`s fascia,and the membranous inner layer,the
Scarpa` fascia,
?The Scarpa` fascia,
1) is attached to linea alba medially,
2) continuse downwards cross the inguinal ligament to
blend with the fascia lata of the thigh about 1.5cm below
the inguinal ligament,
3) is continuous with the superficial fascia of the perineum
(Colles’ fascia),
浅
动
脉
、
浅
静
脉
、
皮
神
经
髂腹股沟区和下腹部的皮瓣
The ilioinguinal and the lower abdominal flaps
（二） 深层结构
The Deep Structures
? 肌肉层次 Muscular layer
? 血管、淋巴及神经
Vessels,lymph and nerve
? 腹横筋膜 Transversalis fascia
? 腹膜下筋膜 Extraperitoneal fascia
? 壁腹膜 Parietal peritoneum
1,肌层 The Muscular layer
?前外侧群 The Anterolateral Group The
three flat muscles are the,
– 腹外斜肌 external oblique muscle
– 腹内斜肌 internal oblique muscle
– 腹横肌 transversus abdominis,
– 腹直肌 rectus abdominis
– 锥状肌 pyramidalis
（ 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、
腔隙韧带 lacunar ligament、耻骨梳韧带 pectineal ligament
? 腹股沟韧带 inguinal ligament、腔隙韧带 lacunar
ligament、耻骨梳韧带 pectineal ligament
（ 2）腹内斜肌及其腱膜 internal oblique muscle & aponeurosis
,参与构成腹直肌鞘前、后层，结合腱 和提睾肌。
Internal oblique
muscle
Internal oblique m,
aponeurosis
Transversus
abdominis,
aponeurosis
Transversus
abdominis
（ 3）腹横肌及其腱膜 transversus muscle & aponeurosis：
参与构成腹直肌鞘前层（弓状线以下）、后层（弓状线以上）,
结合腱 和提睾肌。
☆ 提睾肌
Cremaster muscle ☆ 腹股沟镰 Inquinal 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
Rectus sheath,
posterior layer
腱 划
tendinous intersections
Rectus abdominis
弓状线
Arcuate line
Pyramidal m,
（ 4） 腹直肌 rectus abdominis
（ 5） 锥状肌 pyramidal muscle
tendinous intersections
Rectus sheath,
anterior layer
腹
直
肌
鞘
☆ 腹直肌鞘 rectus sheath
☆ 腹直肌鞘 Rectus sheath
? 腹直肌鞘 包绕腹直肌，由腹外侧壁三个扁肌的腱膜构成，分
为前、后两层。
? 在弓状线以上,
– 腹直肌鞘前层 anterior layer of the rectus sheath 由腹
外斜肌腱膜和腹内斜肌腱膜前层构成；
– 腹直肌鞘后层 posterior layer of the rectus sheath 由腹
内斜肌腱膜的后层和腹横肌腱膜构成。
? 在弓状线以下,
– 腹直肌鞘前层由三个扁肌的腱膜构成；
– 腹直肌鞘后层缺如。
2.血管、淋巴及神经
Vessels,Lymph and Nerve
(1)
动
脉
(2)
静
脉
(3)
神
经
3.
腹
横
筋
膜 Transversalis Fascia
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
5,
腹
前
壁
手
术
常
用
切
口
Thoracoabdominal
incision
Superior
median incision
Transrectus incision
Pararectus
incision
Paramedian
incision
Subcostal incision
Superior
transverse incision
McBurney’s
incision
Inferior
median incision
Inferior
transverse incision
Above the arcuate line
Below the arcuate line
四、腹 股 沟 区
The Inguinal Region
? 境界 The boundary
? 层次与特点 The layers and characteristics
? 腹股沟管 The inguinal canal
? 腹股沟三角 The inguinal triangle
? 疝 hernias,腹股沟直疝 Direct inguinal
hernias,腹股沟斜疝 indirect inguinal hernias、
股疝 femoralhernias
（一） 境界 Boundary
1,皮肤 skin
2,浅筋膜 superficial fascia
3,腹外斜肌 aponeurosis of external obliquus abdominis
（二）腹股沟区层次结构
The Layers of the Inguinal Region
4,髂腹下神经 Iliohypogastric n,和髂腹股沟神经 ilioinguinal n,
5,腹内斜肌 Obliquus internus abdominis
6,腹横肌 Transversus abdominis
（二） 腹股沟区层次结构
The Layers of the Inguinal Region
7,腹横筋膜 Transverse fascia
8,腹膜外筋膜 Extraperitoneal fascia
9,腹璧下动脉 Inferior epigastric a,and 旋髂深动脉 deep circumflex iliac a,
10.璧腹膜 Parietal peritoneum
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。
（三）腹股沟管
The inguinal canal
? 位置 Position
? 通过的结构 Structures passing through it
? 两口、四璧 Two opening and four walls
? 精索 Forming of the spermatic cord
? 腹股沟斜疝 Indirect inguinal hernia
（三）腹股沟管 Inguinal Canal
1.位置
2.内容
3.构成
4.临床意义
? The inguinal canal is an oblique,inferomedially
passage(between the superficial and deep inguinial rings) through
the inferior part of the anterior abdominal wall),3~5cm long,
? 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
contains blood and lymphatic vessels and the ilioinguinal nerve in
both sexes,
?The 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
inferior epigastric vessels,
? The anterior wall of the inguinal canal is formed by the
external oblique aponeurosis throughout the length of the
canal,with the anteri r wall of the lateral part of the canal
being einforced by fibers of internus oblique,
?The 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,
Roof ( uperior wall) is formed by the arching fibers of the
internal ob que and transv rse abd minal muscles,
?Floor( i fe ior wall ) is formed by the inguinal ligament,
?The superficial ( external ) inguinal ring-exit from inguinal canal-
is a slitlike opening between the diagonal fibers of the aponeurosis
fo the external oblique,superolateral to the pubic tubercle,
腹股沟三角 Inguinal Triangle
（ 海氏三角 Hesselbach’s triangle）
① 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。
②临床意义,由腹股沟三角突出的疝，称腹股沟直疝。
腹
股
沟
三
角
腹
股
沟
直
疝
、
腹
股
沟
斜
疝
、
股
疝
Indirect Hernia
Direct Hernia
股疝 femoral hernia
睾
丸
下
降
过
程
卵
巢
下
降
过
程
睾丸下降过程 descending process of the testis
? 先天性腹股沟斜疝
A congenital indirect inguinal
hernia
? 后天性腹股沟斜疝
A acquired indirect inguinal
hernia
? 先天性腹股沟斜疝
A congenital indirect inguinal hernia ? 后天性腹股沟斜疝 A acquired indirect inguinal hernia
精索
的被
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
解剖与观察
Dissection and Observation
? 浅层结构 superficial structures
? 三层阔肌、血管和神经
Three flat muscles,vessels and nerves
? 腹直肌 rectus abdominis
– 腹直肌 rectus sheath
? 腹股沟区 inguinal region
– 腹股沟管 inguinal canal
– 腹股沟三角 inguinal triangle
1.切口 Incision
2.将皮瓣翻向外侧 reflect skin flaps laterally,
3,Identify the fatty layer of the superificial fascia,
4.Identify the superficial epigastric vessels,
5.Remove the superficial fascia,
6,Identify the membranous layer of the superficial fascia,
7,Identify several anterior cutaneous branches of the lowest
five intercostal nerves (T7~T11)and the subcostal nerve (T12),
8,Identify the terminal branches of the iliohypogastric nerve
(L1) and the ilioinguinal nerve (L1),
9,Remove deep investing covering the external abdominal oblique
muscle,
10.Identify the direction of the fibers and the aponeurosis of the external
abdominal oblique muscle,
11.Identify the inguinal ligament,the superficial inguinal ring,
the medial crus,the lateral crus and the intercrural fibers,
12.Reflect the external abdominal oblique and expose the internal
abdominal oblique,Reflect the internal abdominal oblique and expose
the transversalis muscle,
13.Identify the vessels and nerves,
14.Cut through the anterior layer of the rectus abdominis,
15.Identify the muscular part and tendinous part of the rectus abdominis,
and the pyramidal muscle,
16.Free the lateral edge of rectus abdominis,and make a horizontal incision
through the entire width of the rectus abdominis muscle at the level of the
umbilicus,Reflect the segments of transected muscle superiorly and inferiorly,
17,Identify the superior and inferior epigastric vessels,the intercostal
and subcostal nerves,the posterior layer of the rectus sheath and the
arcuate line,
18,Dissect the inguinal region,Identify the iliohygogastric nerve,the
ilioinguinal nerve,the transverse fascia and the inferior epigastric
artery,
19,Identify the two openings and four walls of the inguinial canal,
20,Dissect the spermatic cord and identify its components,
21,Identify five folds of the peritoneum and fossae located on
the inner surface of the anterior abdominal wall,
The End
