腹膜后隙解剖ppt課件

1、january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 腹膜后隙腹膜后隙january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 一、概一、概 述述 腹膜后隙位置腹膜后隙位置：位于腹后：位于腹后壁，介于腹后壁腹膜與腹壁，介于腹后壁

2、腹膜與腹內(nèi)筋膜之間。內(nèi)筋膜之間。范圍：范圍：上起膈，下至骶骨上起膈，下至骶骨岬，兩側(cè)續(xù)于腹膜外筋膜岬，兩側(cè)續(xù)于腹膜外筋膜，向下續(xù)于盆部的腹膜后間向下續(xù)于盆部的腹膜后間隙。隙。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 主要結(jié)構(gòu)：主要結(jié)構(gòu)：腹膜后腹膜后隙有腎、腎上腺、隙有腎、腎上腺、輸尿管、腹部大血輸尿管、腹部大血管、神經(jīng)和淋巴結(jié)管、神經(jīng)和淋巴結(jié)等重要結(jié)構(gòu)。等重要結(jié)構(gòu)。( (胰胰腺、十二指腸已于腺、十

3、二指腸已于結(jié)腸上區(qū)內(nèi)介紹結(jié)腸上區(qū)內(nèi)介紹) ) january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 二、腎二、腎 kidney 內(nèi)容：內(nèi)容： （一）（一）腎的位置和腎的位置和毗鄰毗鄰（二）腎門、腎竇和腎蒂（二）腎門、腎竇和腎蒂（三）（三）腎的血管腎的血管（四）腎的被膜（四）腎的被膜 january, 2007copyright depart. anatomy, school of medicine, lanz

4、hou university. all right reserved by yp hou and yf song （一）腎的位置及（一）腎的位置及毗鄰毗鄰 位置：位置：腎位于脊柱兩側(cè)，緊腎位于脊柱兩側(cè)，緊貼于腹后壁。由于肝的存貼于腹后壁。由于肝的存在，左腎略高于右腎。在，左腎略高于右腎。 左腎：上端左腎：上端平第平第1111胸椎下緣胸椎下緣 下端下端平第平第2 2腰椎下緣腰椎下緣 右腎：上端右腎：上端平第平第1212胸椎上緣胸椎上緣 下端下端平第平第3 3腰椎上緣腰椎上緣january, 2007copyright depart. anatomy, school of medicine, la

5、nzhou university. all right reserved by yp hou and yf song 腎的毗鄰：腎的毗鄰： 毗鄰（相同點(diǎn)）：毗鄰（相同點(diǎn)）：兩腎上端兩腎上端: 腎上腺腎上腺兩腎后面：膈兩腎后面：膈 腰大肌腰大肌 腰方肌腰方肌 腹橫肌腹橫肌兩腎內(nèi)下方：腎盂兩腎內(nèi)下方：腎盂 輸尿管輸尿管兩腎內(nèi)后方：左右腰交感干兩腎內(nèi)后方：左右腰交感干膈肌膈肌腰大肌腰大肌腰方肌腰方肌腹橫肌腹橫肌january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserv

6、ed by yp hou and yf song 毗鄰（不同點(diǎn)）：毗鄰（不同點(diǎn)）：兩腎內(nèi)側(cè)：兩腎內(nèi)側(cè)： 左腎：腹主動(dòng)脈左腎：腹主動(dòng)脈 右腎：下腔靜脈右腎：下腔靜脈左腎前面鄰：左腎前面鄰： 胃胃 胰胰 空腸空腸 結(jié)腸左曲結(jié)腸左曲右腎前面鄰：右腎前面鄰： 肝右葉肝右葉 結(jié)腸右曲結(jié)腸右曲 十二指腸降部十二指腸降部january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 腎區(qū)腎區(qū) 豎脊肌外側(cè)緣與第豎脊肌外側(cè)緣與第1212

7、肋之間所夾的部位稱肋之間所夾的部位稱腎區(qū)腎區(qū)（脊肋角脊肋角）。在某。在某些腎疾病患者，叩擊或些腎疾病患者，叩擊或觸壓該區(qū)可引起疼痛。觸壓該區(qū)可引起疼痛。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song （二）（二）腎門、腎竇和腎門、腎竇和腎蒂腎蒂 腎門：腎門： 腎的內(nèi)側(cè)緣中腎的內(nèi)側(cè)緣中部凹陷，是腎的血管、部凹陷，是腎的血管、神經(jīng)、淋巴管和腎盂出神經(jīng)、淋巴管和腎盂出入腎的部位，稱入腎的部位，稱腎門腎門。 腎

8、竇：腎竇：腎門深入腎實(shí)質(zhì)腎門深入腎實(shí)質(zhì)所圍成的腔隙稱為腎竇。所圍成的腔隙稱為腎竇。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 腎蒂腎蒂 ：出入腎門的結(jié)構(gòu)合稱出入腎門的結(jié)構(gòu)合稱腎腎蒂蒂，主要結(jié)構(gòu)有，主要結(jié)構(gòu)有腎動(dòng)脈、腎腎動(dòng)脈、腎靜脈、腎盂。靜脈、腎盂。 由前向后依次為：由前向后依次為： 腎靜脈、腎動(dòng)脈、腎盂腎靜脈、腎動(dòng)脈、腎盂 從上向下依次為：從上向下依次為： 腎動(dòng)脈、腎靜脈、腎盂腎動(dòng)脈、腎靜脈、腎盂

9、january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 1. 1.腎動(dòng)脈和腎腎動(dòng)脈和腎段段腎段：腎段：每一段每一段動(dòng)脈供給的動(dòng)脈供給的腎實(shí)質(zhì)區(qū)域腎實(shí)質(zhì)區(qū)域稱為腎段，稱為腎段，共共5 5個(gè)。個(gè)。 上段動(dòng)脈上段動(dòng)脈上前段動(dòng)脈上前段動(dòng)脈下段動(dòng)脈下段動(dòng)脈下前段動(dòng)脈下前段動(dòng)脈后段動(dòng)脈后段動(dòng)脈january, 2007copyright depart. anatomy, school of medicine, lanzho

10、u university. all right reserved by yp hou and yf song 2.腎靜脈腎靜脈右腎靜脈通常無(wú)腎右腎靜脈通常無(wú)腎外屬支，而左腎靜外屬支，而左腎靜脈收納左腎上腺、脈收納左腎上腺、左睪丸（卵巢）靜左睪丸（卵巢）靜脈血，其屬支與周脈血，其屬支與周圍靜脈有吻合，借圍靜脈有吻合，借此可建立門此可建立門- -腔靜脈腔靜脈間的側(cè)支循環(huán)。間的側(cè)支循環(huán)。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou

11、 and yf song （四）腎的被膜（四）腎的被膜 腎表面包有三層被膜，由內(nèi)向外為：腎表面包有三層被膜，由內(nèi)向外為：纖維囊纖維囊脂肪囊脂肪囊腎筋膜腎筋膜january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 三、輸尿管腹部三、輸尿管腹部 輸尿管起于腎盂，終于膀胱，輸尿管起于腎盂，終于膀胱，全長(zhǎng)約全長(zhǎng)約252530cm30cm。分為三部。分為三部: : 腹部、盆部、壁內(nèi)部，其中腹腹部、盆部、壁內(nèi)部，其中腹部長(zhǎng)

12、約部長(zhǎng)約13-14cm,13-14cm,緊貼腰大肌前緊貼腰大肌前面向下內(nèi)斜行，在腰大肌前面面向下內(nèi)斜行，在腰大肌前面中點(diǎn)處有睪丸（卵巢）血管斜中點(diǎn)處有睪丸（卵巢）血管斜過(guò)其前方。過(guò)其前方。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 右輸尿管前方為十二右輸尿管前方為十二指腸降部、升結(jié)腸血管、指腸降部、升結(jié)腸血管、回結(jié)腸血管、睪丸（卵回結(jié)腸血管、睪丸（卵巢血管）、回腸末段。巢血管）、回腸末段。 左輸尿管

13、前方為十二左輸尿管前方為十二指腸空腸曲、降結(jié)腸血指腸空腸曲、降結(jié)腸血管、斜行跨過(guò)的睪丸管、斜行跨過(guò)的睪丸（卵巢血管）。（卵巢血管）。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 腹主動(dòng)脈沿脊柱左前方下腹主動(dòng)脈沿脊柱左前方下行，至第行，至第4 4腰椎下緣平面分為腰椎下緣平面分為左、右髂總動(dòng)脈，全長(zhǎng)左、右髂總動(dòng)脈，全長(zhǎng)14-14-15cm15cm，其右側(cè)鄰下腔靜脈。腹，其右側(cè)鄰下腔靜脈。腹主動(dòng)脈可分為臟支

14、及壁支，其主動(dòng)脈可分為臟支及壁支，其中臟支又可分為：成對(duì)的臟支中臟支又可分為：成對(duì)的臟支 不成對(duì)的臟支不成對(duì)的臟支四、腹主動(dòng)脈四、腹主動(dòng)脈 abdominal aortajanuary, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song （1）成對(duì)的臟支）成對(duì)的臟支 有有3對(duì)對(duì): 腎上腺中動(dòng)脈腎上腺中動(dòng)脈 腎動(dòng)脈腎動(dòng)脈 睪丸動(dòng)脈睪丸動(dòng)脈(卵巢動(dòng)脈卵巢動(dòng)脈)january, 2007copyright depart. ana

15、tomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song （2）不成對(duì)的臟支）不成對(duì)的臟支 有有3支：支： 腹腔干腹腔干 腸系膜上動(dòng)脈腸系膜上動(dòng)脈 腸系膜下動(dòng)脈腸系膜下動(dòng)脈january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 腹主動(dòng)脈毗鄰：腹主動(dòng)脈毗鄰：前方：為胰腺、十二前方：為胰腺、十二 指腸

16、升部、小腸系膜指腸升部、小腸系膜根根后方：為后方：為1-41-4腰椎及椎腰椎及椎 間盤間盤右側(cè)：下腔靜脈右側(cè)：下腔靜脈左側(cè)：左交感干左側(cè)：左交感干january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 五、下腔靜脈五、下腔靜脈 inferior vena cava 下腔靜脈由左右髂總下腔靜脈由左右髂總靜脈在第靜脈在第5腰椎右側(cè)匯腰椎右側(cè)匯合而成，收集下肢、合而成，收集下肢、 盆部和腹部的靜脈。盆部和腹部的靜脈。

17、下腔靜脈在脊柱的右下腔靜脈在脊柱的右前方沿腹主動(dòng)脈右側(cè)前方沿腹主動(dòng)脈右側(cè)上行經(jīng)肝腔靜脈溝，上行經(jīng)肝腔靜脈溝，穿膈的腔靜脈孔，最穿膈的腔靜脈孔，最后開口于右心房。后開口于右心房。january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 3對(duì)：對(duì)：(1)(1)腎靜脈腎靜脈 左側(cè)長(zhǎng)于右側(cè)左側(cè)長(zhǎng)于右側(cè)(2)(2)腎上腺靜脈腎上腺靜脈 右側(cè)注入下腔靜脈右側(cè)注入下腔靜脈 左側(cè)注入腎靜脈左側(cè)注入腎靜脈。生殖腺靜脈生殖腺靜脈 右

18、側(cè)注入下腔靜脈右側(cè)注入下腔靜脈 左側(cè)注入腎靜脈左側(cè)注入腎靜脈成對(duì)臟器的靜脈：成對(duì)臟器的靜脈：january, 2007copyright depart. anatomy, school of medicine, lanzhou university. all right reserved by yp hou and yf song 下腔靜脈毗鄰：下腔靜脈毗鄰：前方：肝臟、胰頭、前方：肝臟、胰頭、十二指腸水平部及右十二指腸水平部及右睪丸（卵巢）血管和睪丸（卵巢）血管和腸系膜根腸系膜根后方：右膈腳、后方：右膈腳、1-41-4腰腰椎、右交感干和腹主椎、右交感干和腹主動(dòng)脈的壁支動(dòng)脈的壁支右側(cè)：腰大肌、右腎右側(cè)：腰大肌、右腎和右腎上腺和右腎上腺左側(cè)：腹主動(dòng)脈左側(cè)：腹主動(dòng)脈january, 2007cop