腹膜后隙解剖ppt课件

January,2019Copyright 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,2019Copyright 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：位于腹后腹膜后隙位置：位于腹后壁，介于腹后壁腹膜与腹壁，介于腹后壁腹膜与腹内筋膜之间。内筋膜之间。范围：上起膈，下至骶骨范围：上起膈，下至骶骨岬，两侧续于腹膜外筋膜，岬，两侧续于腹膜外筋膜，向下续于盆部的腹膜后间向下续于盆部的腹膜后间隙。隙。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 主要构造：腹膜后主要构造：腹膜后隙有肾、肾上腺、隙有肾、肾上腺、输尿管、腹部大血输尿管、腹部大血管、神经和淋巴结管、神经和淋巴结等重要构造。等重要构造。(胰胰腺、十二指肠已于腺、十二指肠已于结肠上区内引见结肠上区内引见)January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 二、肾二、肾 kidney kidney 内容：内容：一肾的位置和毗邻一肾的位置和毗邻二肾门、肾窦和肾蒂二肾门、肾窦和肾蒂三肾的血管三肾的血管四肾的被膜四肾的被膜 January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 一肾的位置及毗邻一肾的位置及毗邻 位置：肾位于脊柱两侧，紧位置：肾位于脊柱两侧，紧贴于腹后壁。由于肝的存贴于腹后壁。由于肝的存在，左肾略高于右肾。在，左肾略高于右肾。左肾：上端平第左肾：上端平第1111胸椎下缘胸椎下缘 下端平第下端平第2 2腰椎下缘腰椎下缘 右肾：上端平第右肾：上端平第1212胸椎上缘胸椎上缘 下端平第下端平第3 3腰椎上缘腰椎上缘January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肾的毗邻：肾的毗邻：毗邻一样点：毗邻一样点：两肾上端两肾上端:肾上腺肾上腺两肾后面：膈两肾后面：膈 腰大肌腰大肌 腰方肌腰方肌 腹横肌腹横肌两肾内下方：肾盂两肾内下方：肾盂 输尿管输尿管两肾内后方：左右腰交感干两肾内后方：左右腰交感干膈肌膈肌腰大肌腰大肌腰方肌腰方肌腹横肌腹横肌January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 毗邻不同点：毗邻不同点：两肾内侧：两肾内侧：左肾：腹自动脉左肾：腹自动脉 右肾：下腔静脉右肾：下腔静脉左肾前面邻：左肾前面邻：胃胃 胰胰 空肠空肠 结肠左曲结肠左曲右肾前面邻：右肾前面邻：肝右叶肝右叶 结肠右曲结肠右曲 十二指肠降部十二指肠降部January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肾区肾区 竖脊肌外侧缘与第12肋之间所夹的部位称肾区脊肋角。在某些肾疾病患者，叩击或触压该区可引起疼痛。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 二肾门、肾窦和肾蒂二肾门、肾窦和肾蒂 肾门：肾门：肾的内侧缘肾的内侧缘中部凹陷，是肾的血中部凹陷，是肾的血管、神经、淋巴管和管、神经、淋巴管和肾盂出入肾的部位，肾盂出入肾的部位，称肾门。称肾门。肾窦：肾门深化肾肾窦：肾门深化肾本质所围成的腔隙称本质所围成的腔隙称为肾窦。为肾窦。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肾蒂肾蒂 ：出入肾门的构造合称肾：出入肾门的构造合称肾蒂，主要构造有肾动脉、肾蒂，主要构造有肾动脉、肾静脉、肾盂。静脉、肾盂。肾蒂内主要构造的陈列关系肾蒂内主要构造的陈列关系:由前向后依次为：由前向后依次为：肾静脉、肾动脉、肾盂肾静脉、肾动脉、肾盂 从上向下依次为：从上向下依次为：肾动脉、肾静脉、肾盂肾动脉、肾静脉、肾盂January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肾动脉和肾肾动脉和肾段段 肾段：每一肾段：每一段动脉供应段动脉供应的肾本质区的肾本质区域称为肾段，域称为肾段，共共5 5个。个。上段动脉上段动脉上前段动脉上前段动脉下段动脉下段动脉下前段动脉下前段动脉后段动脉后段动脉January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.肾静脉右肾静脉通常无肾右肾静脉通常无肾外属支，而左肾静外属支，而左肾静脉收纳左肾上腺、脉收纳左肾上腺、左睾丸卵巢静左睾丸卵巢静脉血，其属支与周脉血，其属支与周围静脉有吻合，借围静脉有吻合，借此可建立门此可建立门-腔静脉腔静脉间的侧支循环。间的侧支循环。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 四肾的被膜四肾的被膜 肾外表包有三层被膜，由内向外为：纤维囊纤维囊脂肪囊脂肪囊肾筋膜肾筋膜January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 三、输尿管腹部三、输尿管腹部 输尿管起于肾盂，终于膀胱，全长约输尿管起于肾盂，终于膀胱，全长约252530cm30cm。分为三部。分为三部:腹部、盆部、壁内部，其中腹部、盆部、壁内部，其中腹部长约腹部长约13-14cm,13-14cm,紧贴腰大肌前面向下内斜行紧贴腰大肌前面向下内斜行，在腰大肌前面中点处有睾丸卵巢血管斜，在腰大肌前面中点处有睾丸卵巢血管斜过其前方。过其前方。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 右输尿管前方为十二右输尿管前方为十二指肠降部、升结肠血管、指肠降部、升结肠血管、回结肠血管、睾丸卵回结肠血管、睾丸卵巢血管、回肠末段。巢血管、回肠末段。左输尿管前方为十二左输尿管前方为十二指肠空肠曲、降结肠血指肠空肠曲、降结肠血管、斜行跨过的睾丸管、斜行跨过的睾丸卵巢血管。卵巢血管。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹自动脉沿脊柱左前方下腹自动脉沿脊柱左前方下行，至第行，至第4 4腰椎下缘平面分为腰椎下缘平面分为左、右髂总动脉，全长左、右髂总动脉，全长14-14-15cm15cm，其右侧邻下腔静脉。腹，其右侧邻下腔静脉。腹自动脉可分为脏支及壁支，其自动脉可分为脏支及壁支，其中脏支又可分为：成对的脏支中脏支又可分为：成对的脏支 不成对的脏支不成对的脏支四、腹自动脉四、腹自动脉 Abdominal aorta Abdominal aortaJanuary,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1成对的脏支成对的脏支 有有3对对:肾上腺中动脉肾上腺中动脉 肾动脉肾动脉 睾丸动脉睾丸动脉(卵巢动脉卵巢动脉)January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2不成对的脏支不成对的脏支 有有3支：支：腹腔干腹腔干 肠系膜上动脉肠系膜上动脉 肠系膜下动脉肠系膜下动脉January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 腹自动脉毗邻：腹自动脉毗邻：前方：为胰腺、十二前方：为胰腺、十二 指肠升部、小肠系膜指肠升部、小肠系膜根根后方：为后方：为1-41-4腰椎及椎腰椎及椎 间盘间盘右侧：下腔静脉右侧：下腔静脉左侧：左交感干左侧：左交感干January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 五、下腔静脉五、下腔静脉 Inferior vena cava 下腔静脉由左右下腔静脉由左右髂总静脉在第髂总静脉在第5腰腰椎右侧集合而成，椎右侧集合而成，搜集下肢、搜集下肢、盆部盆部和腹部的静脉。和腹部的静脉。下腔静脉在脊柱下腔静脉在脊柱的右前方沿腹自的右前方沿腹自动脉右侧上行经动脉右侧上行经肝腔静脉沟，穿肝腔静脉沟，穿膈的腔静脉孔，膈的腔静脉孔，最后开口于右心最后开口于右心房。房。January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3对：对：(1)肾静脉肾静脉 左侧长于右侧左侧长于右侧(2)肾上腺静脉肾上腺静脉 右侧注入下腔静脉右侧注入下腔静脉 左侧注入肾静脉。左侧注入肾静脉。(3)生殖腺静脉生殖腺静脉 右侧注入下腔静脉右侧注入下腔静脉 左侧注入肾静脉左侧注入肾静脉成对脏器的静脉：成对脏器的静脉：January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 下腔静脉毗邻：下腔静脉毗邻：前方：肝脏、胰头、前方：肝脏、胰头、十二指肠程度部及右十二指肠程度部及右睾丸卵巢血管和睾丸卵巢血管和肠系膜根肠系膜根后方：右膈脚、后方：右膈脚、1-41-4腰腰椎、右交感干和腹自椎、右交感干和腹自动脉的壁支动脉的壁支右侧：腰大肌、右肾右侧：腰大肌、右肾和右肾上腺和右肾上腺左侧：腹自动脉左侧：腹自动脉January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 左侧睾丸静脉曲张较右侧左侧睾丸静脉曲张较右侧多见，缘由如下：多见，缘由如下：1 1左侧回流流程较长左侧回流流程较长2 2左侧睾丸静脉以直角左侧睾丸静脉以直角汇入左肾静脉，压力较大汇入左肾静脉，压力较大3 3左侧前方有乙状结肠左侧前方有乙状结肠跨过，易受其压迫跨过，易受其压迫4 4左肾静脉在肠系膜上左肾静脉在肠系膜上动脉与腹自动脉夹角中回动脉与腹自动脉夹角中回流，受压时易累及左侧睾流，受压时易累及左侧睾丸静脉丸静脉January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 七、腰交感干自学七、腰交感干自学January,2019Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 八、乳糜池自学八、乳糜池自学