腹膜.ppt

　　The peritoneum  腹 膜

　　General features The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities Parietal peritoneum 壁腹膜 -lines the walls of the abdominal and pelvic cavities Visceral peritoneum 脏腹膜 -covers the organs

　　General features Peritoneal cavity 腹膜腔- the potential space between the parietal and visceral layer of peritoneum, in the male, is a closed sac, but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.

　　Function Secretion分泌 : serous fluid that moistens the organs. Absorption吸收 Support and protection abdominal organs

　　The relationship between viscera and peritoneum Intraperitoneal viscera 腹膜内位器官- viscera completely surrounded by peritoneum, such as： stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen 脾，ovary卵巢 and uterine tube输卵管

　　(Gp:) Intraperitoneal viscera

　　Interperitoneal viscera 腹膜间位器官- most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colon, upper part of rectum, urinary bladder膀胱 and uterus子宫

　　(Gp:) Interperitoneal viscera

　　Retroperitoneal viscera 腹膜外位器官- some organs 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直肠中下部, and ureter输尿管

　　(Gp:) Retroperitoneal viscera

　　Structures formed by peritoneum

　　Omentum 网膜 -two-layered fold of peritoneum that extends from stomach to adjacent 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

　　Lessor omentum 小网膜

　　Hepatogastric ligament 肝胃韧带- from porta hepatis to lesser curvature of stomach Hepatoduodenal ligament 肝十二指肠韧带

　　extends from porta hepatis to superior part of duodenum, it contains common bile duct, proper hepatic a. hepatic portal v.

　　A four-layered fold of peritoneum connecting the greater curvature of stomach and superior part of duodenum to transverse colon, which hangs down like an apron(围裙) in front of coils of small intestine.

　　Greater omentum 大网膜

　　(Gp:) Lessor omentum

　　(Gp:) Greater omentum

　　Omental bursa 网膜囊

　　Position-situated behind the lesser omentum and stomach Walls： Superior-peritoneum which covers the caudate lobe of liver and diaphragm Anterior-lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum

　　Omental bursa 网膜囊

　　Inferior-conjunctive area of anterior and posterior two layers of greater omentum Posterior-posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering posterior abdominal wall.

　　Left- spleen, gastrosplenic ligament胃脾韧带 splenorenal ligament 脾肾韧带 Right-omental foramen

　　Omental bursa 网膜囊

　　Position: lies between the liver and duodenum, behind the lesser omentum and infront of the inferior vena cava

　　Omental (epiploic)foramen 网膜孔

　　The omental bursa (lesser sac) communicates with the greater sac through the omental foramen.

　　Mesenteries or mesocolons 系膜

　　-two-layered fold of peritoneum that attach the intestines to the posterior abdominal wall

　　Mesentery 肠系膜 -suspends the small intestine from the posterior abdominal wall -Broad and a fan-shaped Radix of mesentery 小肠系膜根 15 cm long Directed obliquely from left side of L2 vertebra to right sacroiliac joint

　　Mesoappendix 阑尾系膜 Triangular mesentery-extends from terminal part of ileum to appendix Appendicular 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-attaches the sigmoid colon to the pelvic wall,the sigmoid.

　　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 the ligament contains ligamentum teres

　　Ligaments 韧带

　　Coronary ligament 冠状韧带-the area between upper and lower layer of the coronary ligament is the bare area of liverwhich contract with the diaphragm; Left and right triangular ligaments 左、右三角韧带-formed by left and right extremity of coronary ligament

　　Hepatogastric ligament 肝胃韧带 Hepatoduodenal ligament 肝十二指肠韧带

　　Ligaments of spleen Gastrosplenic ligament 胃脾韧带-connects the fundus of stomach to hilum of spleen. the short gastric and left gastroepiploic vessels pass through it.

　　Splenorenal ligament 脾肾韧带-extends between the hilum of spleen and left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas

　　Ligaments of spleen

　　Phrenicosplenic ligament 膈脾韧带 Splenocolic ligament 脾结肠韧带

　　Hepatogastric ligament 肝胃韧带 Gastrosplenic ligament 胃脾韧带 Gastrophrenic ligament 胃膈韧带 Gastrocolic ligament 胃结肠韧带

　　Ligaments of stomach

　　Folds and recesses of posterior abdominal wall

　　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-between posterior wall of abdomen and sigmoid mesocolon

　　Retrocecal recess 盲肠后隐窝-in which the appendix frequenty lies Hepatorenal recess 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

　　Folds and fossas of anterior abdominal wall

　　Medial umbilical fold 脐正中襞-contain the remnant of urachus脐尿管 (median umbilical ligaments) Medial umbilical fold 脐内侧襞-contains remnants of the umbilical arteries Lateral umbilical fold 脐外侧襞-contains the inferior epigastric vessels

　　Folds and fossas of anterior abdominal wall

　　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 陷凹 In male-rectovesical pouch 直肠膀胱陷凹 In female Rectouterine pouch 直肠子宫陷凹 -between rectum and uterus Vesicouterine pouch 膀胱子宫陷凹 -between bladder and uterus

　　Peritoneal subdivisions

　　The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic compartments 结肠上区和结肠下区.

　　Supracolic compartment 结肠上区(subphrenic space)- may be divided into Suprahepatic space and Infrahepatic space by the liver.

　　Peritoneal subdivisions

　　Suprahepatic space 肝上间隙 lies between the diaphragm and liver; It is divided into right and left suprahepatic spaces by the falciform ligament

　　Left suprahepatic space 左肝上间隙 left anterior suprahepatic spaces 左肝上前间隙 left posterior suprahepatic spaces 左肝上后间隙

　　Right suprahepatic space 右肝上间隙 right anterior suprahepatic spaces bare area of live (extraperitoneal space)

　　Infrahepatic space 肝下间隙 - lies between the live and transverse colon and transverse mesocolon; -the ligamentum teres hepatic divides it into Right infrahepatic space 右肝下间隙 (hepatorenal recess) Left infrahepatic space 左肝下间隙

　　Infrahepatic space 肝下间隙 Left infrahepatic space 左肝下间隙 divieded into(by the leser omentum and stomach) left anterior infrahepatic space左肝下前间隙 left posterior infrahepatic space左肝下后间隙 (omental bursa)

　　Infracolic compartment 结肠下区 -lies below the transverse colon and transverse mesocolon Right paracolic sulcus (gutter) 右结肠旁沟- lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity.

　　Infracolic compartment 结肠下区 Left paracolic sulcus (gutter) 左结肠旁沟 -lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament.

　　Infracolic compartment 结肠下区

　　Left mesenteric sinus 左肠系膜窦-triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon Right mesenteric sinus 右肠系膜窦-lies between root of mesentery, descending colon, right 1/3 of transverse colon, and is continuous with the cavity of the pelvis