1、腹股溝區的臨床運用解剖學丁文龍上海交通大學醫學院2021.8.21淺淺 筋筋膜膜及及腹腹 壁壁SkinSuperficial fasica Scarpas fasciaMuscles of anteriorabdominal Campers fasciaTransversalis fasciawall一. The Muscles of Abdomen (The Anterolateral Group) 腹肌(前外側群)obliquus externus abdominis 腹外斜肌腹外斜肌linea alba 腹白線腹白線 inguinal ligament 腹股溝韌帶腹股溝韌帶 superf

2、icial inguinal ring 腹股溝管淺環腹股溝管淺環 1腹外斜肌腹外斜肌 external oblique muscle 腹股溝管皮下環腹股溝管皮下環 superficial inguinal ring:內側腳內側腳medial crus、外側腳、外側腳lateral crus、腳間纖維、腳間纖維intercrural fibers.腹外斜肌腹外斜肌External oblique腹外斜肌腱膜腹外斜肌腱膜External oblique，aponeurosisIntercrural fibersMedial crusv 腹股溝管皮下環腹股溝管皮下環 superficial ingu

3、inal ring:內側腳內側腳medial crus、外側腳、外側腳lateral crus、腳間纖維、腳間纖維intercrural fibers.v返轉韌帶返轉韌帶reflected ligament、腹股溝韌帶、腹股溝韌帶inguinal ligament、 腹股溝韌帶腹股溝韌帶inguinal ligament、腔隙韌帶、腔隙韌帶lacunar ligament、恥骨梳韌帶、恥骨梳韌帶pectineal ligamentobliquus internus abdominis腹內斜肌Cremaster 提睪肌 transversus abdominis 腹橫肌inguinal falx

4、腹股溝鐮 (conjoined tendon) 腹內斜肌及其腱膜和腹橫肌及其腱膜腹內斜肌及其腱膜和腹橫肌及其腱膜構成的構造構成的構造 腹橫筋膜腹橫筋膜 Transverse fascia 精索內筋膜精索內筋膜internal spermatic fascia 腹股溝深環deep inguinal ring 窩間韌帶 interfoveolar ligament腹橫筋膜腹橫筋膜 Transverse fascia腹前壁內面的皺襞及凹窩腹前壁內面的皺襞及凹窩4. 壁腹膜壁腹膜 Parietal peritoneum二二. The Inguinal Region腹股溝區腹股溝區 The bounda

5、ry 境界境界 The layers and characteristics 層次與特點層次與特點 The inguinal canal 腹股溝管腹股溝管 The inguinal triangle 腹股溝三角腹股溝三角 hernias 疝疝 ： Direct inguinal hernias 腹股溝直疝、腹股溝直疝、 indirect inguinal hernias 腹股溝斜疝腹股溝斜疝 、 femoral hernias 股疝股疝一Boundary1. The skin2. Superficial fascia3. Aponeurosis of external obliquus abd

6、ominis二The Layers of the Inguinal Region4. Iliohypogastric nerve and ilioinguinal nerve5. Obliquus internus abdominis6. Transversus abdominis二The Layers of the Inguinal Region7. Transverse fascia8. Extraperitoneal fascia9. Inferior epigastric artery and deep circumflex artery10.Parietal peritoneum三三

7、. 腹股溝區的特點腹股溝區的特點 腹外斜肌在此區移行為腱膜，并在下部構成一裂口腹外斜肌在此區移行為腱膜，并在下部構成一裂口(淺環淺環)； 腹內斜肌與腹橫肌的下緣未達腹股溝韌帶的內側部，腹內斜肌與腹橫肌的下緣未達腹股溝韌帶的內側部，兩者間無肌層覆蓋；兩者間無肌層覆蓋； 有精索或子宮圓韌帶經過，構成了一潛在性裂隙；有精索或子宮圓韌帶經過，構成了一潛在性裂隙； 在人體站立時，該區所接受的腹內壓力比平臥時高在人體站立時，該區所接受的腹內壓力比平臥時高3倍。倍。 因此，腹股溝區為腹壁的薄弱區，是腹壁疝的多發部因此，腹股溝區為腹壁的薄弱區，是腹壁疝的多發部位。位。 四. The inguinal cana

8、l腹股溝管 Position Structures passing through it Two opening and four walls Forming of the spermatic cord Indirect inguinal herniaThe Inguinal Canal 腹股溝管腹股溝管1.1.位置位置2.2.內容內容3.3.構成構成4.4.臨床意義臨床意義 The inguinal canal is an oblique, inferomedially passage(between the superficial and deep inguinial rings) thr

9、ough the inferior part of the anterior abdominal wall), 35cm long.位于腹股溝帶內側半的上方，是由外上斜向內下的肌筋膜裂隙。 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 i

10、n females. It also contains blood and lymphatic vessels and the ilioinguinal nerve in both sexes. 有精索男性或子宮圓韌帶女性、髂腹股溝神經經過。 vThe 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 ligam

11、ent and lateral to the inferior epigastric vessels.內口：即腹股溝深環，位于腹股溝韌帶中點內口：即腹股溝深環，位于腹股溝韌帶中點上方約一橫指處、腹壁下動脈外側，是腹橫筋膜在向外突構成的一個卵上方約一橫指處、腹壁下動脈外側，是腹橫筋膜在向外突構成的一個卵圓形孔。圓形孔。vThe superficial ( external ) inguinal ring-exit from inguinal canal- is a slitlike opening between the diagonal fibers of the aponeurosis fo

12、 the external oblique, superolateral to the pubic tubercle.v 外口：即腹股溝管淺環，是腹外斜肌腱膜在恥骨結節外上方構成的三外口：即腹股溝管淺環，是腹外斜肌腱膜在恥骨結節外上方構成的三角形裂隙。角形裂隙。 v The anterior wall of the inguinal canal is formed by the external oblique aponeurosis throughout the length of the canal, with the anterior wall of the lateral part o

13、f the canal being reinforced by fibers of internus oblique. 前壁：為淺層前壁：為淺層的腹外斜肌腱膜和深層的腹內斜肌在管的外側的腹外斜肌腱膜和深層的腹內斜肌在管的外側1/3處。處。 v vThe 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.v后壁：為

14、腹橫筋膜和腹股溝鐮在管的內側后壁：為腹橫筋膜和腹股溝鐮在管的內側1/3處。處。 Roof ( superior wall) is formed by the arching fibers of the internal oblique and transverse abdominal muscles. 上壁：為腹內斜肌和腹橫肌的弓狀下緣。上壁：為腹內斜肌和腹橫肌的弓狀下緣。 Floor( inferior wall ) is formed by the inguinal ligament.下壁：為腹股溝韌帶。下壁：為腹股溝韌帶。腹股溝三角腹股溝三角 Inguinal Triangle 海氏三角海氏三角 Hesselbachs triangle構成：腹壁下動脈、腹直肌外側緣和腹股溝韌帶內側半所圍成的三角形區構成：腹壁下動脈、腹直肌外側緣和腹股溝韌帶內側半所圍成的三角形區域。臨床意義：由腹股溝三角突出的疝，稱腹股溝