12.结肠下区.ppt

The Infracolic Compartment 浙江大学医学院 陈明法2013.Location It lies between the transverse colon with its mesocolon and the superior aperture of the lesser pelvis.Contents 空肠、回肠、盲肠、阑尾、结肠、空肠、回肠、盲肠、阑尾、结肠、the jejunum,ileum,cecum,vermiform appendix,colon and other viscera.1.Jejunum and ileum空肠回肠的比较：空肠回肠的比较：空肠空肠 回肠回肠1、位于：、位于：腹腔左上部腹腔左上部 腹腔腹腔右下右下部部2、长度、长度 占占2/5 占占3/5 3、管径、管径 粗粗 细细 4、管壁、管壁 厚厚 薄薄 5、血管、血管 多多 少少 6、颜色、颜色 红润红润 苍白苍白 7、环状皱襞、环状皱襞 密而高密而高 疏而低疏而低 8、绒毛、绒毛 密而高密而高 疏而低疏而低9、淋巴小结、淋巴小结 孤立淋巴小结孤立淋巴小结 集合淋巴小结集合淋巴小结 10、血管弓、血管弓 少少 多多11、直血管、直血管 长长 短短2、肠系膜、肠系膜 mesentery 肠系膜根肠系膜根 radix of mesentery ，L2左侧左侧-右骶右骶髂关节髂关节左肠系膜窦左肠系膜窦左肠系膜窦左肠系膜窦 left mesenteric sinuse 位于：肠系膜根位于：肠系膜根、横结肠及横结肠及系膜的左系膜的左1/3部、部、降结降结肠肠 、乙状结肠之间、乙状结肠之间 右肠系膜窦右肠系膜窦右肠系膜窦右肠系膜窦 right mesenteric sinuse 位于：肠系膜根位于：肠系膜根、升结肠、横结肠及升结肠、横结肠及系膜的右系膜的右2/3部之间部之间.肠系膜根肠系膜根左肠系膜窦左肠系膜窦左肠系膜窦左肠系膜窦右肠系膜窦右肠系膜窦右肠系膜窦右肠系膜窦左肠系膜窦左肠系膜窦左肠系膜窦左肠系膜窦右肠系膜窦右肠系膜窦右肠系膜窦右肠系膜窦3.blood vessels,lymphatic drainage,nerves1）动脉动脉：肠系膜上动脉肠系膜上动脉肠系膜上动脉肠系膜上动脉 L1,分支有：分支有：胰胰十二指肠下十二指肠下动脉、动脉、中中结肠结肠动脉、动脉、右右结肠结肠动脉、动脉、回回结肠结肠动脉、动脉、空肠空肠空肠空肠动脉、动脉、动脉、动脉、回回回回肠肠肠肠动脉动脉动脉动脉、2）静脉：肠系膜上肠系膜上静脉4、cecum、vermiform appendix（1）盲盲盲盲肠肠肠肠 cecum盲盲肠肠：-ileocecal valve 回盲瓣回盲瓣 回盲部回盲部：盲：盲肠肠、阑阑尾、回尾、回肠肠末端末端（2）阑阑阑阑尾尾尾尾 vermiform appendix -a narrow,worm-shaped,blind tube.-about 57cm long.-diameter is 0.51.0cm.-intraperitoneal organ,has a triangular mesentery.The position of the vermiform appendix -the root joins with the posteromedial wallof the cecum.-the 3 colic bands focus at the root.the projection of the root of the vermiform appendix *The McBurngys point at the junction of the lateral and middle thirds of the line between the right ant.sup.iliac spine and the umbilicus.-it is variable in position A.回回肠肠前位前位 the pre-ileal position:28%;B.盆盆位位pelvic position:26%;C.盲盲肠肠后位后位the the retrocecoal position:24%;D.回回肠肠后位后位 the post-ileal position:8%.E.盲盲肠肠下位下位 the subcecal position:6%;The appendicular artery and vein I)the artery arises from the ileocolic a.and usually is single.II)the vein drains into the hepatic portal vein.the appendicular v.the ileocolic v.the superior mesenteric v.hepatic portal v.appendicitis the bacterial emboli enter the liver by the course and lead to hepatic abscess.5、结肠结肠 colon（1）subdivisions.Position.Relation升结肠升结肠 ascending colonascending colon、横结肠横结肠 transverse colon transverse colon 降结肠降结肠 descending colondescending colon乙状结肠乙状结肠 sigmoid colon右结肠旁沟右结肠旁沟右结肠旁沟右结肠旁沟 right paracolic sulcus *在升结肠与外侧的腹壁之间。在升结肠与外侧的腹壁之间。*上通肝肾隐窝、上通肝肾隐窝、*下通右髂窝、盆腔。下通右髂窝、盆腔。左结肠旁沟左结肠旁沟 left paracolic sulcus *在降结肠与外侧的腹壁之间。在降结肠与外侧的腹壁之间。*上有左膈结肠韧带。上有左膈结肠韧带。*下通盆腔。下通盆腔。右结肠旁沟右结肠旁沟左结肠旁沟左结肠旁沟The blood supply of colon肠系膜上动脉肠系膜上动脉肠系膜上动脉肠系膜上动脉 the superior mesenteric artery L1回回结肠结肠动脉、动脉、右右结肠结肠动脉、动脉、中中结肠结肠动脉、动脉、肠系膜下动脉肠系膜下动脉肠系膜下动脉肠系膜下动脉 the inferior mesenteric artery L3左左结肠结肠动脉、动脉、乙状结肠乙状结肠动脉动脉直直肠上肠上动脉动脉The vein of colon肠系膜上肠系膜上静脉肠系膜下肠系膜下静脉腹腔干腹腔干 celiac trunk(celiac trunk(L1、T12)T12)1 1）胃左动脉胃左动脉 leftleft gastric a.gastric a.2 2）脾动脉脾动脉:splenicsplenic a.a.胰支胰支 胃短动脉胃短动脉 胃网膜左动脉胃网膜左动脉 胃后动脉胃后动脉3 3）肝总动脉肝总动脉 common hepatic artery common hepatic artery 肝固有动脉肝固有动脉:proper hepatic a.:proper hepatic a.肝左动脉肝左动脉 肝右动脉肝右动脉-胆囊动脉胆囊动脉 胃右动脉胃右动脉 胃十二指肠动脉胃十二指肠动脉:gastroduodenalgastroduodenal a.a.胃网膜右动脉胃网膜右动脉 胰十二指肠上动脉胰十二指肠上动脉腹腔干腹腔干 celiac trunkceliac trunk腹腔干腹腔干 celiac trunkceliac trunk