Anterolateral Abdominal Wall

1. Regional anatomy Anterolateral Abdominal Wall

2. The Anterolateral Abdominal Wall • Superficial structures 浅层结构 • Deep structures 深层结构

3. The layers of the anterolateral abdominal wall 1.Skin 2.Superficial fascia 3.Deep fascia and muscles 4.Transverse fascia 5.Extraperitoneal fascia 6.Parietal fascia 皮肤 浅筋膜 深筋膜和肌肉 腹横筋膜 腹膜下筋膜 壁腹膜

4. Ⅰ.The superficial structures 浅层结构 • Surface Features of Skin • Superficial fascia 浅筋膜

5. Surface Features of the Abdomen

8. Superficial fascia Divisions below umbilicus（脐以下） • Superficial fatty layer (Camper’s) • Membranous layer (Scarpa’s)

9. Superficial vessels and cutaneous nerves • Arteries • Superficial epigastric a. • Superficial iliac circumflex a. • Veins • Thoracoepigastric v. • Superficial epigastric v. • Cutaneous nerves • Anterior and lateral cutaneous n. of lower six thoracic • Iliohypogastric n. (first lumb nerves)

10. 浅动脉、浅静脉、皮神经

11. The ilioinguinal and the lower abdominal flaps 髂腹股沟区和下腹部的皮瓣

12. Ⅱ.The Deep Structures 深层结构 • Muscular layer 肌层 • Vessels, lymph and nerve 血管、淋巴及神经 • Transversalis fascia 腹横筋膜 • Extraperitoneal fascia 腹膜下筋膜 • Parietal peritoneum 壁腹膜

13. Muscles of abdomen Anterolateral group • obliquus externus abdominis 腹外斜肌 • oblequus enternus abdominis 腹内斜肌 • transversus abdominis 腹横肌 • rectus abdominis 腹直肌

14. Posterior group • Quadiatus lumborum 腰方肌 • Psoas major 腰大肌

15. Obliquus externus absominis 腹外斜肌 General direction of fibers: downward, forward and medially (run down and inward) Structures • Inguinal ligament 腹股沟韧带 • Lacunar ligament 腔隙韧带 • pectineal ligament 耻骨梳韧带 • Superficial inguinal ring 腹股沟浅环 －triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle

16. Inguinal ligament Superficial inguinal ring pectineal ligament Lacunar ligament

17. Superficial inguinal ring

18. Obliquus internus abdominis 腹内斜肌 • Deep to obliquus externus abdominis • General direction of fibres: upwards, forwards and medially

19. Transversels abdominis腹横肌 • Deep to obliquus internus

20. inguinal ligament腹股沟韧带、lacunar ligament腔隙韧带、 pectineal ligament耻骨梳韧带

21. Inguinal falx 腹股沟镰: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis • Cremaster 提睾肌: around the spermatic cord and testis

22. Inguinal falx

23. Rectus abdominis 腹直肌 • Position: lie on to either of midline • Origin: pubic crest and symphysis • Insertion: xiphoid and 5th-7th costal cartilages • Has 3-4 tendinous intersections腱划 • linea semiluaris半月线

24. arcuate line Linea alba 白线 －tendinous raphe between right and left recti from xiphoid to pubic symphysis. Linea alba

25. Deep vessels and nerves Arteres • Superior and inferior epigastric arteris • Lower posterior intercostal a. • Subcostal a. • Four lumbar a. Nerves • Intercostal n.(6-11) • Subcostal n.

26. Nerves • Iliohypogastric n. 髂腹下神经 • Ilioinguinal n. 髂腹股沟神经 • Genitofemoral n. 生殖股神经

27. Regional anatomy

28. Sheath of rectus abdominis 腹直肌鞘 Ant layer－formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis Post layer • Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominis • Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line • Below this line rectus abdominis in contact with transverse fascia

29. arcuate line

30. The Inguinal Region 腹股沟区 • Boundary 境界 • Layers and characteristics 层次与特点 • Inguinal canal 腹股沟管 • Inguinal triangle 腹股沟三角 • Hernias 疝 ： Direct inguinal hernias 腹股沟直疝 Indirect inguinal hernias 腹股沟斜疝 Femoralhernias 股疝

31. Inguinal region 腹股沟区 Boundaries • Inguinal ligament • Lateral margin of rectus abdominis • A horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominis

32. Inguinal canal腹股沟管 Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal lig.

33. Boundaries • Ant wall • Aponeurosis of obliquus externus abdominis • Obliquus internus abdominis (lateral third of wall)

34. Posterior wall • Transverse fascia • Inguinal flax medially • Roof－arched lower fibers of obliquus internus and transversua abdominis • Floor－inguinal lig．

35. Two openings • Superficial inguinal ring 腹股沟浅环 • Deep inguinal ring 腹股沟深环 －defect in transverse fascia 1.5cm above midpoint of inguinal ligament

36. Structures passing through the inguinal canal • Spermatic cord精索and ilioinguinal nerve髂腹股沟神经in males • Round ligament of uterus子宫圆韧带and ilioinguinal nerve髂腹股沟神经in females

37. Descent of testes Seven-week embryo showing the testis before its descent from the dorsal abdominal wall

38. Fetus at 28 week the testis passing through the inguinal canal

39. Newborn

40. Inguinal Triangle (of Hesselbach) 腹股沟三角 Boundaries • Inguinal ligament inferiorly • Lateral border of rectus abdominis medially • Inferior epigastric artery laterally

41. Inguinal Triangle 腹股沟三角 （Hesselbach’s triangle 海氏三角 ） ①构成：腹壁下动脉、腹直肌外侧缘和腹股沟韧带内侧半所围成的三角形区域。②临床意义：由腹股沟三角突出的疝，称腹股沟直疝。

42. 腹股沟直疝、腹股沟斜疝、股疝 腹股沟三角

43. Indirect inguinal heinia and direcet inguinal heinia 斜疝 Indirect inguinal ehinia 直疝 Direcet heinia

44. Hernias

45. Hernias

46. Hernias

47. Transverse incision Subcostal incision Muscle-splitting incision Left paramedian incision Median or midline incision Suprapubic incision Layer ?

48. Regional anatomy The peritoneum Ling Shucai

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

50. Function • Secretes a lubricating serous fluid that continuously moistens the associated organs • Absorb • Support viscera