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1、January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,腹膜后隙,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,一、概 述,腹膜后隙位置：位于腹后壁，介于腹后壁腹膜与腹内筋膜之间。范围：上起膈，下至骶骨岬，两侧续于腹膜外筋膜，向下续于
2、盆部的腹膜后间隙。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,主要结构：腹膜后隙有肾、肾上腺、输尿管、腹部大血管、神经和淋巴结等重要结构。(胰腺、十二指肠已于结肠上区内介绍),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG
3、,二、肾 kidney,内容：（一）肾的位置和毗邻（二）肾门、肾窦和肾蒂（三）肾的血管（四）肾的被膜,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（一）肾的位置及毗邻,位置：肾位于脊柱两侧，紧贴于腹后壁。由于肝的存在，左肾略高于右肾。左肾：上端平第11胸椎下缘 下端平第2腰椎下缘 右肾：上端平第12胸椎上缘 下端平第3腰椎上缘,January,2007,Copyright Depart.Anatomy,Sc
4、hool of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,肾的毗邻：,毗邻（相同点）：两肾上端:肾上腺两肾后面：膈 腰大肌 腰方肌 腹横肌两肾内下方：肾盂 输尿管两肾内后方：左右腰交感干,膈肌,腰大肌,腰方肌,腹横肌,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,毗邻（不同点）：两肾内侧：左肾：腹主动脉 右肾：下腔
5、静脉左肾前面邻：胃 胰 空肠 结肠左曲右肾前面邻：肝右叶 结肠右曲 十二指肠降部,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right res
6、erved by YP HOU and YF SONG,（二）肾门、肾窦和肾蒂,肾门：肾的内侧缘中部凹陷，是肾的血管、神经、淋巴管和肾盂出入肾的部位，称肾门。肾窦：肾门深入肾实质所围成的腔隙称为肾窦。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,肾蒂：出入肾门的结构合称肾蒂，主要结构有肾动脉、肾静脉、肾盂。肾蒂内主要结构的排列关系:由前向后依次为：肾静脉、肾动脉、肾盂 从上向下依次为：肾动脉、肾静脉、肾盂,
7、January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,肾动脉和肾段肾段：每一段动脉供给的肾实质区域称为肾段，共5个。,（三）肾血管和肾段,上段动脉,上前段动脉,下段动脉,下前段动脉,后段动脉,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SO
8、NG,2.肾静脉,右肾静脉通常无肾外属支，而左肾静脉收纳左肾上腺、左睾丸（卵巢）静脉血，其属支与周围静脉有吻合，借此可建立门-腔静脉间的侧支循环。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（四）肾的被膜,肾表面包有三层被膜，由内向外为：,纤维囊脂肪囊肾筋膜,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou Universit
9、y.All right reserved by YP HOU and YF SONG,三、输尿管腹部,输尿管起于肾盂，终于膀胱，全长约2530cm。分为三部:腹部、盆部、壁内部，其中腹部长约13-14cm,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）血管斜过其前方。,January,2007,Copyright 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指肠降部、升结肠血管、回结肠血管、睾丸（卵巢血管）、回肠末段。左输
10、尿管前方为十二指肠空肠曲、降结肠血管、斜行跨过的睾丸（卵巢血管）。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,腹主动脉沿脊柱左前方下行，至第4腰椎下缘平面分为左、右髂总动脉，全长14-15cm，其右侧邻下腔静脉。腹主动脉可分为脏支及壁支，其中脏支又可分为：成对的脏支 不成对的脏支,四、腹主动脉 Abdominal aorta,January,2007,Copyright Depart.Anatomy,Sc
11、hool of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（1）成对的脏支,有3对:肾上腺中动脉 肾动脉 睾丸动脉(卵巢动脉),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（2）不成对的脏支,有3支：腹腔干 肠系膜上动脉 肠系膜下动脉,January,2007,Copyright Depart.Anatomy,S
12、chool of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,腹主动脉毗邻：前方：为胰腺、十二 指肠升部、小肠系膜根后方：为1-4腰椎及椎 间盘右侧：下腔静脉左侧：左交感干,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,五、下腔静脉 Inferior vena cava,下腔静脉由左右髂总静脉在第5腰椎右侧汇合而成，
13、收集下肢、盆部和腹部的静脉。下腔静脉在脊柱的右前方沿腹主动脉右侧上行经肝腔静脉沟，穿膈的腔静脉孔，最后开口于右心房。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,3对：(1)肾静脉 左侧长于右侧(2)肾上腺静脉 右侧注入下腔静脉 左侧注入肾静脉。(3)生殖腺静脉 右侧注入下腔静脉 左侧注入肾静脉,成对脏器的静脉：,January,2007,Copyright Depart.Anatomy,School of
14、 Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,下腔静脉毗邻：前方：肝脏、胰头、十二指肠水平部及右睾丸（卵巢）血管和肠系膜根后方：右膈脚、1-4腰椎、右交感干和腹主动脉的壁支右侧：腰大肌、右肾和右肾上腺左侧：腹主动脉,January,2007,Copyright 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多见，原因如下：（1）左侧回流流程
15、较长（2）左侧睾丸静脉以直角汇入左肾静脉，压力较大（3）左侧前方有乙状结肠跨过，易受其压迫（4）左肾静脉在肠系膜上动脉与腹主动脉夹角中回流，受压时易累及左侧睾丸静脉,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,七、腰交感干（自学）,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,八、乳糜池（自学）,
