腹壁解剖及操作_培训课件.ppt

精索或睾丸被膜与腹前外侧壁层次的关系 解剖与观察Dissection and Observation 浅层结构 superficial structures 三层阔肌、血管和神经 Three flat muscles , vessels and nerves 腹直肌 rectus abdominis 腹直肌 rectus sheath 腹股沟区 inguinal region 腹股沟管 inguinal canal 腹股沟三角 inguinal triangle 1.切口 Incision 2.将皮瓣翻向外侧 reflect skin flaps laterally. 3. Identify the fatty layer of the superificial fascia. 4.Identify the superficial epigastric vessels. 5.Remove the superficial fascia. 6. Identify the membranous layer of the superficial fascia. 7. Identify several anterior cutaneous branches of the lowest five intercostal nerves (T7~T11)and the subcostal nerve (T12). 8. Identify the terminal branches of the iliohypogastric nerve (L1) and the ilioinguinal nerve (L1). 9. Remove deep investing covering the external abdominal oblique muscle. 10.Identify the direction of the fibers and the aponeurosis of the external abdominal oblique muscle. 11.Identify the inguinal ligament, the superficial inguinal ring, the medial crus, the lateral crus and the intercrural fibers. 12.Reflect the external abdominal oblique and expose the internal abdominal oblique. Reflect the internal abdominal oblique and expose the transversalis muscle. 13.Identify the vessels and nerves. 14.Cut through the anterior layer of the rectus abdominis. 15.Identify the muscular part and tendinous part of the rectus abdominis, and the pyramidal muscle. 16.Free the lateral edge of rectus abdominis, and make a horizontal incision through the entire width of the rectus abdominis muscle at the level of the umbilicus. Reflect the segments of transected muscle superiorly and inferiorly. 17. Identify the superior and inferior epigastric vessels, the intercostal and subcostal nerves, the posterior layer of the rectus sheath and the arcuate line. 18. Dissect the inguinal region. Identify the iliohygogastric nerve, the ilioinguinal nerve, the transverse fascia and the inferior epigastric artery. 19. Identify the two openings and four walls of the inguinial canal.