3 курс / Топографическая анатомия и оперативная хирургия / ТАиОХ брюшная полость

ɉɪɢɦɟɱɚɧɢɟ ɉɪɢ ɨɫɦɨɬɪɟ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɢɡɧɭɬɪɢ ɦɵ ɨɛɧɚɪɭɠɢɜɚɟɦ ɟɟ ɡɚɞɧɟ-ɧɢɠɧɸɸ ɱɚɫɬɶ ɪɚɫɩɨɥɨɠɟɧɧɭɸ ɧɢɠɟ ɩɨɹɫɧɢ ɰɵ ɗɬɨ ɩɨɞɜɡɞɨɲɧɚɹ ɹɦɤɚ ɬɚɡɨɜɨɣ ɤɨɫɬɢ ɩɨɤɪɵɬɚɹ ɩɨɞɜɡɞɨɲɧɨɣɩɨɹɫɧɢɱɧɨɣ ɦɵɲɰɟɣ. Ɂɞɟɫɶ ɡɚɛɪɸɲɢɧɧɨ ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɦɵɲɰɵ ɥɟɠɚɬ ɦɨ ɱɟɬɨɱɧɢɤ ɧɟɪɜɵ ɩɨɹɫɧɢɱɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ± ɛɟɞɪɟɧɧɨ-ɩɨɥɨɜɨɣ ɛɟɞɪɟɧɧɵɣ, ɥɚɬɟɪɚɥɶɧɵɣ ɤɨɠɧɵɣ ɧɟɪɜ ɛɟɞɪɚ ɚ ɬɚɤɠɟ ɚɪɬɟɪɢɢ ɜɟɧɵ ± ɹɢɱɤɨɜɚɹɹɢɱɧɢɤɨɜɚɹ), ɝɥɭɛɨɤɚɹ ɨɝɢɛɚɸɳɚɹ ɩɨɞɜɡɞɨɲɧɭɸ ɤɨɫɬɶ ɜɟɬɜɶ ɧɚɪɭɠɧɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɚɪɬɟɪɢɢ ɢɩɨɞɜɡɞɨɲɧɨ-ɩɨɹɫɧɢɱɧɚɹ ɜɟɬɜɶ ɜɧɭɬɪɟɧɧɟɣ ɩɨɞ ɜɡɞɨɲɧɨɣ ɚɪɬɟɪɢɢ ɇɚ ɝɪɚɧɢɰɟ ɫ ɩɨɥɨɫɬɶɸ ɬɚɡɚ ɧɚɯɨɞɹɬɫɹ ɨɛɳɢɟ ɢ ɧɚɪɭɠɧɵɟ ɩɨɞɜɡɞɨɲɧɵɟ ɫɨɫɭɞɵ

ȼɟɫɶ ɨɛɴɟɦ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɦɨɠɧɨ ɪɚɡɞɟɥɢɬɶ ɧɚ ɛɪɸɲɢɧɧɭɸ ɢ ɜɧɟɛ ɪɸɲɢɧɧɭɸ ɱɚɫɬɢ Ȼɪɸɲɢɧɧɚɹ ɱɚɫɬɶ ɨɝɪɚɧɢɱɟɧɚ ɩɚɪɢɟɬɚɥɶɧɵɦ ɥɢɫɬɤɨɦ ɛɪɸɲɢɧɵ ɗɬɚ ɱɚɫɬɶ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɨɬɤɪɵɜɚɟɬɫɹ ɩɪɢ ɥɚɩɚɪɨɬɨɦɢɢ ± ɪɚɫ ɫɟɱɟɧɢɢ ɩɟɪɟɞɧɟɣ ɢɥɢ ɛɨɤɨɜɵɯ ɫɬɟɧɨɤ ɠɢɜɨɬɚ ɉɪɢ ɷɬɨɦ ɦɵ ɩɨɥɭɱɚɟɦ ɞɨɫɬɭɩ ɤ ɨɪɝɚɧɚɦ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɥɟɠɚɳɢɦ ɢɧɬɪɚ- ɢɥɢ ɦɟɡɨɩɟɪɢɬɨɧɟɚɥɶɧɨ.

ȼɧɟɛɪɸɲɢɧɧɚɹ ɱɚɫɬɶ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɢɥɢ ɜɧɟɛɪɸɲɢɧɧɨɟ ɩɪɨ ɫɬɪɚɧɫɬɜɨ (spatium extraperitoneale) ± ɩɪɨɫɬɪɚɧɫɬɜɨ ɜ ɩɨɥɨɫɬɢ ɠɢɜɨɬɚ ɦɟɠɞɭ ɩɚɪɢɟɬɚɥɶɧɨɣ ɛɪɸɲɢɧɨɣ ɢ ɜɧɭɬɪɢɛɪɸɲɧɨɣ ɮɚɫɰɢɟɣ Ɉɬɞɟɥɶɧɵɟ ɧɚɢɛɨɥɟɟ ɜɵɪɚɠɟɧɧɵɟ ɱɚɫɬɢ ɜɧɟɛɪɸɲɢɧɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɢɦɟɸɬ ɫɨɛɫɬɜɟɧɧɵɟ ɧɚɡɜɚ ɧɢɹ ± ɡɚɛɪɸɲɢɧɧɨɟ ɩɨɡɚɞɢɥɨɛɤɨɜɨɟ ɩɨɡɚɞɢɩɚɯɨɜɨɟ

Ɂɚɛɪɸɲɢɧɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ (spatium retroperitoneale), ± ɱɚɫɬɶ ɜɧɟɛɪɸ ɲɢɧɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɭ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɩɨɥɨɫɬɢ ɠɢɜɨɬɚ ɫɚɦɨɟ ɜɚɠɧɚɹ ɱɚɫɬɶ ɜɧɟɛɪɸɲɢɧɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɫ ɩɪɚɤɬɢɱɟɫɤɨɣ ɬɨɱɤɢ ɡɪɟɧɢɹ ɡɚɩɨɥɧɟɧɨ ɛɨɥɶɲɢɦ ɤɨɥɢɱɟɫɬɜɨɦ ɤɥɟɬɱɚɬɤɢ ɢ ɦɧɨɝɨɱɢɫɥɟɧɧɵɦɢ ɨɪɝɚɧɚɦɢ ɥɟɠɚɳɢɦɢ ɷɤɫɬɪɚɩɟɪɢɬɨɧɟɚɥɶɧɨ ɩɨɱɤɢ ɧɚɞɩɨɱɟɱɧɢɤɢ ɦɨɱɟɬɨɱɧɢɤɢ ɚɨɪɬɚ ɧɢɠɧɹɹ ɩɨɥɚɹ ɜɟɧɚ ɢ ɞɪ ȼ ɡɚɛɪɸɲɢɧɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɦɨɠɧɨ ɩɪɨɧɢɤɧɭɬɶ ɥɢɛɨ ɫɩɟɪɟɞɢ ɱɪɟɡɛɪɸɲɢɧɧɨ ɥɢɛɨ ɫɡɚɞɢ ɜɧɟɛɪɸɲɢɧɧɨ

ɉɨɥɨɫɬɶ ɛɪɸɲɢɧɵ (cavitas peritonealis), ɫɢɧɨɧɢɦ ± ɛɪɸɲɢɧɧɚɹ ɩɨ ɥɨɫɬɶ ± ɷɬɨ ɫɨɜɨɤɭɩɧɨɫɬɶ ɥɚɛɢɪɢɧɬ ɳɟɥɟɜɢɞɧɵɯ ɩɪɨɫɬɪɚɧɫɬɜ ɦɟɠɞɭ ɜɢɫɰɟ ɪɚɥɶɧɨɣ ɢ ɩɚɪɢɟɬɚɥɶɧɨɣ ɛɪɸɲɢɧɨɣ ɚ ɬɚɤɠɟ ɦɟɠɞɭ ɨɬɞɟɥɶɧɵɦɢ ɭɱɚɫɬɤɚɦɢ ɜɢɫɰɟɪɚɥɶɧɨɣ ɛɪɸɲɢɧɵ ɉɨɥɨɫɬɶ ɛɪɸɲɢɧɵ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɤɚɩɢɥɥɹɪ ɧɭɸ ɳɟɥɶ ɫɨɞɟɪɠɚɳɭɸ ± ɦɥ ɫɟɪɨɡɧɨɣ ɠɢɞɤɨɫɬɢ

ɉɪɢɦɟɱɚɧɢɟ: ɜ ɭɱɟɛɧɢɤɚɯ ɢ ɧɚ ɩɪɚɤɬɢɤɟ ɱɚɫɬɨ ɜɫɬɪɟɱɚɟɬɫɹ ɬɟɪɦɢɧɨ ɥɨɝɢɱɟɫɤɚɹ ɧɟɬɨɱɧɨɫɬɶ ± ɛɪɸɲɢɧɧɭɸ ɱɚɫɬɶ ɩɨɥɨɫɬɢ ɠɢɜɨɬɚ ɧɚɡɵɜɚɸɬ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɶɸ ɪɚɡɞɟɥɹɹ ɬɚɤɢɦ ɨɛɪɚɡɨɦ ɩɨɥɨɫɬɶ ɠɢɜɨɬɚ ɧɚ ɛɪɸɲɧɭɸ ɩɨɥɨɫɬɶ ɢ ɡɚɛɪɸɲɢɧɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɚ ɢɧɨɝɞɚ ɩɨɧɹɬɢɟ ©ɛɪɸɲɧɚɹ ɩɨ ɥɨɫɬɶª ɩɨɞɦɟɧɹɸɬ ɩɨɧɹɬɢɟɦ ©ɛɪɸɲɢɧɧɚɹ ɩɨɥɨɫɬɶª ɉɪɢɱɢɧɚ ɷɬɨɣ ɬɟɪɦɢ ɧɨɥɨɝɢɱɟɫɤɨɣ ɩɭɬɚɧɢɰɵ ɡɚɤɥɸɱɚɟɬɫɹ ɜ ɫɯɨɞɫɬɜɟ ɫɨɡɜɭɱɢɢ ɫɥɨɜ ©ɛɪɸɲɧɨɣª ɢ ©ɛɪɸɲɢɧɧɵɣª Ⱦɨɩɭɫɬɢɦɨ ɭɩɨɬɪɟɛɥɟɧɢɟ ɤɨɪɨɬɤɨɝɨ ɩɭɫɬɶ ɢ ɧɟ ɬɨɱɧɨɝɨ

ɬɟɪɦɢɧɚ ©ɛɪɸɲɧɚɹ ɩɨɥɨɫɬɶª ɜɦɟɫɬɨ ɛɨɥɟɟ ɩɪɚɜɢɥɶɧɨɝɨ ɧɨ ɛɨɥɟɟ ɞɥɢɧɧɨ ɝɨ ɬɟɪɦɢɧɚ ©ɛɪɸɲɢɧɧɚɹ ɱɚɫɬɶ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢª.

2

ɫɬɪɚɥɶɧɚɹ ɨɛɥɚɫɬɶª ȼ Ɇɟɠɞɭɧɚɪɨɞɧɨɣ ɚɧɚɬɨɦɢɱɟɫɤɨɣ ɬɟɪɦɢɧɨɥɨɝɢɢ ɧɚɞɱɪɟɜɶɟ ɧɚɞɱɪɟɜɧɚɹ ɨɛɥɚɫɬɶ ɧɚɞɱɪɟɜɧɚɹ ɹɦɤɚ ± ɫɢɧɨɧɢɦɵ

Ɋɢɫ Ɉɛɥɚɫɬɢ ɠɢɜɨɬɚ

1 ² regio epigastrica;

2 ²regio hypochondrica;

3 ² regio umbilicalis;

4 ² regio abdominalis lateralis;

5 ² regio inguinalis;

6 ² region pubica.

4

ɉɊɈȿɄɐɂə ɈɊȽȺɇɈȼ ȻɊɘɒɇɈɃ ɉɈɅɈɋɌɂ ɇȺ ɈȻɅȺɋɌɂ ɀɂ ȼɈɌȺ

ɉɪɚɜɚɹ ɩɨɞɪɟɛɟɪɧɚɹ ɨɛɥɚɫɬɶ UHJLR K\SRKRQGULDFD GH[WUD ² ɧɢɫɯɨɞɹ ɳɚɹ ɱɚɫɬɶ ɞɜɟɧɚɞɰɚɬɢɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɪɚɜɵɣ ɢɡɝɢɛ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɜɟɪɯɧɢɣ ɩɨɥɸɫ ɩɪɚɜɨɣ ɩɨɱɤɢ ɠɟɥɱɧɵɣ ɩɭɡɵɪɶ

ɇɚɞɱɪɟɜɧɚɹ ɨɛɥɚɫɬɶ UHJLR HSLJDVWULFD ² ɛɨɥɶɲɚɹ ɱɚɫɬɶ ɥɟɜɨɣ ɞɨɥɢ ɢ ɧɟɡɧɚɱɢɬɟɥɶɧɚɹ ɱɚɫɬɶ ɩɪɚɜɨɣ ɞɨɥɢ ɩɟɱɟɧɢ ɛɪɸɲɧɚɹ ɱɚɫɬɶ ɩɢɳɟɜɨɞɚ ɬɟɥɨ ɠɟɥɭɞɤɚ ɢ ɩɪɢɜɪɚɬɧɢɤ ɦɚɥɵɣ ɫɚɥɶɧɢɤ ɜɟɪɯɧɹɹ ɱɚɫɬɶ ɞɜɟɧɚɞɰɚɬɢɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɨɞɠɟɥɭɞɨɱɧɚɹ ɠɟɥɟɡɚ ɛɪɸɲɧɚɹ ɚɨɪɬɚ ɢ ɱɪɟɜɧɵɣ ɫɬɜɨɥ ɜɨɪɨɬɧɚɹ ɜɟɧɚ ɫɨɥɧɟɱɧɨɟ ɫɩɥɟɬɟɧɢɟ

Ʌɟɜɚɹ ɩɨɞɪɟɛɟɪɧɚɹ ɨɛɥɚɫɬɶ UHJLR K\SRKRQGULDFD VLQLVWUD ² ɤɚɪɞɢɚɥɶ ɧɚɹ ɱɚɫɬɶ ɞɧɨ ɬɟɥɨ ɠɟɥɭɞɤɚ ɧɟɡɧɚɱɢɬɟɥɶɧɚɹ ɱɚɫɬɶ ɥɟɜɨɣ ɞɨɥɢ ɩɟɱɟɧɢ ɫɟɥɟ ɡɟɧɤɚ ɯɜɨɫɬ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɥɟɜɵɣ ɢɡɝɢɛ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɜɟɪɯɧɢɣ ɩɨɥɸɫ ɥɟɜɨɣ ɩɨɱɤɢ

ɉɪɚɜɚɹ ɛɨɤɨɜɚɹ ɨɛɥɚɫɬɶ UHJLR ODWHUDOLV GH[WUD ± ɜɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɱɚɫɬɶ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ɩɪɚɜɚɹ ɩɨɱɤɚ ɫ ɦɨɱɟɬɨɱɧɢɤɨɦ

ɉɭɩɨɱɧɚɹ ɨɛɥɚɫɬɶ UHJLR XPELOLFDOLV ± ɛɨɥɶɲɚɹ ɤɪɢɜɢɡɧɚ ɠɟɥɭɞɤɚ ɩɨ ɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɛɨɥɶɲɨɣ ɫɚɥɶɧɢɤ ɧɢɠɧɹɹ ɢ ɜɨɫɯɨɞɹɳɚɹ ɱɚɫɬɢ ɞɜɟɧɚɞɰɚɬɢɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɟɬɥɢ ɬɨɧɤɨɣ ɤɢɲɤɢ ɛɪɸɲɧɚɹ ɚɨɪɬɚ ɧɢɠɧɹɹ ɩɨɥɚɹ ɜɟɧɚ ɜɨɪɨɬɚ ɩɨɱɟɤ ɦɨɱɟɬɨɱɧɢɤɢ

Ʌɟɜɚɹ ɛɨɤɨɜɚɹ ɨɛɥɚɫɬɶ UHJLR ODWHUDOLV VLQLVWUD ± ɧɢɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɥɟɜɚɹ ɩɨɱɤɚ ɫ ɦɨɱɟɬɨɱɧɢɤɨɦ ɩɟɬɥɢ ɬɨɳɟɣ ɤɢɲɤɢ

ɉɪɚɜɚɹ ɩɚɯɨɜɚɹ ɨɛɥɚɫɬɶ UHJLR LQJXLQDOLV GH[WUD ± ɫɥɟɩɚɹ ɤɢɲɤɚ ɫ ɱɟɪɜɟɨɛɪɚɡɧɵɦ ɨɬɪɨɫɬɤɨɦ ɤɨɧɟɱɧɵɣ ɨɬɞɟɥ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ɩɪɚɜɵɣ ɦɨ ɱɟɬɨɱɧɢɤ

Ʌɟɜɚɹ ɩɚɯɨɜɚɹ ɨɛɥɚɫɬɶ UHJLR LQJXLQDOLV VLQLVWUD ± ɫɢɝɦɨɜɢɞɧɚɹ ɤɢɲɤɚ ɩɟɬɥɢ ɬɨɧɤɨɣ ɤɢɲɤɢ ɥɟɜɵɣ ɦɨɱɟɬɨɱɧɢɤ

Ʌɨɛɤɨɜɚɹ ɨɛɥɚɫɬɶ UHJLR SXELFD ± ɩɟɬɥɢ ɬɨɧɤɨɣ ɤɢɲɤɢ ɦɨɱɟɜɨɣ ɩɭ ɡɵɪɶ ɜ ɧɚɩɨɥɧɟɧɧɨɦ ɫɨɫɬɨɹɧɢɢ ɫɢɝɦɨɜɢɞɧɚɹ ɤɢɲɤɚ

5

Ɋɢɫ Ƚɨɥɨɬɨɩɢɹ ɨɪɝɚɧɨɜ ɠɢɜɨɬɚ

I ² linea parasternalis;

ɉ ² linea edioclavicularis; ɒ ² lineabicostarum;

IV ²linea bispinarum. 1 ² diaphragma;

2 ² processus xiphoideus;

3 ² splen;

4 ² arcus costalis;

5 ²umbilicus;

6 ² colon descendens;

7 ² spina iliaca anterior superior;

8 ² colon sigmoidem;

9 ² rectum;

10 ² caecum;

11 ² colon ascendens; 12 ² colon transversum;

13 ² vesica bili aris (fellea);

14 ² gaster;

15 ² hepar.

ɉɨɫɥɨɣɧɨɟ ɫɬɪɨɟɧɢɟ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ

Ȼɪɸɲɧɚɹ ɫɬɟɧɤɚ ɷɥɚɫɬɢɱɧɚ ɫɩɨɫɨɛɧɚ ɤ ɪɚɫɬɹɠɟɧɢɸ ɩɪɢ ɭɜɟɥɢɱɟɧɢɢ ɨɛɴɟ ɦɚ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɧɚɩɪɢɦɟɪ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɚɫɰɢɬɟ ɛɨɥɶɲɢɯ ɨɩɭɯɨ ɥɹɯ.

Ʉɨɠɚ.ɗɥɚɫɬɢɱɧɚ ɩɨɞɜɢɠɧɚ ɥɟɝɤɨ ɛɟɪɟɬɫɹ ɜ ɫɤɥɚɞɤɭ ɜɛɥɢɡɢ ɩɭɩɤɚ ɢ ɧɚ ɩɪɨ ɬɹɠɟɧɢɢ ɛɟɥɨɣ ɥɢɧɢɢ ɦɚɥɨɩɨɞɜɢɠɧɚ ɬɚɤ ɤɚɤ ɩɥɨɬɧɨ ɫɪɚɳɟɧɚ ɫ ɩɨɞɥɟɠɚɳɢ ɦɢ ɬɤɚɧɹɦɢ ɉɪɢ ɛɵɫɬɪɨɦ ɭɜɟɥɢɱɟɧɢɢ ɦɚɫɫɵ ɬɟɥɚ ɚ ɭ ɠɟɧɳɢɧ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɚ

ɤɨɠɟ ɠɢɜɨɬɚ ɩɨɹɜɥɹɸɬɫɹ ɛɟɥɵɟ ɩɨɥɨɫɤɢ ɗɬɨ ɫɬɪɢɢ ± ɫɥɟɞɵ ɪɚɫɬɹɠɟɧɢɹ ɤɨ ɠɢ ɜ ɦɟɫɬɚɯ ɟɟ ɧɚɢɛɨɥɶɲɟɝɨ ɧɚɩɪɹɠɟɧɢɹ

ɉɨɫɥɟ ɪɨɞɨɜ, ɩɨ ɦɟɪɟ ɩɨɫɬɟɩɟɧɧɨɝɨ ɭɦɟɧɶɲɟɧɢɹ ɪɚɡɦɟɪɨɜ ɦɚɬɤɢ ɪɚɡ ɦɟɪɵ ɠɢɜɨɬɚ ɜɨɡɜɪɚɳɚɸɬɫɹ ɤ ɞɨɪɨɞɨɜɨɣ ɧɨɪɦɟ ɋɬɪɢɢ ɧɟ ɢɫɱɟɡɚɸɬ

ȼɨ ɜɬɨɪɨɣ ɩɨɥɨɜɢɧɟ ɫɪɨɤɚ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɚ ɤɨɠɟ ɠɢɜɨɬɚ ɦɨɠɟɬ ɩɨ ɹɜɢɬɶɫɹ ɩɢɝɦɟɧɬɢɪɨɜɚɧɧɧɚɹ ɩɨɥɨɫɤɚ ɢɞɭɳɚɹ ɨɬ ɩɭɩɤɚ ɤ ɥɨɛɤɭ ɚ ɢɧɨɝɞɚ ɢ

6

ɜɵɲɟ ɩɭɩɤɚ ɗɬɨ ɬɟɦɧɚɹ ɥɢɧɢɢ Linia negra) ɩɪɢɱɢɧɚ ɩɨɹɜɥɟɧɢɹ ɤɨɬɨɪɨɣ ± ɝɨɪɦɨɧɚɥɶɧɵɟ ɢɡɦɟɧɟɧɢɹ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɉɨɥɨɫɤɚ ɨɛɵɱɧɨ ɢɫɱɟɡɚɟɬ ɱɟɪɟɡ 1.5- ɝɨɞɚ ɩɨɫɥɟ ɪɨɞɨɜ

Ɋɟɥɶɟɮɧɵɟ ɨɛɪɚɡɨɜɚɧɢɹ ɧɚ ɤɨɠɟ ɠɢɜɨɬɚ ± ɷɬɨ ɩɭɩɨɤ ɧɚɞɥɨɛɤɨɜɚɹ ɫɤɥɚɞɤɚ ɢ ɧɚɞɱɪɟɜɧɚɹ ɹɦɤɚ

ɉɨ ɢɡɦɟɧɟɧɢɸ ɮɨɪɦɵ ɢ ɪɚɡɦɟɪɨɜ ɩɭɩɤɚ ɦɨɠɧɨ ɫɭɞɢɬɶ ɨ ɫɨɫɬɨɹɧɢɢ ɩɭ ɩɨɱɧɨɝɨ ɤɨɥɶɰɚ ɜɧɭɬɪɢɛɪɸɲɧɨɝɨ ɞɚɜɥɟɧɢɹ ɍɜɟɥɢɱɟɧɢɟ ɢ ɜɵɩɹɱɢɜɚɧɢɟ ɩɭɩ ɤɚ ɜɨ ɜɬɨɪɨɣ ɩɨɥɨɜɢɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ± ɹɜɥɟɧɢɟ ɧɨɪɦɚɥɶɧɨɟ Ɉɞɧɚɤɨ ɷɬɨ ɠɟ ɩɪɨɢɫɯɨɞɢɬ ɢ ɩɪɢ ɮɨɪɦɢɪɨɜɚɧɢɢ ɩɭɩɨɱɧɨɣ ɝɪɵɠɢ

ɇɚɞɥɨɛɤɨɜɚɹ ɫɤɥɚɞɤɚ ± ɷɬɨ ɩɨɩɟɪɟɱɧɚɹ ɫɤɥɚɞɤɚ ɤɨɠɢ ɧɚ - ɫɦ ɜɵɲɟ ɥɨɛɤɨɜɨɝɨ ɫɢɦɮɢɡɚ ȼ ɩɪɨɟɤɰɢɢ ɷɬɨɣ ɫɤɥɚɞɤɢ ɜɵɩɨɥɧɹɟɬɫɹ ɤɟɫɚɪɟɜɨ ɫɟɱɟɧɢɟ ɤɨɫɦɟɬɢɱɟɫɤɢɦ ɪɚɡɪɟɡɨɦ ɉɮɚɧɧɟɧɲɬɢɥɹ ɉɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɣ ɪɭɛɟɰ ɩɪɢ ɬɚɤɨɦ ɪɚɡɪɟɡɟ ɛɭɞɟɬ ɫɤɪɵɬ ɤɨɠɧɨɣ ɫɤɥɚɞɤɨɣ ɢ ɩɪɢɤɪɵɬ ɧɢɠɧɢɦ ɛɟɥɶɟɦ.

ɇɚɞɱɪɟɜɧɚɹ ɹɦɤɚ ɫɢɧ ± ɧɚɞɱɪɟɜɧɚɹ ɨɛɥɚɫɬɶ ɢɦɟɟɬ ɫɬɚɪɨɟ ɫɬɚɪɨɪɭɫ ɫɤɨɟ ɧɚɡɜɚɧɢɟ ± ɫɟɪɞɟɱɧɚɹ ɥɨɠɟɱɤɚ scrobis ± ɥɨɠɤɚ scrobiculum cordis ± ɫɟɪɞɟɱɧɚɹ ɥɨɠɟɱɤɚ Ⱦɟɣɫɬɜɢɬɟɥɶɧɨ ɷɬɚ ɹɦɤɚ ɩɨ ɮɨɪɦɟ ɩɨɯɨɠɚ ɧɚ ɥɨɠɤɭ Ɍɚ ɤɢɦ ɨɛɪɚɡɨɦ ɧɚɞɱɪɟɜɧɚɹ ɹɦɤɚ ɢɥɢ ɧɚɞɱɪɟɜɧɚɹ ɨɛɥɚɫɬɶ ± ɷɬɨ ©ɥɨɠɟɱɤɚª ɚ ɧɟ ©ɩɨɞɥɨɠɟɱɤɚª ȼɵɪɚɠɟɧɢɟ ©ɫɨɫɟɬ ɩɨɞ ɥɨɠɟɱɤɨɣª ɨɡɧɚɱɚɟɬ ɨɳɭɳɟɧɢɟ ɝɨɥɨɞɚ ɩɭɫɬɨɬɵ ɩɨɞ ɥɨɠɟɱɤɨɣ ɬ ɟ ɩɨɞ ɧɚɞɱɪɟɜɧɨɣ ɹɦɤɨɣ ɜ ɝɥɭɛɢɧɟ ɠɢɜɨɬɚ ȼɵɪɚ

ɠɟɧɢɟ ©ɩɨɞɥɨɠɟɱɧɚɹ ɨɛɥɚɫɬɶª ɬɟɪɦɢɧɨɥɨɝɢɱɟɫɤɢ ɨɲɢɛɨɱɧɨ ɢ ɞɨɥɠɧɨ ɛɵɬɶ ɢɫɤɥɸɱɟɧɨ ɢɡ ɭɩɨɬɪɟɛɥɟɧɢɹ

ȼ ɩɪɟɞɟɥɚɯ ɧɚɞɱɪɟɜɧɨɣ ɹɦɤɢ ɜ ɬɨɥɳɟ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɫɤɪɵɜɚɟɬɫɹ ɦɟɱɟ ɜɢɞɧɵɣ ɨɬɪɨɫɬɨɤ ɝɪɭɞɢɧɵ ɤɨɬɨɪɵɣ ɨɬɥɢɱɚɟɬɫɹ ɦɧɨɠɟɫɬɜɨɦ ɢɧɞɢɜɢɞɭɚɥɶ ɧɵɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɮɨɪɦɵ ɢ ɪɚɡɦɟɪɨɜ ɗɬɚ ©ɧɟɫɬɚɧɞɚɪɬɧɨɫɬɶª ɦɟɱɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɧɟ ɩɨɡɜɨɥɹɟɬ ɢɫɩɨɥɶɡɨɜɚɬɶ ɟɝɨ ɞɥɹ ɤɚɤɢɯ-ɥɢɛɨ ɢɡɦɟɪɟɧɢɣ ɢɥɢ ɩɪɨ ɟɤɰɢɣ Ⱦɥɹ ɷɬɢɯ ɰɟɥɟɣ ɢɫɩɨɥɶɡɭɟɬɫɹ ɛɨɥɟɟ ©ɫɬɚɧɞɚɪɬɧɚɹª ɬɨɱɤɚ ± ɜɟɪɲɢɧɚ ɩɨɞɝɪɭɞɢɧɧɨɝɨ ɭɝɥɚ ɉɨɞɝɪɭɞɢɧɧɵɣ ɭɝɨɥ ± ɜɚɠɧɟɣɲɢɣ ɬɨɩɨɝɪɚɮɢɱɟɫɤɢɣ ɨɪɢɟɧɬɢɪ ɨɛɪɚɡɨɜɚɧ ɪɟɛɟɪɧɵɦɢ ɞɭɝɚɦɢ ȿɝɨ ɜɟɪɲɢɧɚ ɧɚɯɨɞɢɬɫɹ ɜ ɦɟɫɬɟ ɫɨ ɟɞɢɧɟɧɢɹ ɬɟɥɚ ɝɪɭɞɢɧɵ ɢ ɦɟɱɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ

ɉɨɞɤɨɠɧɚɹ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ɢ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ

ɉɨɞɤɨɠɧɚɹ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ȿɟ ɤɨɥɢɱɟɫɬɜɨ ɬɨɥɳɢɧɚ ɢ ɪɚɫɩɪɟ ɞɟɥɟɧɢɟ ɩɨ ɩɨɜɟɪɯɧɨɫɬɢ ɠɢɜɨɬɚ ɢɦɟɸɬ ɡɧɚɱɢɬɟɥɶɧɵɟ ɢɧɞɢɜɢɞɭɚɥɶɧɵɟ ɢ ɩɨ ɥɨɜɵɟ ɪɚɡɥɢɱɢɹ ɇɚɩɪɢɦɟɪ ɨɬɥɨɠɟɧɢɟ ɠɢɪɚ ɜ ɫɪɟɞɧɟɣ ɱɚɫɬɢ ɬɭɥɨɜɢɳɚ ɨɫɨ ɛɟɧɧɨ ɜ ɧɢɠɧɟɣ ɱɚɫɬɢ ɠɢɜɨɬɚ ± ɷɬɨ ɚɧɞɪɨɢɞɧɵɣ ɢɥɢ ɦɭɠɫɤɨɣ ɬɢɩ ɨɠɢɪɟɧɢɹ©ɩɢɜɧɨɣ ɠɢɜɨɬª ɩɪɢ ɤɨɬɨɪɨɦ ɬɟɥɨ ɩɪɢɨɛɪɟɬɚɟɬ ɮɨɪɦɭ ɹɛɥɨɤɚ Ⱦɥɹ ɠɟɧ ɳɢɧ ɯɚɪɚɤɬɟɪɧɨ ɨɬɥɨɠɟɧɢɟ ɠɢɪɚ ɜ ɨɛɥɚɫɬɢ ɹɝɨɞɢɰ ɢ ɛɟɞɟɪ ɮɨɪɦɚ ɝɪɭɲɢ

Ʉɥɢɧɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɨɫɨɛɟɧɧɨɫɬɟɣ ɫɬɪɨɟɧɢɹ ɠɢɪɨɜɨɝɨ ɫɥɨɹ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ

Ɇɧɨɝɨɱɢɫɥɟɧɧɵɦɢ ɫɨɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ ɩɨɞɤɨɠɧɚɹ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ɪɚɡɞɟɥɟɧɚ ɧɚ ɫɥɨɢ ɢ ɭɱɚɫɬɤɢ ɉɟɪɟɦɵɱɤɢ ɨɫɨɛɟɧɧɨ ɜɵɪɚ ɠɟɧɵ ɨɤɨɥɨ ɩɭɩɤɚ ɢ ɩɨ ɛɟɥɨɣ ɥɢɧɢɢ ɠɢɜɨɬɚ ɝɞɟ ɨɧɢ ɩɥɨɬɧɨ ɫɨɟɞɢɧɹɸɬ ɛɟ

7

ɥɭɸ ɥɢɧɢɸ ɢ ɤɨɠɭ ɞɟɥɚɹ ɤɨɠɭ ɦɚɥɨɩɨɞɜɢɞɠɧɨɣ ɢ ɩɪɚɤɬɢɱɟɫɤɢ ɢɡɨɥɢɪɭɹ ɞɪɭɝ ɨɬ ɞɪɭɝɚ ɠɢɪɨɜɭɸ ɤɥɟɬɱɚɬɤɭ ɩɪɚɜɨɣ ɢ ɥɟɜɨɣ ɩɨɥɨɜɢɧ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ

ɉɪɢ ɡɧɚɱɢɬɟɥɶɧɨɣ ɬɨɥɳɢɧɟ ɩɨɞɤɨɠɧɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɭɜɟɥɢɱɢɜɚ ɟɬɫɹ ɨɛɳɚɹ ɬɨɥɳɢɧɚ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɗɬɨ ɡɚɬɪɭɞɧɹɟɬ ɩɚɥɶɩɚɰɢɸ ɨɪɝɚɧɨɜ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɢ ɚɭɫɤɭɥɶɬɚɰɢɸ ɫɨɫɭɞɢɫɬɵɯ ɢ ɤɢɲɟɱɧɵɯ ɩɟɪɢɫɬɚɥɶɬɢɱɟ ɫɤɢɯ ɲɭɦɨɜ ɍɜɟɥɢɱɢɜɚɟɬɫɹ ɝɥɭɛɢɧɚ ɨɩɟɪɚɰɢɨɧɧɨɣ ɪɚɧɵ ɡɚɬɪɭɞɧɹɟɬɫɹ ɭɲɢ ɜɚɧɢɟ ɥɚɩɚɪɨɬɨɦɧɨɣ ɪɚɧɵ ɂɧɨɝɞɚ ɬɪɟɛɭɟɬɫɹ ɢɫɫɟɱɟɧɢɟ ɢɡɛɵɬɤɚ ɠɢɪɨɜɨɣ ɬɤɚɧɢ ɜ ɤɨɫɦɟɬɢɱɟɫɤɢɯ ɰɟɥɹɯ ȼɩɪɨɱɟɦ ɨɬ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɜɧɢɡɭ ɠɢɜɨɬɚ ɦɨɠɧɨ ɢɡɜɥɟɱɶ ɢ ɩɨɥɶɡɭ ± ɢɫɩɨɥɶɡɨɜɚɬɶ ɟɟ ɜɦɟɫɬɟ ɫ ɤɨɠɟɣ ɤɚɤ ɦɚɬɟɪɢɚɥ ɞɥɹ ɩɥɚɫɬɢɤɢ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɩɨɫɥɟ ɟɟ ɪɟɡɟɤɰɢɢ ɢɥɢ ɭɞɚɥɟɧɢɹ

2. ȼ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɠɢɜɨɬɚ ɩɪɨɯɨɞɹɬ ɩɚɪɧɵɟ ɞɨɜɨɥɶɧɨ ɤɪɭɩɧɵɟ ɜɟɬɜɢ ɛɟɞɪɟɧɧɨɣ ɚɪɬɟɪɢɢ ɢ ɨɞɧɨɢɦɟɧɧɵɟ ɢɦ ɜɟɧɵ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ a. epigastrica superficialis ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɚɪɬɟɪɢɹ ɨɝɢɛɚɸɳɚɹ ɩɨɞ ɜɡɞɨɲɧɭɸ ɤɨɫɬɶ a. circumflexa ilium superficialis ɧɚɪɭɠɧɵɟ ɩɨɥɨɜɵɟ ɚɪɬɟ ɪɢɢ aa. pudendae externae) ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ ɩɟɪɟɫɟɤɚɟɬ ɩɚɯɨɜɭɸ ɫɜɹɡɤɭ ɧɚ ɝɪɚɧɢɰɟ ɦɟɞɢɚɥɶɧɨɣ ɢ ɫɪɟɞɧɟɣ ɟɟ ɬɪɟɬɢ ɢ ɧɚɩɪɚɜɥɹɟɬɫɹ ɜɜɟɪɯ ɤ ɩɭɩɤɭ. ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɚɪɬɟɪɢɹ ɨɝɢɛɚɸɳɚɹ ɩɨɞɜɡɞɨɲɧɭɸ ɤɨɫɬɶ ɧɚɩɪɚɜɥɹɟɬɫɹ ɥɚɬɟɪɚɥɶɧɨ ɜ ɩɚɯɨɜɭɸ ɨɛɥɚɫɬɶ ɧɚɪɭɠɧɚɹ ɩɨɥɨɜɚɹ ɚɪɬɟɪɢɹ ± ɦɟɞɢɚɥɶɧɨ ɜ ɩɚɯɨɜɭɸ ɢ ɥɨɛɤɨɜɭɸ ɨɛɥɚɫɬɢ ɗɬɢ ɚɪɬɟɪɢɢ ɢ ɢɯ ɜɟɬɜɢ ɦɨɝɭɬ ɩɨ ɜɪɟɠɞɚɬɶɫɹ ɭɠɟ ɩɟɪɜɵɦ ɪɚɡɪɟɡɨɦ ɩɪɢ ɧɟɤɨɬɨɪɵɯ ɨɩɟɪɚɰɢɹɯ ȼɟɬɜɢ ɩɨɜɟɪɯ ɧɨɫɬɧɨɣ ɚɪɬɟɪɢɢ ɨɝɢɛɚɸɳɟɣ ɩɨɞɜɡɞɨɲɧɭɸ ɤɨɫɬɶ ɧɚɯɨɞɹɬɫɹ ɜ ɩɪɨɟɤɰɢɢ ɪɚɡ ɪɟɡɚ ɩɨ ȼɨɥɤɨɜɢɱɭ ± Ⱦɶɹɤɨɧɨɜɭ ɩɪɢ ɚɩɩɟɧɞɷɤɬɨɦɢɢ ɚ ɜɟɬɜɢ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɧɚɞɱɪɟɜɧɨɣ ɚɪɬɟɪɢɢ ɢ ɧɚɪɭɠɧɨɣ ɩɨɥɨɜɨɣ ± ɜ ɩɪɨɟɤɰɢɢ ɪɚɡɪɟɡɚ ɩɪɢ ɩɚɯɨɜɵɯ ɝɪɵɠɚɯ

ɇɟɪɜɵ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ

Ȼɪɸɲɧɚɹ ɫɬɟɧɤɚ ɢɧɧɟɪɜɢɪɭɟɬɫɹ ɲɟɫɬɶɸ ɧɢɠɧɢɦɢ ɦɟɠɪɟɛɟɪɧɵɦɢ ɧɟ ɪɜɚɦɢ ɚ ɜ ɧɢɠɧɟɦ ɨɬɞɟɥɟ ɠɢɜɨɬɚ ± ɧɟɪɜɚɦɢ ɩɨɹɫɧɢɱɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ± ɩɨɞ ɜɡɞɨɲɧɨ-ɩɨɞɱɪɟɜɧɵɦ ɢ ɩɨɞɜɡɞɨɲɧɨ-ɩɚɯɨɜɵɦ n. iliohypogastricus et n. ilioinguinalis).

Ɇɟɠɪɟɛɟɪɧɵɟ ɧɟɪɜɵ ɩɨɡɚɞɢ ɭɝɥɨɜ ɪɟɛɟɪɧɵɯ ɯɪɹɳɟɣ ɩɪɨɯɨɞɹɬ ɜ ɬɨɥɳɭ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɡɚɬɟɦ ɦɟɠɞɭ ɩɨɩɟɪɟɱɧɨɣ ɢ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɦɵɲɰɚɦɢ ɢɞɭɬ ɤ ɩɪɹɦɨɣ ɦɵɲɰɟ ɠɢɜɨɬɚ ɉɨ ɩɭɬɢ ɨɧɢ ɨɬɞɚɸɬ ɜɟɬɜɢ ɤ ɦɵɲɰɚɦ ɢ ɤɨɠɟ ɠɢɜɨɬɚ ɤ ɛɪɸɲɢɧɟ

ɉɪɢ ɜɫɟɯ ɜɢɞɚɯ ɥɚɩɚɪɨɬɨɦɢɣ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɫɪɟɞɢɧɧɵɯ ɧɟɢɡɛɟɠɧɨ ɩɨɜɪɟɠɞɚɸɬɫɹ ɧɟɪɜɵ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ȿɫɥɢ ɩɨɬɟɪɹ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɨɛɵɱ ɧɨ ɧɟ ɢɦɟɟɬ ɤɚɤɢɯ-ɥɢɛɨ ɫɟɪɶɟɡɧɵɯ ɩɨɫɥɟɞɫɬɜɢɣ ɬɨ ɩɨɬɟɪɹ ɢɧɧɟɪɜɚɰɢɢ ɦɵɲɰ ɩɪɢɜɨɞɢɬ ɤ ɢɯ ɚɬɪɨɮɢɢ ɨɫɥɚɛɥɟɧɢɸ ɛɪɸɲɧɨɝɨ ɩɪɟɫɫɚ ɢ ɪɚɡɜɢɬɢɸ ɩɨɫɥɟɨɩɟ ɪɚɰɢɨɧɧɵɯ ɝɪɵɠ ɉɨ ɷɬɨɣ ɩɪɢɱɢɧɟ ɧɟ ɪɟɤɨɦɟɧɞɭɸɬɫɹ ɬɚɤɢɟ ɜɢɞɵ ɥɚɩɚɪɨɬɨ ɦɢɣ ɤɚɤ ɩɚɪɚɪɟɤɬɚɥɶɧɚɹ ɥɚɩɚɪɨɬɨɦɢɹ ɩɨ ɩɨɥɭɥɭɧɧɨɣ ɫɩɢɝɟɥɢɟɜɨɣ ɥɢɧɢɢ ɩɨɞɪɟɛɟɪɧɚɹ ɥɚɩɚɪɨɬɨɦɢɹ ɇɚɩɪɢɦɟɪ ɩɪɢ ɜɵɩɨɥɧɟɧɢɢ ɩɨɞɪɟɛɟɪɧɨɝɨ ɨɩɟɪɚ ɬɢɜɧɨɝɨ ɞɨɫɬɭɩɚ ɩɪɢ ɯɨɥɞɟɰɢɫɬɷɤɬɨɦɢɢ ɩɟɪɟɪɟɡɚɸɬɫɹ ɱɟɬɵɪɟ ɢɡ ɲɟɫɬɢ ɦɟɠ ɪɟɛɟɪɧɵɯ ɧɟɪɜɨɜ ɢɧɧɟɪɜɢɪɭɸɳɢɯ ɛɪɸɲɧɭɸ ɫɬɟɧɤɭ ɢ ɦɟɠɪɟɛɟɪɧɵɟ ɧɟɪɜɵ

ɇɟɩɪɢɹɬɧɵɟ ɩɨɫɥɟɞɫɬɜɢɹ ɦɨɝɭɬ ɜɨɡɧɢɤɧɭɬɶ ɧɟ ɬɨɥɶɤɨ ɩɪɢ ɩɨɜɪɟɠɞɟɧɢɢ

8

ɧɟɪɜɨɜ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɧɨ ɢ ɩɪɢ ɢɯ ɩɟɪɟɜɹɡɤɟ ɇɚɩɪɢɦɟɪ ɩɪɢ ɩɥɚɫɬɢɤɟ ɝɪɵɠɟɜɵɯ ɜɨɪɨɬ ɜ ɩɚɯɨɜɨɦ ɤɚɧɚɥɟ ɩɨ ɧɟɨɫɬɨɪɨɠɧɨɫɬɢ ɦɨɠɧɨ ɡɚɯɜɚɬɢɬɶ ɜ ɲɨɜ ɩɪɨɯɨɞɹɳɢɣ ɡɞɟɫɶ ɩɨɞɜɡɞɨɳɧɨ-ɩɚɯɨɜɵɣ ɧɟɪɜ ȼ ɪɟɡɭɥɶɬɚɬɟ ɜ ɩɨɫɥɟɨɩɟ ɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ ɩɚɰɢɟɧɬ ɞɥɢɬɟɥɶɧɨɟ ɜɪɟɦɹ ɛɭɞɟɬ ɢɫɩɵɬɵɜɚɬɶ ɦɭɱɢɬɟɥɶ ɧɵɟ ɛɨɥɢ ɜ ɩɚɯɨɜɨɣ ɨɛɥɚɫɬɢ ɢ ɦɨɲɨɧɤɟ

ɉɪɢɦɟɱɚɧɢɟ ɩɨɥɨɜɚɹ ɜɟɬɜɶ ɛɟɞɪɟɧɧɨ-ɩɨɥɨɜɨɝɨ ɧɟɪɜɚ ɢɧɧɟɪɜɢɪɭɸɳɚɹ ɨɛɨɥɨɱɤɢ ɹɢɱɤɚ ɢ m. cremaster ɬɚɤɠɟ ɦɨɠɟɬ ɛɵɬɶ ɩɨɜɪɟɠɞɟɧɚ ɩɪɢ ɜɵɞɟɥɟ ɧɢɢ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ ɢɡ ɨɛɨɥɨɱɟɤ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ

ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɜɟɧɵ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɨɛɪɚɡɭɸɬ ɲɢɪɨɤɭɸ ɫɟɬɶ ɚɧɚɫɬɨɦɨɡɨɜ ɪɢɫ . ȼ ɩɭɩɨɱɧɨɣ ɨɛɥɚɫɬɢ ɧɚɱɢɧɚɟɬɫɹ ɝɪɭɞɨɧɚɞɱɪɟɜɧɵɟ ɜɟ ɧɵ (vv. thoracoepigastricae ɢ ɢɞɭɬ ɜɜɟɪɯ ɧɚ ɩɟɪɟɞɧɟɛɨɤɨɜɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɢ ɜɩɚɞɚɸɬ ɜ ɥɚɬɟɪɚɥɶɧɭɸ ɝɪɭɞɧɭɸ ɜɟɧɭ ɢɥɢ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɜ ɩɨɞɦɵɲɟɱɧɭɸ ɜɟɧɭ v. axillaris) - ɷɬɨ ɫɢɫɬɟɦɚ ɜɟɪɯɧɟɣ ɩɨɥɨɣ ɜɟɧɵ v.cava superior ȼ ɷɬɨɣ ɠɟ ɨɛɥɚɫɬɢ ɧɚɱɢɧɚɟɬɫɹ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɧɚɞɱɪɟɜɧɚɹ ɜɟɧɚ v. epigastrica superficialis ɤɨɬɨɪɚɹ ɢɞɟɬ ɜɧɢɡ ɢ ɜɩɚɞɚɟɬ ɜ ɛɟɞɪɟɧɧɭɸ ɜɟɧɭ v. femoralis) ± ɷɬɨ ɫɢɫɬɟɦɚ ɧɢɠɧɟɣ ɩɨɥɨɣ ɜɟɧɵ v. cava inferior Ɂɞɟɫɶ ɠɟ ɜ ɨɛ ɥɚɫɬɢ ɩɭɩɤɚ ɛɟɪɭɬ ɫɜɨɟ ɧɚɱɚɥɨ ɨɤɨɥɨɩɭɩɨɱɧɵɟ ɜɟɧɵ vv.paraumbelicales ɢɡ ɫɢ ɫɬɟɦɵ ɜɨɪɨɬɧɨɣ ɜɟɧɵ v. portae).

Ɋɢɫ Ⱥɩɨɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɢ ɟɝɨ ɩɪɨɢɡɜɨɞɧɵɟɫɩɪɚɜɚ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɫɥɟɜɚ

I ² m. obliquus ext. abdominis ɢ ɟɝɨ ɚɩɨɧɟɜɪɨɡ; 2 ² lig. inguinale; 3 ² n. ilioinguinalis; 4 ² ramus genitalis n. genitofemoralis; 5 ² ductus deferens ɢ ɨɤɪɭɠɚɸɳɢɟ ɟɝɨ ɫɨɫɭɞɵ; 6 ² lig. reflexum;

7 ² cms mediale (ɨɬɬɹɧɭɬɚ ɤɜɟɪɯɭ); 8 ² funiculus spermaticus, a. et v. pudendae ext.; 9 ² a. et v. epigastricae superficiales, n. iliohypogastricus; 10 ² a. et v. circumflexae ilium superficiales; II² ramus cutaneus lat. n. iliohypogastrici; 12 ² rami cutanei lat. abdominales XI ɢ XII ɦɟɠɪɟɛɟɪɧɵɯ ɧɟɪɜɨɜ.

9

Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɜ ɩɨɞɤɨɠɧɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɜɨɤɪɭɝ ɩɭɩɤɚ ɮɨɪɦɢ ɪɭɸɬɫɹ ɩɨɪɬɨ-ɤɚɜɚ-ɤɚɜɚɥɶɧɵɟ ɚɧɚɫɬɨɦɨɡɵ ɪɢɫ

Ɋɢɫ ɋɯɟɦɚ ɜɟɧɨɡɧɵɯ ɚɧɚɫɬɨɦɨɡɨɜ ɩɟɪɟɞɧɟɣ ɢ ɛɨɤɨɜɵɯ ɫɬɟɧɨɤ ɝɪɭɞɢ ɢ ɠɢɜɨɬɚ

1 - v. cava superior; 2 - v. brachiocephalica;

3 - v. subclavia sinistra; 4 - v. axillaris sinistra: 5 - v. thoracica interna sinistra;

6 - v. epigastrica superior sinistra;

7 - v. thoracica lateralis sinistra;

8 - v. thoracoepigastrica sinistra;

9 - vv. subcutaneae abdominis;

10 - v. cava inferior; 11 - v. iliaca communis sinistra; 12 - v. iliaca externa sinistra; 13 - v. femoralis sinistra; 14 - v. epigastrica inferior sinistra;

15 - v. epigastrica superficialis sinistra.

Ɋɟɡɭɥɶɬɚɬɨɦ ɧɚɪɭɲɟɧɢɹ ɨɬɬɨɤɚ ɤɪɨɜɢ ɩɨ ɩɨɥɵɦ ɢɥɢ ɜɨɪɨɬɧɨɣ ɜɟɧɚɦ ɹɜɥɹɟɬɫɹ ɪɚɫɲɢɪɟɧɢɟ ɫɟɬɢ ɩɨɞɤɨɠɧɵɯ ɜɟɧ ɩɟɪɟɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ȼ ɬɚɤɢɯ ɫɥɭɱɚɹɯ ɨɧɢ ɜɵɛɭɯɚɸɬ ɱɟɪɟɡ ɤɨɠɭ ɜ ɜɢɞɟ ɡɦɟɟɜɢɞɧɵɯ ɫɩɥɟɬɟɧɢɣ ɜ ɩɭɩɨɱɧɨɣ ɨɛɥɚɫɬɢ ©ɝɨɥɨɜɚ Ɇɟɞɭɡɵª ɂɧɨɝɞɚ ɩɪɢ ɷɬɨɦ ɧɚɞ ɩɭɩɤɨɦ ɩɪɨɫɥɭɲɢɜɚɟɬɫɹ ɜɟɧɨɡɧɵɣ ɲɭɦ

Ɋɢɫ ɋɯɟɦɚ ɩɨɪɬɨ-ɤɚɜɚ-ɤɚɜɚɥɶɧɨɝɨ ɚɧɚɫɬɨɦɨɡɚ ɜ ɩɟɪɟɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɟ

I - v. cava superior;

2 - v. brachiocephalica sinistra;

3 - v. subclavia sinistra;

4 - v.axillaris sinistra;

5 - v. thoracica interna sinistra;

6 - v. epigastrica superior sinistra;

7 - v. thoracica lateralis sinistra;

8 - v. thoracoepigastrica sinistra;

10 - v. epigastrica superficialis; II - v. cava inferior;

12 - v. iliaca communis sinistra;

13 - v. iliaca externa sinistra;

14 - v. femoralis sinistra;

15 - v. paraumbilicalis;

16 - v. portae.

10