3 курс / Топографическая анатомия и оперативная хирургия / ТАиОХ брюшная полость
.pdfɉɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɠɢɜɨɬɚ ɧɢɠɟ ɩɭɩɤɚ ɞɟɥɢɬɫɹ ɧɚ ɞɜɟ ɩɥɚɫɬɢɧɤɢ
± ɩɨɜɟɪɯɧɨɫɬɧɭɸ ɢ ɝɥɭɛɨɤɭɸ ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɩɥɚɫɬɢɧɤɚ, ɧɟ ɩɪɢɤɪɟɩɥɹɹɫɶ ɤ ɩɭɩɚɪɬɨɜɨɣ ɫɜɹɡɤɟ, ɩɟɪɟɯɨɞɢɬ ɜ ɩɨɜɟɪɯɧɨɫɬɧɭɸ ɮɚɫɰɢɸ ɛɟɞɪɚ ɩɪɨɦɟɠɧɨɫɬɢ ɢ ɦɹɫɢɫɬɭɸ ɨɛɨɥɨɱɤɭ ɦɨɲɨɧɤɢ Ƚɥɭɛɨɤɚɹ ɩɥɚɫɬɢɧɤɚ Ɍɨɦɫɨɧɨɜɚ ɮɚɫɰɢɹ , ɛɨɥɟɟ ɩɥɨɬɧɚɹ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɩɚɯɨɜɨɣ ɫɜɹɡɤɟ ɧɟ ɩɟɪɟɯɨɞɹ ɧɚ ɛɟɞɪɨ.
Ƚɥɭɛɨɤɚɹ ɩɥɚɫɬɢɧɤɚ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɢ ɠɢɜɨɬɚ ɱɚɫɬɨ ɧɚɫɬɨɥɶɤɨ ɩɥɨɬɧɚɹ ɨɫɨɛɟɧɧɨ ɩɪɢ ɬɨɥɫɬɨɦ ɫɥɨɟ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɢ ɱɬɨ ɟɟ ɥɟɝɤɨ ɩɪɢ ɧɹɬɶ ɡɚ ɚɩɨɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ Ɉɞɧɚɤɨ ɷɬɚ ɨɲɢɛɤɚ ɨɛɧɚ ɪɭɠɢɜɚɟɬɫɹ ɬɨɬɱɚɫ ɩɨɫɥɟ ɪɚɫɫɟɱɟɧɢɹ ɷɬɨɝɨ ©ɚɩɨɧɟɜɪɨɡɚª ± ɩɨɞ ɧɢɦ ɨɛɧɚɪɭ ɠɢɜɚɟɬɫɹ ɧɟ ɜɧɭɬɪɟɧɧɹɹ ɤɨɫɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ ɚ ɜɬɨɪɨɣ ɫɥɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬ ɱɚɬɤɢ ȼ ȼ Ʉɨɜɚɧɨɜ Ɍ ɂ Ⱥɧɢɤɢɧɚ
Ȼɥɚɝɨɞɚɪɹ ɫɪɚɳɟɧɢɸ ɝɥɭɛɨɤɨɣ ɩɥɚɫɬɢɧɤɢ ɫ ɩɭɩɚɪɬɨɜɨɣ ɫɜɹɡɤɨɣ ɩɚɯɨɜɚɹ ɫɤɥɚɞɤɚ ɧɟ ɪɚɡɝɥɚɠɢɜɚɟɬɫɹ ɚ ɧɚɨɛɨɪɨɬ ɭɝɥɭɛɥɹɟɬɫɹ ɭ ɬɭɱɧɵɯ ɫɭɛɴɟɤɬɨɜ
Ɋɚɡɥɢɱɧɨɟ ɨɬɧɨɲɟɧɢɟ ɩɥɚɫɬɢɧɨɤ ɩɨɞɤɨɠɧɨɣ ɮɚɫɰɢɢ ɠɢɜɨɬɚ ɤ ɩɭɩɚɪɬɨ ɜɨɣ ɫɜɹɡɤɟ ɜɚɠɧɨ ɢ ɜ ɤɥɢɧɢɱɟɫɤɨɦ ɨɬɧɨɲɟɧɢɢ ɟɫɥɢ ɧɚɩɪɢɦɟɪ ɝɧɨɣɧɢɤ ɢɥɢ ɜɨɡɞɭɯ ɩɪɢ ɩɨɞɤɨɠɧɨɣ ɷɦɮɢɡɟɦɟ ɧɚɯɨɞɢɬɫɹ ɩɨɞ ɝɥɭɛɨɤɨɣ ɩɥɚɫɬɢɧɤɨɣ ɩɨ ɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɢ ɬɨ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ ɩɪɨɰɟɫɫɚ ɧɚ ɛɟɞɪɨ ɧɟɜɨɡɦɨɠɧɨ ɇɚɨɛɨɪɨɬ ɢɡ ɩɨɞ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɩɥɚɫɬɢɧɤɢ ɩɪɨɰɟɫɫɵ ɥɟɝɤɨ ɪɚɫɩɪɨɫɬɪɚɧɹ ɸɬɫɹ ɫ ɠɢɜɨɬɚ ɧɚ ɛɟɞɪɨ ɬɚɤ ɤɚɤ ɨɧɢ ɧɟ ɜɫɬɪɟɱɚɸɬ ɩɪɟɩɹɬɫɬɜɢɟ ɜ ɜɢɞɟ ɩɭɩɚɪ ɬɨɜɨɣ ɫɜɹɡɤɢ Ⱥ Ⱥ Ȼɨɛɪɨɜ
ɉɨ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɩɥɨɬɧɨ ɫɪɚɫɬɚɟɬɫɹ ɫ ɫɨɛ ɫɬɜɟɧɧɨɣ ɮɚɫɰɢɟɣ ɢ ɛɟɥɨɣ ɥɢɧɢɟɣ ɠɢɜɨɬɚ ɱɬɨ ɡɚɬɪɭɞɧɹɟɬ ɩɟɪɟɯɨɞ ɩɨɞɮɚɫɰɢ ɚɥɶɧɨɝɨ ɧɚɝɧɨɟɧɢɹ ɫ ɨɞɧɨɣ ɫɬɨɪɨɧɵ ɠɢɜɨɬɚ ɧɚ ɞɪɭɝɭɸ
ȼɧɢɡɭ ɠɢɜɨɬɚ ɝɥɭɛɨɤɚɹ ɩɥɚɫɬɢɧɤɚ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɢ ɨɛɪɚɡɭɟɬ ɩɨɞ ɜɟɲɢɜɚɸɳɭɸ ɫɜɹɡɤɭ ɩɨɥɨɜɨɝɨ ɱɥɟɧɚ ɢɥɢ ɤɥɢɬɨɪɚ ɚ ɬɚɤɠɟ ɧɚɪɭɠɧɭɸ ɫɟɦɟɧ ɧɭɸ ɮɚɫɰɢɸ fascia spermatica externa) ɤɨɬɨɪɚɹ ɹɜɥɹɟɬɫɹ ɫɚɦɨɣ ɧɚɪɭɠɧɨɣ ɨɛɨɥɨɱɤɨɣ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ
Ɇɟɠɞɭ ɩɥɚɫɬɢɧɤɚɦɢ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɢ ɩɪɨɯɨɞɢɬ ɩɨɜɟɪɯɧɨɫɬ ɧɚɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ ɢ ɜɟɧɚ Ⱥɪɬɟɪɢɹ ɛɟɪɟɬ ɧɚɱɚɥɨ ɨɬ ɛɟɞɪɟɧɧɨɣ ɚɪ ɬɟɪɢɢ ɜ ɛɟɞɪɟɧɧɨɦ ɤɚɧɚɥɟ ɜɩɟɪɟɞɢ ɩɭɩɚɪɬɨɜɨɣ ɫɜɹɡɤɢ ɩɪɨɯɨɞɢɬ ɤɨɫɨ ɤ ɩɭɩɤɭ ȼɟɧɚ ɜɩɚɞɚɟɬ ɜ v. saphena magna.
ɋɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ ɠɢɜɨɬɚ ɨɛɪɚɡɭɟɬ ɬɨɧɤɨɫɬɟɧɧɭɸ ɨɛɨɥɨɱɤɭ ɬɪɟɯ ɛɨɤɨɜɵɯ ɦɵɲɰ ɠɢɜɨɬɚ (ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɩɨɩɟɪɟɱɧɨɣ ɢ ɜɦɟɫɬɟ ɫ ɚɩɨɧɟɜɪɨɡɚɦɢ ɫɭɯɨɠɢɥɢɹɦɢ ɷɬɢɯ ɦɵɲɰ ɩɪɢɧɢɦɚɟɬ ɭɱɚɫɬɢɟ ɜ ɨɛ ɪɚɡɨɜɚɧɢɢ ɜɥɚɝɚɥɢɳɚ ɩɪɹɦɵɯ ɦɵɲɰ ɠɢɜɨɬɚ ɉɥɚɫɬɢɧɤɢ ɫɨɛɫɬɜɟɧɧɨɣ ɮɚɫɰɢɢ ɩɨɤɪɵɜɚɸɬ ɤɚɠɞɭɸ ɦɵɲɰɭ ɫ ɨɛɟɢɯ ɫɬɨɪɨɧ, ɨɬɞɚɸɬ ɦɧɨɝɨɱɢɫɥɟɧɧɵɟ ɦɟ ɠɦɵɲɟɱɧɵɟ ɩɟɪɟɝɨɪɨɞɤɢ, ɬɚɤ ɱɬɨ ɨɬɞɟɥɢɬɶ ɮɚɫɰɢɸ ɨɬ ɦɵɲɰɵ ɧɟ ɩɪɟɞɫɬɚɜ ɥɹɟɬɫɹ ɜɨɡɦɨɠɧɵɦ ȼ ɩɪɚɤɬɢɱɟɫɤɨɦ ɩɥɚɧɟ ɷɬɨ ɨɡɧɚɱɚɟɬ ɱɬɨ ɛɨɤɨɜɵɟ ɲɢɪɨ ɤɢɟ ɦɵɲɰɵ ɠɢɜɨɬɚ ɪɚɡɴɟɞɢɧɹɸɬɫɹ ɪɚɫɫɟɤɚɸɬɫɹ ɢ ɫɨɟɞɢɧɹɸɬɫɹ ɫɲɢɜɚɸɬ ɫɹ ɨɞɧɨɜɪɟɦɟɧɧɨ ɢ ɜɦɟɫɬɟ ɫ ɩɨɤɪɵɜɚɸɳɢɦɢ ɢɯ ɮɚɫɰɢɹɦɢ
11
ȼ ɨɛɥɚɫɬɢ ɩɨɜɟɪɯɧɨɫɬɧɨɝɨ ɩɚɯɨɜɨɝɨ ɤɨɥɶɰɚ ɩɥɚɫɬɢɧɤɚ ɫɨɛɫɬɜɟɧɧɨɣ ɮɚɫ ɰɢɢ ɠɢɜɨɬɚ ɩɨɤɪɵɜɚɸɳɚɹ ɧɚɪɭɠɧɭɸ ɤɨɫɭɸ ɦɵɲɰɭ ɨɛɪɚɡɭɟɬ ɦɟɠɧɨɠɤɨɜɵɟ ɜɨɥɨɤɧɚ fibrae intercrurales ɫɝɥɚɠɢɜɚɸɳɢɟ ɨɫɬɪɵɣ ɭɝɨɥ ɩɨɜɟɪɯɧɨɫɬɧɨɝɨ ɩɚ ɯɨɜɨɝɨ ɤɨɥɶɰɚ ɚ ɬɚɤɠɟ ɮɚɫɰɢɸ ɦɵɲɰɵ ɩɨɞɧɢɦɚɸɳɟɣ ɹɢɱɤɨ fascia cremasterica ɋoopery).
Ɇɵɲɰɵ
ɇɚɪɭɠɧɚɹ ɤɨɫɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ m. obliquus externus abdominis)
ɧɚɱɢɧɚɟɬɫɹ ɡɭɛɰɚɦɢ ɨɬ ɛɨɤɨɜɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɧɢɠɧɢɯ - ɪɟɛɟɪ ɨɬ ɩɨɹɫɧɢɱ ɧɨ-ɝɪɭɞɧɨɣ ɮɚɫɰɢɢ fascia thoracolumbalis ɢ ɧɚɩɪɚɜɥɹɟɬɫɹ ɫɜɟɪɯɭ ɜɧɢɡ ɫɡɚɞɢ ɧɚɩɟɪɟɞ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɧɚɪɭɠɧɵɦ ɝɪɟɛɧɹ ɩɨɞɜɡɞɨɲɧɨɣ ɤɨɫɬɢ ɢ ɩɟɪɟ ɯɨɞɢɬ ɧɚ ɩɟɪɟɞɧɸɸ ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɉɟɪɟɯɨɞ ɦɵɲɟɱɧɵɯ ɜɨɥɨɤɨɧ ɜ ɚɩɨɧɟɜɪɨɡ ɜ ɜɟɪɯɧɟɣ ɩɨɥɨɜɢɧɟ ɠɢɜɨɬɚ ɩɪɨɢɫɯɨɞɢɬ ɧɚ - ɫɦ ɤɧɚɪɭɠɢ ɨɬ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɚ ɜɧɢɡɭ ± ɩɨ ɥɢɧɢɢ ɫɨɟɞɢɧɹɸɳɟɣ ɩɭɩɨɤ ɫ ɜɟɪɯɧɟɩɟɪɟɞɧɟɣ ɨɫɬɶɸ ɩɨɞɜɡɞɨɲɧɨɣ ɤɨɫɬɢ Ⱥɩɨɧɟɜɪɨɬɢɱɟɫɤɢɣ ɥɢɫɬɨɤ ɩɨ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɠɢɜɨɬɚ ɜɫɬɪɟɱɚɟɬɫɹ ɫ ɨɞɧɨɢɦɟɧɧɵɦ ɥɢɫɬɤɨɦ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɫɬɨɪɨɧɵ ɩɪɢɱɟɦ ɟɝɨ ɜɨɥɨɤɧɚ ɩɟɪɟɩɥɟɬɚɹɫɶ ɩɪɢɧɢɦɚɸɬ ɭɱɚɫɬɢɟ ɜ ɨɛɪɚɡɨɜɚɧɢɢ ɛɟɥɨɣ ɥɢɧɢɢ ȼɧɢɡɭ ɚɩɨɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɩɟɪɟɤɢɞɵɜɚɹɫɶ ɨɬ ɜɟɪɯɧɟɣ ɩɟɪɟɞɧɟɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɫɬɢ ɤ ɥɨɛɤɨɜɨɦɭ ɛɭɝɨɪɤɭ ɩɨɞɜɨɪɚɱɢɜɚɟɬɫɹ ɭɬɨɥɳɚɟɬɫɹ ɨɛɪɚɡɭɹ ɩɚɯɨɜɭɸ ɫɜɹɡɤɭ
ȼɧɭɬɪɟɧɧɹɹ ɤɨɫɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ m. obliquus internus abdominis)
ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɩɨɹɫɧɢɱɧɨ-ɝɪɭɞɧɨɣ ɮɚɫɰɢɢ ɩɨɞɜɡɞɨɲɧɨɝɨ ɝɪɟɛɧɹ ɢ ɧɚɪɭɠɧɵɯɩɚɯɨɜɨɣ ɫɜɹɡɤɢ Ɇɵɲɟɱɧɵɟ ɜɨɥɨɤɧɚ ɧɚɩɪɚɜɥɹɸɬɫɹ ɜɟɟɪɨɨɛɪɚɡɧɨ ɫɧɢɡɭ ɢ ɫɧɚɪɭɠɢ ɜɜɟɪɯ ɢ ɜɧɭɬɪɶ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɧɢɠɧɢɯ ɧɚɩɪɚɜɥɹɸɳɢɯɫɹ ɤɧɢɡɭ ɢ ɤɧɭɬɪɢ ɩɟɪɟɯɨɞɹɬ ɜ ɚɩɨɧɟɜɪɨɡ ɢ ɩɨ ɫɪɟɞɧɟɣ ɥɢɧɢɢ ɠɢɜɨɬɚ ɩɟɪɟɩɥɟɬɚɸɬɫɹ ɫ ɜɨɥɨɤɧɚɦɢ ɚɩɨɧɟɜɪɨɡɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɫɬɨɪɨɧɵ ɭɱɚɫɬɜɭɹ ɜ ɨɛɪɚɡɨɜɚɧɢɢ ɛɟɥɨɣ ɥɢɧɢɢ ɠɢɜɨɬɚ
ɉɨɩɟɪɟɱɧɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ m. transversus abdominis) ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɜɧɭɬɪɟɧɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɧɢɠɧɢɯ ɲɟɫɬɢ ɫɟɦɢ ɪɟɛɟɪ ɝɥɭɛɨɤɨɝɨ ɥɢɫɬɤɚ ɩɨɹɫ ɧɢɱɧɨ-ɝɪɭɞɧɨɣ ɮɚɫɰɢɢ ɩɨɞɜɡɞɨɲɧɨɝɨ ɝɪɟɛɧɹ ɢ ɨɬ ɧɚɪɭɠɧɵɯ ɩɚɯɨɜɨɣ ɫɜɹɡɤɢ lig. inguinale Ɇɵɲɟɱɧɵɟ ɜɨɥɨɤɧɚ ɢɦɟɸɬ ɩɨɩɟɪɟɱɧɨɟ ɧɚɩɪɚɜɥɟɧɢɟ ɇɚ ɦɟɫɬɟ ɩɟɪɟɯɨɞɚ ɦɵɲɟɱɧɵɯ ɜɨɥɨɤɨɧ ɜ ɚɩɨɧɟɜɪɨɡ ɨɛɪɚɡɭɟɬɫɹ ɩɨɥɭɥɭɧɧɚɹ ɥɢɧɢɹ linea semilunaris s. Spigelii ɉɨ ɫɪɟɞɧɟɣ ɥɢɧɢɢ ɠɢɜɨɬɚ ɜɨɥɨɤɧɚ ɚɩɨ ɧɟɜɪɨɡɚ ɩɟɪɟɩɥɟɬɚɹɫɶ ɫ ɜɨɥɨɤɧɚɦɢ ɚɩɨɧɟɜɪɨɡɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɫɬɨɪɨɧɵ ɬɚɤɠɟ ɩɪɢɧɢɦɚɸɬ ɭɱɚɫɬɢɟ ɜ ɨɛɪɚɡɨɜɚɧɢɢ ɛɟɥɨɣ ɥɢɧɢɢ ɠɢɜɨɬɚ
ɉɪɹɦɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ m. rectus abdominis) ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɬɹɠ ɲɢɪɢɧɨɣ - ɫɦ ɪɚɡɞɟɥɟɧɧɵɣ ɧɚ ɫɟɤɰɢɢ ɫɭɯɨɠɢɥɶɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ intersectiones tendineɚɟ Ɍɚɤɢɯ ɩɟɪɟɦɵɱɟɤ ɨɛɵɱɧɨ ɛɵɜɚɟɬ ɨɬ ɞɜɭɯ ɞɨ ɱɟɬɵɪɟɯ: ɞɜɟ ɜɵɲɟ ɩɭɩɤɚ ɨɞɧɚ ɧɚ ɭɪɨɜɧɟ ɩɭɩɤɚ ɢ ɨɞɧɚ ɧɢɠɟ ɟɝɨ ȼɞɨɥɶ ɫɭɯɨɠɢɥɶɧɵɯ ɩɟɪɟɦɵɱɟɤ ɩɪɨɯɨɞɹɬ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɹɜɥɹɸɳɢɟɫɹ ɜɟɬɜɹɦɢ ɦɟɠɪɟɛɟɪɧɵɯ ɫɨ ɫɭɞɨɜ ɢ ɧɟɪɜɨɜ
ɉɪɹɦɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ ɡɚɤɥɸɱɟɧɚ ɜɨ ɜɥɚɝɚɥɢɳɟ ɨɛɪɚɡɨɜɚɧɧɨɟ ɚɩɨɧɟɜɪɨ ɡɚɦɢ ɜɫɟɯ ɬɪɟɯ ɲɢɪɨɤɢɯ ɦɵɲɰ ɠɢɜɨɬɚ (ɪɢɫ ) ɉɟɪɟɞɧɹɹ ɫɬɟɧɤɚ ɜɥɚɝɚ
12
ɥɢɳɚ ɨɛɪɚɡɨɜɚɧɚ ɚɩɨɧɟɜɪɨɡɨɦ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɢ ɩɨɜɟɪɯ ɧɨɫɬɧɵɦ ɥɢɫɬɤɨɦ ɚɩɨɧɟɜɪɨɡɚ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɡɚɞɧɹɹ ɫɬɟɧ ɤɚ ± ɝɥɭɛɨɤɢɦ ɥɢɫɬɤɨɦ ɚɩɨɧɟɜɪɨɡɚ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɦɵɲɰɵ ɢ ɚɩɨɧɟɜɪɨɡɨɦ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ Ɍɚɤɨɜɨɟ ɫɬɪɨɟɧɢɟ ɜɥɚɝɚɥɢɳɟ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɢɦɟɟɬ ɨɬ ɦɟɱɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɞɨ ɫɟɪɟɞɢɧɵ ɪɚɫɫɬɨɹɧɢɹ ɦɟɠɞɭ ɩɭɩ ɤɨɦ ɢ ɥɨɧɨɦ ɇɚɱɢɧɚɹ ɨɬ ɷɬɨɝɨ ɭɪɨɜɧɹ ɜɫɟ ɬɪɢ ɥɢɫɬɤɚ ɚɩɨɧɟɜɪɨɡɨɜ ɩɟɪɟɯɨɞɹɬ ɧɚ ɩɟɪɟɞɧɸɸ ɩɨɜɟɪɯɧɨɫɬɶ ɚ ɡɚɞɧɹɹ ɫɬɟɧɤɚ ɜɥɚɝɚɥɢɳɚ ɨɛɪɚɡɨɜɚɧɧɚ ɩɨɩɟɪɟɱ ɧɨɣ ɮɚɫɰɢɟɣ
Ɋɢɫ Ⱦɟɥɟɧɢɟ ɚɩɨɧɟɜɪɨɡɚ ɤɨ ɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɧɚ ɥɢɫɬɤɢ ɭɱɚɫɬɜɭɸɳɢɟ ɜ ɨɛɪɚɡɨɜɚɧɢɢ ɜɥɚ ɝɚɥɢɳɚ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚɩɨ ɒɩɚɥɶɬɟɯɨɥɶɰɭ ɫ ɢɡɦɟɧɟɧɢ ɹɦɢ
1 ² m. rectus abdominis;
2 ²nn.intercostales; 3 ² ɡɚɞɧɢɣ ɥɢɫɬɨɤ ɚɩɨɧɟɜɪɨɡɚ m. obliquus internus abdominis;
4 ² ɩɟɪɟɞɧɢɣ ɥɢɫɬɨɤ ɚɩɨɧɟɜɪɨɡɚ m. obliquus internus abdominis; 5 ² m. transversus abdominis;
6 ² m. obliquus internus abdominis; 7 ² m. obliquus externus abdominis; 8 ² ɩɟ ɪɟɞɧɹɹ ɩɥɚɫɬɢɧɤɚ ɜɥɚɝɚɥɢɳɚ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
Ɇɟɫɬɨ ɩɟɪɟɯɨɞɚ ɩɨɥɭɬɨɪɚ ɥɢɫɬɤɨɜ ɚɩɨɧɟɜɪɨɡɚ ɫ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɜɥɚɝɚɥɢ ɳɚ ɧɚ ɩɟɪɟɞɧɸɸ ɨɛɪɚɡɭɟɬ ɞɭɝɨɨɛɪɚɡɧɭɸ ɥɢɧɢɸ linea arcuata s.Douglasi) ɪɢɫ
13
Ɋɢɫ ȼɥɚɝɚɥɢɳɟ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɧɚ ɪɚɡɧɵɯ ɭɪɨɜɧɹɯ ɫɪɟɡɨɜ ɩɨ ɒɩɚɥɶ ɬɟɯɨɥɶɰɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ
Ⱥ ² ɜɵɲɟ ɞɭɝɨɨɛɪɚɡɧɨɣ ɥɢɧɢɢ ɞɭ ɝɥɚɫɨɜɨɣ Ȼ ² ɧɢɠɟ ɞɭɝɨɨɛɪɚɡɧɨɣ ɥɢɧɢɢ
I ² ɩɟɪɟɞɧɹɹ ɫɬɟɧɤɚ ɜɥɚɝɚɥɢɳɚ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ² ɚɩɨ ɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢ ɜɨɬɚ ² ɤɨɠɚ ɢ ɩɨɞɤɨɠɧɚɹ ɠɢɪɨ ɜɚɹ ɤɥɟɬɱɚɬɤɚ -ɧɚɪɭɠɧɚɹ ɤɨɫɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ ² ɜɧɭɬɪɟɧɧɹɹ ɤɨ ɫɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ -ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɩɭɧɤɬɢɪ ² ɩɨɩɟɪɟɱɧɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ ² ɚɩɨɧɟɜɪɨɡ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ 9 ² ɩɪɹɦɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ
10²ɡɚɞɧɹɹ ɫɬɟɧɤɚ ɜɥɚɝɚɥɢɳɚ ɩɪɹ ɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
11² ɛɟɥɚɹ ɥɢɧɢɹ ɠɢɜɨɬɚ
12² ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ
13² ɚɩɨɧɟɜɪɨɡ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
14
Ɋɢɫ ɉɟɪɟɞɧɹɹ ɫɬɟɧɤɚ ɠɢɜɨɬɚ ɫɡɚɞɢ ɩɨ ɋɢɧɟɥɶɧɢɤɨɜɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ
1 ² diaphragma (pars sternalis); 2 ² diaphragma (pars costalis); 3 ² vagina m. recti abdominis; 4 ² m. transversus abdominis; 5 ² m. obliquus intern us abdominis; 6 ² m. obliquus externus abdominis; 7 ² m. transversus abdominis; 8 ² m. rectus abdominis; 9 - lig. inguinale; 10 ² lacuna musculorum; 11 ² m. cremaster; 12 ² arcus iliopectineus; 13 ² lacuna vasorum; 14 ² canalis obturatorius; 15 ² linea Spigelii; 16 ² membrana obturatoria; 17 ² v. iliaca externa; 18 ² a. iliaca externa; 19 ² funiculus spermaticus; 20 ² n. femoralis; 21 ² anulus inguinalis abdominis (profundus); 22 ² m. iliopsoas; 23 ² linea Douglasi; 24 ² fascia umbilicalis;
25 ² fascia transversalis; 26 ² m. transversus thoracis
ɉɟɪɟɞɧɹɹ ɫɬɟɧɤɚ ɜɥɚɝɚɥɢɳɚ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɫɪɚɳɟɧɚ ɫ ɫɭɯɨ ɠɢɥɶɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ ɜɫɥɟɞɫɬɜɢɟ ɱɟɝɨ ɜɨɫɩɚɥɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ ɝɟɦɚ ɬɨɦɵ ɛɵɜɚɸɬ ɨɝɪɚɧɢɱɟɧɵ ɜ ɩɪɟɞɟɥɚɯ ɞɜɭɯ ɫɦɟɠɧɵɯ ɩɟɪɟɦɵɱɟɤ Ɂɚɞɧɹɹ ɫɬɟɧ ɤɚ ɜɥɚɝɚɥɢɳɚ ɫ ɩɟɪɟɦɵɱɤɚɦɢ ɧɟ ɫɩɚɹɧɚ ɩɨɷɬɨɦɭ ɧɚɝɧɨɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ ɫɜɨɛɨɞɧɨ ɪɚɫɩɪɨɫɬɪɚɧɹɸɬɫɹ ɩɨ ɯɨɞɭ ɫɨɫɭɞɨɜ ɜɞɨɥɶ ɜɫɟɣ ɦɵɲɰɵ
ɉɨ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɩɪɨɯɨɞɹɬ ɤɪɭɩɧɵɟ ɫɨɫɭ ɞɵ ɜ ɜɟɪɯɧɢɯ ɨɬɞɟɥɚɯ ± ɜɟɪɯɧɹɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ a. epigastrica superior), ɹɜɥɹɸɳɚɹɫɹ ɤɨɧɟɱɧɨɣ ɜɟɬɜɶɸ ɜɧɭɬɪɟɧɧɟɣ ɝɪɭɞɧɨɣ ɚɪɬɟɪɢɢ a. thoracica interna ɜ ɧɢɠɧɢɯ ± ɧɢɠɧɹɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ a. epigastrica inferior) ± ɜɟɬɜɶ ɧɚɪɭɠɧɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɚɪɬɟɪɢɢ a. iliaca externa Ɂɚ ɫɱɟɬ ɷɬɢɯ ɚɪɬɟɪɢɣ ɨɫɭ ɳɟɫɬɜɥɹɟɬɫɹ ɚɧɚɫɬɨɦɨɡ ɦɟɠɞɭ ɩɨɞɤɥɸɱɢɱɧɨɣ ɢ ɧɚɪɭɠɧɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɚɪ ɬɟɪɢɹɦɢ ɢɦɟɸɳɢɣ ɩɪɚɤɬɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɩɪɢ ɩɟɪɟɜɹɡɤɟ ɩɨɫɥɟɞɧɟɣ
15
ȼɟɧɵ ɫɨɨɬɜɟɬɫɬɜɭɸɬ ɯɨɞɭ ɨɞɧɨɢɦɟɧɧɵɯ ɚɪɬɟɪɢɣ ɢ ɭɱɚɫɬɜɭɸɬ ɜ ɨɛɪɚɡɨ ɜɚɧɢɢ ɤɚɜɚ-ɤɚɜɚɥɶɧɨɝɨ ɚɧɚɫɬɨɦɨɡɚ
Ɂɚ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰɟɣ ɠɢɜɨɬɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜɧɭɬɪɢɛɪɸɲɧɚɹ ɮɚɫɰɢɹ (fascia endoabdominalis). Ɉɧɚ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɥɢɫɬɨɤ ɜɵɫɬɢɥɚɸɳɢɣ ɢɡ ɧɭɬɪɢ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɢ ɩɨ ɦɟɫɬɭ ɟɟ ɩɪɟɞɥɟɠɚɧɢɹ ɧɨɫɢɬ ɨɞɧɨɢɦɟɧɧɨɟ ɧɚɡɜɚ ɧɢɟ Ɍɚɤ ɭɱɚɫɬɨɤ ɮɚɫɰɢɢ ɩɨɤɪɵɜɚɸɳɢɣ ɢɡɧɭɬɪɢ ɩɨɩɟɪɟɱɧɭɸ ɦɵɲɰɭ ɠɢɜɨ ɬɚ ɧɚɡɵɜɚɟɬɫɹ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɟɣ fascia transversalis ɤɜɚɞɪɚɬɧɭɸ ɦɵɲɰɭ
± ɤɜɚɞɪɚɬɧɨɣ ɮɚɫɰɢɟɣ fascia quadrata ɞɢɚɮɪɚɝɦɭ ± ɞɢɚɮɪɚɝɦɚɥɶɧɨɣ ɮɚɫɰɢ ɟɣ fascia diaphragmatica ɢ ɬ ɞ ɉɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɜ ɧɢɠɧɢɯ ɨɬɞɟɥɚɯ ɫɨɟɞɢ ɧɹɟɬɫɹ ɫ ɩɚɯɨɜɨɣ ɫɜɹɡɤɨɣ ɚ ɩɨ ɩɟɪɟɞɧɟɣ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɫɢɦɮɢɡɭ
Ɂɚ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɟɣ ɠɢɜɨɬɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɫɥɨɣ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɢ (tela subserosa ɨɬɞɟɥɹɸɳɟɣ ɛɪɸɲɢɧɭ ɨɬ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɢ ɉɪɟɞɛɪɸɲɢɧ ɧɵɚɹ ɤɥɟɬɱɚɬɤɚ ɥɭɱɲɟ ɜɵɪɚɠɟɧ ɜ ɧɢɠɧɢɯ ɨɬɞɟɥɚɯ ɠɢɜɨɬɚ ɫ ɛɨɤɨɜ ɨɧɚ ɩɟɪɟ ɯɨɞɢɬ ɜ ɡɚɛɪɸɲɢɧɧɭɸ ɤɥɟɬɱɚɬɤɭ textus cellulosus retroperitonealis).
ȼ ɩɪɟɞɛɪɸɲɢɧɧɨɣ ɤɥɟɬɱɚɬɤɟ ɦɟɠɞɭ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɟɣ ɢ ɛɪɸɲɢɧɨɣ ɩɪɨɯɨɞɹɬ ɞɜɚ ɫɨɫɭɞɚ ɧɢɠɧɹɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ a. epigastrica inferior ɨɬ ɯɨɞɹɳɚɹ ɨɬ ɧɚɪɭɠɧɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɚɪɬɟɪɢɢ a. iliaca externa). Ɉɧɚ ɩɨɞɯɨɞɢɬ ɤ ɧɚɪɭɠɧɨɦɭ ɤɪɚɸ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɩɪɨɛɨɞɚɟɬ ɩɨɩɟɪɟɱɧɭɸ ɮɚɫɰɢɸ ɢ ɬɹɧɟɬɫɹ ɩɨ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɪɹɦɨɣ ɦɵɲɰɵ ɞɨ ɩɭɩɤɚ ɝɞɟ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɜɟɪɯɧɟɣ ɧɚɞɱɪɟɜɧɨɣ ɚɪɬɟɪɢɟɣ a. epigastrica superior Ʉɪɨɦɟ ɬɨɝɨ ɧɢɠɧɹɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɤɨɧɟɱɧɵɦɢ ɜɟɬɜɹɦɢ ɦɟɠɪɟɛɟɪɧɵɯ ɢ ɩɨɹɫɧɢɱɧɵɯ ɚɪɬɟɪɢɣ ɩɪɢɧɢɦɚɹ ɭɱɚɫɬɢɟ ɜ ɤɪɨɜɨɫɧɚɛɠɟɧɢɢ ɦɵɲɰ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɢ ɤɨɠɢ ȼ ɧɚɱɚɥɶɧɨɣ ɱɚɫɬɢ ɨɬ ɧɢɠɧɟɣ ɧɚɞɱɪɟɜɧɨɣ ɚɪɬɟɪɢɢ ɨɬ ɯɨɞɢɬ ɤɪɟɦɚɫɬɟɪɧɚɹ ɚɪɬɟɪɢɹ a. cremasterica ɩɪɨɧɢɤɚɸɳɚɹ ɜ ɩɚɯɨɜɵɣ ɤɚɧɚɥ ɢ ɩɢɬɚɸɳɚɹ ɭ ɦɭɠɱɢɧ ɦɵɲɰɭ ɩɨɞɧɢɦɚɸɳɭɸ ɹɢɱɤɨ m. cremaster), ɨɛɨɥɨɱɤɢ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɜ ɬɨɦ ɱɢɫɥɟ ɤɨɠɭ ɦɨɲɨɧɤɢ ɭ ɠɟɧɳɢɧ ± ɤɪɭɝɥɭɸ ɫɜɹɡɤɭ ɦɚɬɤɢ ɢ ɤɨɠɭ ɛɨɥɶɲɢɯ ɝɭɛ
Ȼɟɥɚɹ ɥɢɧɢɹ ɠɢɜɨɬɚ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɩɟɪɟɩɥɟɬɟɧɢɟ ɜɨɥɨɤɨɧ ɜɫɟɯ ɬɪɟɯ ɚɩɨɧɟɜɪɨɡɨɜ Ɉɞɧɚɤɨ ɫɬɪɨɟɧɢɟ ɟɟ ɧɟ ɜɟɡɞɟ ɨɞɢɧɚɤɨɜɨ ȼ ɧɚɞɱɪɟɜɧɨɦ ɨɬ ɞɟɥɟ ɧɚɱɢɧɚɹɫɶ ɭ ɦɟɱɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɭɡɤɨɣ ɩɨɥɨɫɤɨɣ ɩɨ ɧɚɩɪɚɜɥɟɧɢɸ ɤ ɩɭɩɨɱɧɨɣ ɨɛɥɚɫɬɢ ɨɧɚ ɪɚɫɲɢɪɹɟɬɫɹ ± ɭ ɠɟɧɳɢɧ ɨɬ ɞɨ ɫɦ ɭ ɦɭɠɱɢɧ ɨɬ ɞɨ ɫɦ ɨɞɧɨɜɪɟɦɟɧɧɨ ɢɫɬɨɧɱɚɹɫɶ ɞɨ ɦɦ Ⱥɩɨɧɟɜɪɨɡ ɛɟɥɨɣ ɥɢɧɢɢ ɜ ɧɚɞɱɪɟɜɧɨɣ ɢ ɩɭɩɨɱɧɨɣ ɨɛɥɚɫɬɹɯ ɧɟ ɬɨɥɶɤɨ ɲɢɪɨɤ ɢ ɬɨɧɨɤ ɧɨ ɤ ɬɨɦɭ ɠɟ ɟɳɟ ɢɦɟɟɬ ɳɟɥɟɜɢɞɧɵɟ ɩɪɨɦɟɠɭɬɤɢ ȼ ɨɬɞɟɥɶɧɵɯ ɫɥɭɱɚɹɯ ɜ ɷɬɢ ɩɪɨɦɟɠɭɬɤɢ ɦɨ ɠɟɬ ɜɵɩɹɱɢɜɚɬɶɫɹ ɢ ɭɳɟɦɥɹɬɶɫɹ ɩɪɟɞɛɪɸɲɢɧɧɵɣ ɠɢɪ ɂɧɨɝɞɚ ɨɛɪɚɡɭɸɬɫɹ ɝɪɵɠɢ ɛɟɥɨɣ ɥɢɧɢɢ ɇɢɠɟ ɩɭɩɤɚ ɛɟɥɚɹ ɥɢɧɢɹ ɪɟɡɤɨ ɫɭɠɢɜɚɟɬɫɹ ɢ ɡɧɚɱɢɬɟɥɶ ɧɨ ɭɬɨɥɳɚɟɬɫɹ ɜ ɫɚɝɢɬɬɚɥɶɧɨɣ ɩɥɨɫɤɨɫɬɢ ȼɫɥɟɞɫɬɜɢɟ ɷɬɨɝɨ ɧɟɜɨɡɦɨɠɧɨ ɜɵ ɩɨɥɧɢɬɶ ɧɢɠɧɸɸ ɫɪɟɞɢɧɧɭɸ ɥɚɩɚɪɨɬɨɦɢɸ ɫɬɪɨɝɨ ɩɨ ɫɟɪɟɞɢɧɟ ɱɟɪɟɡ ɛɟɥɭɸ ɥɢɧɢɸ ɬɚɤ ɟɟ ɬɨɥɳɢɧɚ ɡɞɟɫɶ ɦɟɧɟɟ ɨɞɧɨɝɨ ɦɢɥɥɢɦɟɬɪɚ.
ɉɭɩɨɤ (umbilicus), ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɜɬɹɧɭɬɵɣ ɪɭɛɟɰ ɤɨɠɢ ɪɚɫɩɨɥɚ ɝɚɟɬɫɹ ɩɨ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɩɪɢɛɥɢɡɢɬɟɥɶɧɨ ɧɚ ɫɟɪɟɞɢɧɟ ɪɚɫɫɬɨɹɧɢɹ ɦɟɠɞɭ ɦɟɱɟɜɢɞɧɵɦ ɨɬɪɨɫɬɤɨɦ ɢ ɥɨɧɧɵɦ ɫɨɱɥɟɧɟɧɢɟɦ ɧɚ ɦɟɫɬɟ ɩɭɩɨɱɧɨɝɨ ɤɨɥɶɰɚ. Ɉɧ ɢɦɟɟɬ ɪɚɡɥɢɱɧɭɸ ɮɨɪɦɭ ɜɬɹɧɭɬɭɸ ɩɥɨɫɤɭɸ ɢ ɜɵɫɬɭɩɚɸɳɭɸ Ʉɨɠɚ ɜ ɨɛ
16
ɥɚɫɬɢ ɩɭɩɤɚ ɬɨɧɤɚɹ ɩɥɨɬɧɨ ɫɩɚɹɧɚ ɩɨ ɤɪɚɹɦ ɫ ɩɭɩɨɱɧɵɦ ɤɨɥɶɰɨɦ annulus umbilicalis).
ɉɭɩɨɱɧɨɟ ɤɨɥɶɰɨ (annulus umbilicalis) - ɨɬɜɟɪɫɬɢɟ ɜ ɛɟɥɨɣ ɥɢɧɢɢ ɠɢɜɨɬɚ ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɢ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɜ ɨɛɥɚɫɬɢ ɩɭɩɤɚ ɨɬɫɭɬɫɬɜɭɸɬ ȼɧɭɬɪɟɧɧɹɹ ɮɚɫɰɢɹ ɧɟɫɤɨɥɶɤɨ ɭɬɨɥɳɟɧɚ ɢ ɧɨɫɢɬ ɧɚɡɜɚɧɢɟ ɩɭɩɨɱɧɨɣ umbilicalis Ɉɧɚ ɩɥɨɬɧɨ ɫɪɚɳɟɧɚ ɫ ɩɚɪɢɟɬɚɥɶɧɵɦ ɥɢɫɬɤɨɦ ɛɪɸɲɢɧɵ ɬ ɤ ɩɪɟɞ ɛɪɸɲɢɧɧɚɹ ɤɥɟɬɱɚɬɤɚ ɨɬɫɭɬɫɬɜɭɟɬ ɑɟɪɟɡ ɩɭɩɨɱɧɨɟ ɤɨɥɶɰɨ ɜ ɩɟɪɢɨɞ ɜɧɭɬɪɢ ɭɬɪɨɛɧɨɝɨ ɪɚɡɜɢɬɢɹ ɩɪɨɯɨɞɹɬ ɞɜɟ ɩɭɩɨɱɧɵɟ ɚɪɬɟɪɢɢ ɢ ɦɨɱɟɜɨɣ ɩɪɨɬɨɤ urachus ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɩɨ ɧɢɠɧɟɣ ɩɨɥɭɨɤɪɭɠɧɨɫɬɢ ɤɨɥɶɰɚ ɧɚ ɜɟɪɯɧɟɣ ɟɝɨ ɩɨ ɥɭɨɤɪɭɠɧɨɫɬɢ ɫɩɪɚɜɚ ɩɪɨɯɨɞɢɬ ɩɭɩɨɱɧɚɹ ɜɟɧɚ ȼ ɞɚɥɶɧɟɣɲɟɦ ɜɫɟ ɷɬɢ ɨɛɪɚɡɨ ɜɚɧɢɹ ɨɛɥɢɬɟɪɢɪɭɸɬɫɹ ɉɭɩɨɱɧɨɟ ɤɨɥɶɰɨ ɹɜɥɹɟɬɫɹ ɧɚɢɛɨɥɟɟ ɫɥɚɛɵɦ ɦɟɫɬɨɦ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɢ ɩɪɢ ɢɫɬɨɧɱɟɧɢɢ ɫɥɨɟɜ ɚ ɬɚɤɠɟ ɩɪɢ ɭɜɟɥɢɱɟɧɢɢ ɪɚɡɦɟɪɨɜ ɩɭɩɨɱɧɨɝɨ ɤɨɥɶɰɚ ɦɨɝɭɬ ɨɛɪɚɡɨɜɚɬɶɫɹ ɩɭɩɨɱɧɵɟ ɝɪɵɠɢ ɱɚɳɟ ɭ ɠɟɧɳɢɧ
Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɤɨɠɧɵɯ ɩɨɤɪɨɜɨɜ ɨɛɪɚɡɭɸɬ ɞɜɟ ɫɟɬɢ ɩɨɜɟɪɯ ɧɨɫɬɧɭɸ ɢ ɝɥɭɛɨɤɭɸ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜ ɫɨɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɨɦ ɫɥɨɟ ɤɨɠɢ ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɫɨɫɭɞɵ ɜ ɨɫɧɨɜɧɨɦ ɜɩɚɞɚɸɬ ɜ ɩɨɞɦɵɲɟɱɧɵɟ ɢ ɩɚɯɨɜɵɟ ɥɢɦ ɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɩɪɢɱɟɦ ɫɨɫɭɞɵ ɨɞɧɨɣ ɩɨɥɨɜɢɧɵ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɲɢɪɨɤɨ ɚɧɚɫɬɨɦɨɡɢɪɭɸɬ ɫ ɫɨɫɭɞɚɦɢ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɫɬɨɪɨɧɵ ɚ ɫɨ ɫɭɞɵ ɜɟɪɯɧɢɯ ɨɛɥɚɫɬɟɣ ± ɫ ɧɢɠɧɢɦɢ Ƚɥɭɛɨɤɢɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɤɚɤ ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ ɬɚɤ ɢ ɩɨ ɯɨɞɭ ɤɪɨɜɟɧɨɫɧɵɯ ɫɨɫɭɞɨɜ ɩɪɨɧɢɤɚɸɬ ɜ ɝɥɭɛɠɟɥɟ ɠɚɳɢɟ ɫɥɨɢ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɩɪɨɛɨɞɚɹ ɮɚɫɰɢɚɥɶɧɵɟ ɥɢɫɬɤɢ ɜɧɟɞɪɹɹɫɶ ɜ ɬɨɥɳɭ ɦɵɲɰ ɠɢɜɨɬɚ Ɉɬ ɝɥɭɛɠɟɥɟɠɚɳɢɯ ɫɥɨɟɜ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɥɢɦɮɚ ɨɬɬɟɤɚɟɬ ɧɟ ɬɨɥɶɤɨ ɜ ɩɨɞɦɵɲɟɱɧɵɟ ɢ ɩɚɯɨɜɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɧɨ ɢ ɜ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜ ɛɪɸɲɢɧɧɨɣ ɩɨɥɨɫɬɢ ɢ ɡɚɛɪɸɲɢɧɧɨɦ ɩɪɨɫɬɪɚɧɫɬɜɟ
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɥɢɦɮɚɬɢɱɟɫɤɚɹ ɫɢɫɬɟɦɚ ɨɛɥɚɫɬɢ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɢɦɟɟɬ ɨɛɲɢɪɧɵɟ ɚɧɚɫɬɨɦɨɡɵ ɤɚɤ ɦɟɠɞɭ ɥɢɦɮɚɬɢɱɟɫɤɢɦɢ ɫɨɫɭɞɚɦɢ ɜɫɟɯ ɫɥɨɟɜ ɷɬɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɧɚɱɢɧɚɹ ɫ ɤɨɠɧɵɯ ɩɨɤɪɨɜɨɜ ɢ ɤɨɧɱɚɹ ɛɪɸɲɢ ɧɨɣ ɬɚɤ ɢ ɦɟɠɞɭ ɫɨɫɭɞɚɦɢ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɫ ɫɨɫɭɞɚɦɢ ɫɨɫɟɞ ɧɢɯ ɨɛɥɚɫɬɟɣ ɢ ɨɪɝɚɧɨɜ
ɉɚɯɨɜɚɹ ɨɛɥɚɫɬɶ, regio inguinalis
ɉɚɯɨɜɚɹ ɨɛɥɚɫɬɶ ɢɦɟɟɬ ɮɨɪɦɭ ɩɪɹɦɨɭɝɨɥɶɧɨɝɨ ɬɪɟɭɝɨɥɶɧɢɤɚ ɪɢɫ , ɝɪɚɧɢɰɚɦɢ ɤɨɬɨɪɨɝɨ ɹɜɥɹɸɬɫɹ:
ɫɜɟɪɯɭ ± ɥɢɧɢɹ ɫɨɟɞɢɧɹɸɳɚɹ ɜɟɪɯɧɢɟ ɩɟɪɟɞɧɢɟ ɩɨɞɜɡɞɨɲɧɵɟ ɨɫɬɢ, ɫɧɢɡɭ ɢ ɥɚɬɟɪɚɥɶɧɨ ± ɩɪɨɟɤɰɢɹ ɩɚɯɨɜɨɣ ɫɜɹɡɤɢ, ɦɟɞɢɚɥɶɧɨ - ɩɪɨɟɤɰɢɹ ɥɚɬɟɪɚɥɶɧɨɝɨ ɤɪɚɹ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
ɉɚɯɨɜɵɣ ɩɪɨɦɟɠɭɬɨɤ ɹɜɥɹɟɬɫɹ ©ɫɥɚɛɵɦ ɦɟɫɬɨɦª ɩɟɪɟɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ
Ƚɪɚɧɢɰɵ ɩɚɯɨɜɨɝɨ ɩɪɨɦɟɠɭɬɤɚ
ɜɜɟɪɯɭ ± ɧɢɠɧɢɟ ɤɪɚɹ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɢ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰ ɠɢɜɨɬɚ ɜɧɢɡɭ ± ɩɚɯɨɜɚɹ ɫɜɹɡɤɚ ɦɟɞɢɚɥɶɧɨ ± ɧɚɪɭɠɧɵɣ ɤɪɚɣ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
17
Ɋɢɫ Ɍɪɟɭɝɨɥɶɧɢɤɢ ɩɚɯɨɜɨɣ ɨɛɥɚɫɬɢ
1 ² ɩɪɹɦɚɹ ɦɵɲɰɚ ɠɢɜɨɬɚ
2 ² ɩɟɪɟɞɧɹɹ ɜɟɪɯɧɹɹ ɩɨɞ ɜɡɞɨɲɧɚɹ ɨɫɬɶ 3 ² ɥɨɛɤɨɜɵɣ ɛɭɝɨɪɨɤ
ABE ² ɩɚɯɨɜɚɹ ɨɛɥɚɫɬɶ CDE ² ɩɚɯɨɜɵɣ ɬɪɟɭɝɨɥɶɧɢɤ EF ² ɩɚɯɨɜɵɣ ɩɪɨɦɟɠɭɬɨɤ BE ² ɩɪɨɟɤɰɢɹ ɩɚɯɨɜɨɣ ɫɜɹɡ ɤɢ Ⱥȿ ² ɩɪɨɟɤɰɢɹ ɥɚɬɟɪɚɥɶɧɨɝɨ
ɤɪɚɹ ɩɪɹɦɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ
ȼɫɬɪɟɱɚɟɬɫɹ ɱɟɬɵɪɟ ɮɨɪɦɵ ɩɚɯɨɜɨɝɨ ɩɪɨɦɟɠɭɬɤɚ ɳɟɥɟɜɢɞɧɚɹ ɨɤɪɭɝɥɚɹ ɨɜɚɥɶɧɚɹ ɢ ɬɪɟɭɝɨɥɶɧɚɹ ɋɚɦɵɟ ɛɨɥɶɲɢɟ ɪɚɡɦɟɪɵ ɩɚɯɨɜɨɝɨ ɩɪɨɦɟɠɭɬɤɚ ɧɚɛɥɸɞɚɸɬɫɹ ɩɪɢ ɬɪɟɭɝɨɥɶɧɨɣ ɮɨɪɦɟ ɨɫɨɛɟɧɧɨ ɭ ɦɭɠɱɢɧ ɉɪɢ ɬɚɤɨɣ ɮɨɪɦɟ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɨɛɪɚɡɭɸɬɫɹ ɩɚɯɨɜɵɟ ɝɪɵɠɢ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɩɪɹɦɵɟ
Ʉɨɠɚ ɬɨɧɤɚ ɩɨɞɜɢɠɧɚ ɥɟɝɤɨ ɪɚɫɬɹɠɢɦɚ ɢɦɟɟɬ ɜɨɥɨɫɹɧɨɣ ɩɨɤɪɨɜ ɛɨɝɚ ɬɚ ɩɨɬɨɜɵɦɢ ɢ ɫɚɥɶɧɵɦɢ ɠɟɥɟɡɚɦɢ ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɪɚɡɜɢɬɚ ɨɛɢɥɶɧɨ ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɫɨɫɬɨɢɬ ɢɡ ɞɜɭɯ ɥɢɫɬɤɨɜ
ȼ ɨɛɥɚɫɬɢ ɩɚɯɨɜɨɝɨ ɬɪɟɭɝɨɥɶɧɢɤɚ ɜ ɩɨɞɤɨɠɧɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɟ ɢɥɢ ɠɟ ɩɨɞ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɟɣ ɩɪɨɯɨɞɹɬ ɜɟɬɜɢ ɛɟɞɪɟɧɧɨɣ ɚɪɬɟɪɢɢ ɩɨɜɟɪɯ ɧɨɫɬɧɚɹ ɧɚɞɱɪɟɜɧɚɹ ɚɪɬɟɪɢɹ ɦɟɞɢɚɥɶɧɨ ɨɬ ɧɟɟ ɥɟɠɢɬ ɧɚɪɭɠɧɚɹ ɩɨɥɨɜɚɹ ɚɪɬɟ ɪɢɹ ɤɧɚɪɭɠɢ ± ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɚɪɬɟɪɢɹ ɨɝɢɛɚɸɳɚɹ ɩɨɞɜɡɞɨɲɧɭɸ ɤɨɫɬɶ ȼɦɟ ɫɬɟ ɫ ɚɪɬɟɪɢɹɦɢ ɩɪɨɯɨɞɹɬ ɨɞɧɨɢɦɟɧɧɵɟ ɜɟɧɵ Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɜɩɚɞɚ ɸɬ ɜ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɩɚɯɨɜɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ
Ʉɨɠɧɵɟ ɧɟɪɜɵ ɩɚɯɨɜɨɣ ɨɛɥɚɫɬɢ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɜɟɬɜɢ ɩɨɞɪɟɛɟɪ ɧɵɟ ɧɟɪɜɵ nn. subcostales ɩɨɞɜɡɞɨɲɧɨ-ɩɨɞɱɪɟɜɧɵɣ ɢ ɩɨɞɜɡɞɨɲɧɨ-ɩɚɯɨɜɵɣ ɧɟɪɜɵ nn. iliohypogastricus et ilioinguinalis) ɉɨɞɜɡɞɨɲɧɨ-ɩɨɞɱɪɟɜɧɵɣ ɢ ɩɨɞ ɜɡɞɨɲɧɨ-ɩɚɯɨɜɵɣ ɧɟɪɜɵ ɜɟɬɜɢ ɩɨɹɫɧɢɱɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ɩɪɨɛɨɞɚɹ ɦɵɲɟɱ ɧɵɟ ɫɥɨɢ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɢɡɧɭɬɪɢ ɧɚɪɭɠɭ ɜɛɥɢɡɢ ɩɟɪɟɞɧɟɣ ɜɟɪɯɧɟɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɫɬɢ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɦɟɠɞɭ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɢ ɩɨɩɟ ɪɟɱɧɨɣ ɦɵɲɰɚɦɢ ɠɢɜɨɬɚ Ɂɚɬɟɦ ɩɨɞɜɡɞɨɲɧɨ-ɩɨɞɱɪɟɜɧɵɣ ɧɟɪɜ ɩɪɨɛɨɞɚɟɬ ɚɩɨɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɧɚ ɫɦ ɤɜɟɪɯɭ ɨɬ ɩɨɜɟɪɯɧɨɫɬɧɨ ɝɨ ɩɚɯɨɜɨɝɨ ɤɨɥɶɰɚ ɩɪɨɧɢɤɚɹ ɜ ɩɨɞɤɨɠɧɭɸ ɤɥɟɬɱɚɬɤɭ ɉɨɞɜɡɞɨɲɧɨ-ɩɚɯɨɜɵɣ ɧɟɪɜ ɩɪɨɯɨɞɹ ɜɧɭɬɪɢ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɜɦɟɫɬɟ ɫ ɫɟɦɟɧɧɵɦ ɤɚɧɚɬɢɤɨɦ ɢɥɢ ɤɪɭɝɥɨɣ ɫɜɹɡɤɨɣ ɜɵɯɨɞɢɬ ɱɟɪɟɡ ɩɨɜɟɪɯɧɨɫɬɧɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ ɩɚɯɨɜɨɝɨ ɤɚ ɧɚɥɚ ɢ ɤɨɧɱɚɟɬɫɹ ɜ ɤɨɠɟ ɥɨɛɤɚ
ɏɢɪɭɪɝɢɱɟɫɤɚɹ ɚɧɚɬɨɦɢɹ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ.
Ⱥɧɚɬɨɦɢɱɟɫɤɢ ɩɚɯɨɜɵɣ ɤɚɧɚɥ (canalis inguinalis) ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɞɟɮɟɤɬ ɜ ɧɢɠɧɟɣ ɱɚɫɬɢ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ Ɉɧ ɩɨɥɭɱɚɟɬɫɹ ɜ ɪɟɡɭɥɶɬɚɬɟ
18
ɨɩɭɫɤɚɧɢɹ ɹɢɱɤɚ ɤɨɬɨɪɨɟ ɦɢɝɪɢɪɭɟɬ ɢɡ ɡɚɛɪɸɲɢɧɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɜ ɦɨ ɲɨɧɤɭ
ɉɚɯɨɜɵɣ ɤɚɧɚɥ ɡɚɧɢɦɚɟɬ ɤɨɫɨɟ ɩɨɥɨɠɟɧɢɟ ɩɚɪɚɥɥɟɥɶɧɨ ɩɚɯɨɜɨɣ ɫɜɹɡɤɟ ɧɚɩɪɚɜɥɹɹɫɶ ɫɜɟɪɯɭ ɜɧɢɡ ɫɡɚɞɢ ɧɚɩɟɪɟɞ ɫɧɚɪɭɠɢ ɤɧɭɬɪɢ Ⱦɥɢɧɚ ɤɚɧɚɥɚ ɭ ɦɭɠɱɢɧ - ɫɦ
ɋɬɟɧɤɚɦɢ ɟɝɨ ɹɜɥɹɸɬɫɹ ɫɩɟɪɟɞɢ ± ɚɩɨɧɟɜɪɨɡ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɫɜɟɪɯɭ ± ɧɚɜɢɫɚɸɳɢɟ ɤɪɚɹ ɜɧɭɬɪɟɧɧɟɣ ɤɨɫɨɣ ɢ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰ ɠɢɜɨɬɚ ɫɡɚɞɢ ± ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɫɧɢɡɭ ± ɠɟɥɨɛ ɩɚɯɨɜɨɣ ɫɜɹɡɤɢ
ȼ ɜɟɪɯɧɟɦ ɨɬɞɟɥɟ ɠɢɜɨɬɚ ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɬɨɧɤɚɹ ɜɧɢɡɭ ɨɫɨɛɟɧɧɨ ɛɥɢɠɟ ɤ ɩɚɯɨɜɨɣ ɫɜɹɡɤɟ ɭɬɨɥɳɚɟɬɫɹ ɩɪɟɜɪɚɳɚɹɫɶ ɜ ɮɢɛɪɨɡɧɭɸ ɩɥɚɫɬɢɧɤɭ ɗɬɨ ɭɬɨɥɳɟɧɢɟ ɧɚɡɵɜɚɟɬɫɹ ɩɨɞɜɡɞɨɲɧɨ-ɥɨɛɤɨɜɵɦ ɬɪɚɤɬɨɦ, tractus iliopubicus ɪɢɫ 1.10 Ɉɧ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɬɚɤ ɠɟ ɤɚɤ ɢ ɩɚɯɨɜɚɹ ɫɜɹɡɤɚ lig. inguinale ɤ ɥɨɛɤɨɜɨɦɭ ɛɭɝɨɪɤɭ ɢ ɩɟɪɟɞ-ɧɟɜɟɪɯɧɟɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɫɬɢ ɢ ɢɞɟɬ ɩɚɪɚɥɥɟɥɶɧɨ ɩɚɯɨɜɨɣ ɫɜɹɡɤɟ ɤɡɚɞɢ ɨɬ ɧɟɟ ɂɯ ɪɚɡɞɟɥɹɟɬ ɬɨɥɶɤɨ ɨɱɟɧɶ ɭɡɤɚɹ ɳɟɥɶ ɩɨɷɬɨɦɭ ɜ ɯɢɪɭɪɝɢɢ ɤɨɦɩɥɟɤɫ ɷɬɢɯ ɞɜɭɯ ɫɜɹɡɨɱɧɵɯ ɨɛɪɚɡɨɜɚɧɢɣ ɱɚɳɟ ɧɚɡɵɜɚɸɬ ɨɞɧɢɦ ɬɟɪɦɢɧɨɦ ɩɚɯɨɜɨɣ ɫɜɹɡɤɨɣ
Ɋɢɫ 1.10 ɉɚɯɨɜɚɹ ɫɜɹɡɤɚ ɢ ɩɨɞɜɡɞɨɲɧɨ-ɥɨɛɤɨɜɵɣ ɬɪɚɤɬ
1 ² ɚɩɨɧɟɜɪɨɡ m. obliquus externus abdominis; 2 ² m. obliquus internus abdominis; 3 ² funiculus spermaticus, fascia spermatica interna; 4 ² lig. inguinale;
5 ² tractus iliopubicus;
6 ² anulus inguinalis profundus;
7 ² ductus deferens;
8 ² a. et v.testiculares;
9 ² fascia transversalis;
10 ² m. transversus abdominis.
ȼ ɩɚɯɨɜɨɦ ɤɚɧɚɥɟ ɪɚɡɥɢɱɚɸɬ ɞɜɚ ɤɨɥɶɰɚ ɩɨɜɟɪɯɧɨɫɬɧɨɟ ɢ ɝɥɭɛɨɤɨɟ
ɉɨɜɟɪɯɧɨɫɬɧɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ anulus inguinalis superficialis) ɨɛɪɚɡɨ ɜɚɧɨ ɜɫɥɟɞɫɬɜɢɟ ɪɚɫɳɟɩɥɟɧɢɹ ɜɨɥɨɤɨɧ ɚɩɨɧɟɜɪɨɡɚ ɧɚɪɭɠɧɨɣ ɤɨɫɨɣ ɦɵɲɰɵ ɠɢɜɨɬɚ ɪɢɫ , 1.11, 1.13) ɉɪɢ ɷɬɨɦ ɨɛɪɚɡɭɸɬɫɹ ɞɜɟ ɧɨɠɤɢ ɦɟɞɢɚɥɶɧɚɹ (crus mediale ɩɪɢɤɪɟɩɥɹɸɳɚɹɫɹ ɤ ɥɨɧɧɨɦɭ ɫɨɱɥɟɧɟɧɢɸ ɢ ɥɚɬɟɪɚɥɶɧɚɹ crus
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laterale ɩɪɢɤɪɟɩɥɹɸɳɚɹɫɹ ɤ ɥɨɧɧɨɦɭ ɛɭɝɨɪɤɭ ɋɧɚɪɭɠɢ ɬɨ ɟɫɬɶ ɭ ɦɟɫɬɚ ɪɚɫɳɟɩɥɟɧɢɹ ɚɩɨɧɟɜɪɨɡɚ ɩɨɜɟɪɯɧɨɫɬɧɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ ɨɝɪɚɧɢɱɢɜɚɟɬɫɹ ɦɟɠɧɨɠɤɨɜɵɦɢ ɜɨɥɨɤɧɚɦɢ fibrae intercrurales).
ɂɡɧɭɬɪɢ ɤɨɥɶɰɨ ɨɝɪɚɧɢɱɟɧɨ ɡɚɝɧɭɬɨɣ ɫɜɹɡɤɨɣ lig. reflexum)[ɪɚɫɩɨɥɨɠɟɧɧɨɣ ɩɨɡɚɞɢ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɑɟɪɟɡ ɩɨɜɟɪɯɧɨɫɬɧɨɟ ɤɨɥɶɰɨ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɭ ɦɭɠɱɢɧ ɜɵɯɨɞɹɬ ɫɟɦɟɧɧɨɣ ɤɚɧɚɬɢɤ ɢ ɤɨɧɟɱɧɵɟ ɜɟɬɜɢ ɩɨɞɜɡɞɨɲɧɨ-ɩɚɯɨɜɨɝɨ ɧɟɪɜɚ ɭ ɠɟɧɳɢɧ ± ɤɪɭɝɥɚɹ ɫɜɹɡɤɚ ɦɚɬɤɢ ȼ ɧɨɪ ɦɟ ɩɪɢ ɨɛɫɥɟɞɨɜɚɧɢɢ ɩɨɜɟɪɯɧɨɫɬɧɨɟ ɤɨɥɶɰɨ ɩɪɨɩɭɫɤɚɟɬ ɤɨɧɱɢɤ ɭɤɚɡɚɬɟɥɶɧɨ ɝɨ ɩɚɥɶɰɚ
Ƚɥɭɛɨɤɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ anulus inguinalis profundus, ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨ ɛɨɣ ɜɨɪɨɧɤɨɨɛɪɚɡɧɨɟ ɭɝɥɭɛɥɟɧɢɟ ɜ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɢ ɪɢɫ , 1.13), ɬɨ ɟɫɬɶ ɷɬɨ ɧɟ ɨɬɜɟɪɫɬɢɟ ɫ ɪɨɜɧɵɦɢ ɤɪɚɹɦɢ ɧɚɩɨɞɨɛɢɟ ɩɟɬɥɢ ɞɥɹ ɩɭɝɨɜɢɰɵ ɚ ɜɵɩɹɱɢɜɚɧɢɟ ɮɚɫɰɢɢ ɜ ɩɚɯɨɜɵɣ ɤɚɧɚɥ ɜ ɜɢɞɟ ɩɚɥɶɰɚ ɨɬ ɪɟɡɢɧɨɜɨɣ ɩɟɪɱɚɬɤɢ ɗɬɨ ɥɟɝɱɟ ɫɟɛɟ ɩɪɟɞɫɬɚɜɢɬɶ ɟɫɥɢ ɜɫɩɨɦɧɢɬɶ ɱɬɨ ɹɢɱɤɨ ɨɩɭɫɤɚɹɫɶ ɜ ɦɨɲɨɧ ɤɭ ɜɵɩɹɱɢɜɚɟɬ ɜɩɟɪɟɞɢ ɫɟɛɹ ɜɫɟ ɫɥɨɢ ɩɟɪɟɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɜ ɬɨɦ ɱɢɫɥɟ ɢ ɩɨɩɟɪɟɱɧɭɸ ɮɚɫɰɢɸ
Ɋɢɫ ɉɚɯɨɜɵɣ ɤɚɧɚɥ ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ
1 ² m. obliquus externus bdominis; 2 ² ɚɩɨɧɟɜɪɨɡ ɬ. obliquus externus abdominis; 3 ² spina iliaca anterior superior; 4 ² m. obliquus internus abdominis; 5 ² m. transversus abdominis; 6 ² anulus inguinalis profundus; 7 ² a. et v. epigastrica inferior ɩɨɞ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɟɣ ² funiculus spermaticus ɩɨɤɪɵɬɵɣ fascia spermatica interna ɢ m. cremaster; 9 ² lig. inguinale; 10 ² crus laterale anulus inguinalis superficialis; 11 ² lig. fundiforme penis; 12 ²
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