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

funiculus spermaticus ɩɨɤɪɵɬɵɣ fascia spermatica externa; 13 ² anulus inguinalis superficialis; 14 ² fibrae intercrarales; 15 ² crus mediale anulus inguinalis superficialis 16 ² lig. reflexum; 17 ² falx inguinalis (tendo conjunctive); 18 ² fascia transversalis ɦɟɫɬɨ ɜɵɯɨɞɚ ɩɪɹɦɵɯ ɝɪɵɠ ² linea alba.

ȼ ɫɜɹɡɢ ɫ ɷɬɢɦ ɜɵɩɹɱɢɜɚɧɢɟ ɨɤɪɭɠɚɹ ɫɟɦɹɜɵɧɨɫɹɳɢɣ ɩɪɨɬɨɤ ɢ ɞɪɭɝɢɟ ɷɥɟɦɟɧɬɵ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɹɜɥɹɟɬɫɹ ɟɝɨ ɨɛɨɥɨɱɤɨɣ fascia spermatica interna ɉɨ ɯɨɞɭ ɤɚɧɚɬɢɤɚ ɷɬɚ ɮɚɫɰɢɹ ɞɨɯɨɞɢɬ ɞɨ ɦɨɲɨɧɤɢ ɭ ɦɭɠɱɢɧ ɢ ɩɨ ɯɨɞɭ ɤɪɭɝɥɨɣ ɫɜɹɡɤɢ ɦɚɬɤɢ ɞɨ ɛɨɥɶɲɢɯ ɩɨɥɨɜɵɯ ɝɭɛ ɭ ɠɟɧɳɢɧ

Ƚɥɭɛɨɤɨɦɭ ɩɚɯɨɜɨɦɭ ɤɨɥɶɰɭ ɫɨ ɫɬɨɪɨɧɵ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɥɚɬɟɪɚɥɶɧɚɹ ɩɚɯɨɜɚɹ ɹɦɤɚ.

Ɋɢɫ . Ƚɥɭɛɨɤɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ ɬɪɟɭɝɨɥɶɧɢɤ Ƚɟɫɫɟɥɶɛɚɯɚ ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² linea arcuata; 2 ² m. rectus abdominis; 3 ² linea alba; 4 ² trigonum Hesselbachii;

5 ² falx inguinalis; 6 ² symphysis pubica; 7 ² lig. lacunare; 8 ² anulus femoralis ɩɭɧɤ ɬɢɪ ² lig. pectineale; 10 ² ɚɧɚɫɬɨɦɨɡ ɦɟɠɞɭ a. obturatoria ɢ a. epigastrica inferior;

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11 ² a. obturatoria; 12 ² ductus deferens; 13 ² m. iliopsoas; 14 ² a. epigastrica inferior; 15 ² a., v. iliaca externa; 16 ² a., v. testicularis; 17 ² anulus inguinalis profundus; 18 ² fascia transversalis (ɨɬɪɟɡɚɧɚ); 19 ² lig. inguinale; 20 ² spina iliaca anterior superior.

ɇɚ ɜɧɭɬɪɟɧɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɜ ɟɟ ɧɢɠɧɢɯ ɨɬɞɟ ɥɚɯ ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ɨɛɪɚɡɭɟɬ ɩɹɬɶ ɫɤɥɚɞɨɤ ɪɢɫ ɉɨ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɦɟɠɞɭ ɩɭɩɤɨɦ ɢ ɦɨɱɟɜɵɦ ɩɭɡɵɪɟɦ ɪɚɫɩɨɥɨɠɟɧɚ ɧɟɩɚɪɧɚɹ ɫɪɟɞɢɧɧɚɹ ɩɭɩɨɱɧɚɹ ɫɤɥɚɞɤɚ plica umbilicalis mediana), ɨɛɪɚɡɨɜɚɧɚ ɨɧɚ ɧɚɞ ɨɛɥɢɬɟɪɢɪɨ ɜɚɧɧɵɦ ɦɨɱɟɜɵɦ ɩɪɨɬɨɤɨɦ (urachus) Ɉɬ ɛɨɤɨɜɵɯ ɩɨɜɟɪɯɧɨɫɬɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɤ ɩɭɩɤɭ ɢɞɭɬ ɞɜɟ ɦɟɞɢɚɥɶɧɵɟ ɩɭɩɨɱɧɵɟ ɫɤɥɚɞɤɢ plicae umbilicales mediales), ɧɚɞ ɨɛɥɢɬɟɪɢɪɨɜɚɧɧɵɦɢ ɩɭɩɨɱɧɵɦɢ ɚɪɬɟɪɢɹɦɢ Ʉɧɚɪɭɠɢ ɨɬ ɦɟ ɞɢɚɥɶɧɵɯ ɩɭɩɨɱɧɵɯ ɫɤɥɚɞɨɤ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɧɚɞ ɧɢɠɧɢɦɢ ɧɚɞɱɪɟɜɧɵɦɢ ɫɨ ɫɭɞɚɦɢ ɜɢɞɧɵ ɫɤɥɚɞɤɢ ɛɪɸɲɢɧɵ ɧɨɫɹɳɢɟ ɧɚɡɜɚɧɢɟ ɥɚɬɟɪɚɥɶɧɵɯ ɩɭɩɨɱɧɵɯ ɫɤɥɚɞɨɤ plicae umbilicales laterales).

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Ɋɢɫ ɉɚɯɨɜɵɣ ɤɚɧɚɥ ɢ ɫɟɦɟɧɧɨɣ ɤɚɧɚɬɢɤ ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² ductus deferens ɩɪɢɤɪɵɬ ɛɪɸɲɢɧɨɣ ² a., v. epigastrica inferior; 3 ² plica umbilicalis medialis; 4 ² plica umbilicalis mediana; 5 ² m. rectus abdominis; 6 ² m. pyramidalis;

7 ² falx inguinalis; 8 ² anulus inguinalis superficialis; 9 ² fascia spermatica externa; 10 ² tuberculum pubicum; 11 ² lig. inguinale; 12 ² a., v. femoralis; 13 ² m. cremaster et fascia cremasterica; 14 ² funiculus spcrmaticus; 15 ² n. ilioinguinalis; 16 ² fascia spermatica interna ɜɵɩɹ ɱɢɜɚɧɢɟ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɢ ² m. obliquus externus abdominis; 18 ² m. obliquus internus abdominis; 19 ² m. transversus abdominis; 20 ² fascia transversalis; 21 ² tela subserosa; 22 ² peritoneum parietale; 23 ² a., v. testicularis ɩɪɢɤɪɵɬɵ ɛɪɸɲɢɧɨɣ);

24 ² a., v. iliaca externa ɩɪɢɤɪɵɬɵ ɛɪɸɲɢɧɨɣ

Ɇɟɠɞɭ ɷɬɢɦɢ ɫɤɥɚɞɤɚɦɢ ɫ ɤɚɠɞɨɣ ɫɬɨɪɨɧɵ ɨɬ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɢɦɟɟɬɫɹ ɩɨ ɬɪɢ ɹɦɤɢ Ɇɟɠɞɭ ɫɪɟɞɢɧɧɨɣ ɢ ɦɟɞɢɚɥɶɧɨɣ ɩɭɩɨɱɧɵɦɢ ɫɤɥɚɞɤɚɦɢ ɨɛɪɚɡɭ ɟɬɫɹ ɧɚɞɩɭɡɵɪɧɚɹ ɹɦɤɚ fossa supravesicalis ɦɟɠɞɭ ɦɟɞɢɚɥɶɧɵɦɢ ɢ ɥɚɬɟɪɚɥɶ ɧɵɦɢ ɩɭɩɨɱɧɵɦɢ ɫɤɥɚɞɤɚɦɢ ± ɦɟɞɢɚɥɶɧɚɹ ɩɚɯɨɜɚɹ ɹɦɤɚ fossa inguinalis medialis ɢ ɤɧɚɪɭɠɢ ɨɬ ɥɚɬɟɪɚɥɶɧɵɯ ɩɭɩɨɱɧɵɯ ɫɤɥɚɞɨɤ ± ɥɚɬɟɪɚɥɶɧɚɹ ɩɚɯɨɜɚɹ ɹɦɤa (fossa inguinalis lateralis ɉɨɫɥɟɞɧɹɹ ɤɚɤ ɭɤɚɡɵɜɚɥɨɫɶ ɹɜɥɹɟɬɫɹ ɦɟɫɬɨɦ ɪɚɫɩɨɥɨɠɟɧɢɹ ɝɥɭɛɨɤɨɝɨ ɩɚɯɨɜɨɝɨ ɤɨɥɶɰɚ. ɨɛɪɚɡɨɜɚɥɨɫɶ ɜ ɪɟɡɭɥɶɬɚɬɟ ɨɩɭɫɤɚ ɧɢɹ ɹɢɱɤɚ

Ɋɢɫ 4 ɉɟɪɟɞɧɹɹ ɫɬɟɧɤɚ ɠɢɜɨɬɚ ɫɨ ɫɬɨɪɨɧɵ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢɩɨ ɋɢɧɟɥɶɧɢɤɨɜɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² m. iliopsoas; 2 ² fossa inguinalis lateralis; 3 ² fossa inguinalis medialis;

4 ² fossa supravesicalis; 5 ² peritoneum parietale; 6 ² m. obturatorius externus;

7 ² m. obturatorius internus; 8 ² m. levator ani; 9 ² prostata; 10 ² glandula seminalis; 11 ² vesica urinaria; 12 ² ureter; 13 ² ductus deferens; 14 ² lig. interfoveo-

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lare; 15 ² v. iliaca externa; 16 ² a. iliaca externa;17 ² vasa testicularia; 18 ² fascia iliaca; 19 ² anulus inguinalis profundus; 20 ² a. et v. epigastricae inferiores; 21 ² lig. umbilicale laterale; 22 ² vagina m. recti abdominis (lamina posterior); 23 ² m. rectus abdominis; 24 ² plica umbilicalis mediana; 25 ² lig. umbilicale medium; 26 ² peritoneum parietale; 27 ² plica umbilicalis medialis; 28 ² plica umbilicalis lateral.

ɉɪɨɰɟɫɫ ɨɩɭɫɤɚɧɢɹ ɹɢɱɤɚ ɩɪɨɢɫɯɨɞɢɬ ɫɥɟɞɭɸɳɢɦ ɨɛɪɚɡɨɦ ȼ ɬɟɱɟɧɢɟ ɩɟɪɜɵɯ ɦɟɫɹɰɟɜ ɜɧɭɬɪɢɭɬɪɨɛɧɨɣ ɠɢɡɧɢ ɹɢɱɤɨ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɩɨɹɫɧɢɱɧɨɣ ɨɛɥɚɫɬɢ Ȼɪɸɲɢɧɚ ɩɨɤɪɵɜɚɟɬ ɟɝɨ ɫ ɬɪɟɯ ɫɬɨɪɨɧ ɢ ɫɪɚɫɬɚɟɬɫɹ ɫ ɛɟɥɨɱɧɨɣ ɨɛɨ ɥɨɱɤɨɣ ɹɢɱɤɚ Ɉɬ ɧɢɠɧɟɝɨ ɩɨɥɸɫɚ ɹɢɱɤɚ ɩɨɡɚɞɢ ɛɪɸɲɢɧɵ ɢɞɟɬ ɨɫɨɛɵɣ ɫɨ ɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɵɣ ɬɹɠ ɬɚɤ ɧɚɡɵɜɚɟɦɵɣ ɩɪɨɜɨɞɧɢɤ ɹɢɱɤɚ ± gubernaculums testis (Hunteri). Ɉɧ ɩɪɨɧɢɤɚɟɬ ɧɚ ɭɪɨɜɧɟ ɛɭɞɭɳɟɝɨ ɜɧɭɬɪɟɧɧɟɝɨ ɨɬɜɟɪɫɬɢɹ ɩɚ ɯɨɜɨɝɨ ɤɚɧɚɥɚ ɜ ɦɨɲɨɧɤɭ Ɍɭɞɚ ɠɟ ɜɵɩɹɱɢɜɚɸɬɫɹ ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɢ ɩɚɪɢ ɟɬɚɥɶɧɵɣ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɩɪɢɱɟɦ ɩɨɫɥɟɞɧɹɹ ɟɳɟ ɞɨ ɫɩɭɫɤɚɧɢɹ ɹɢɱɤɚ ɨɛɪɚ ɡɭɟɬ ɬɚɤ ɧɚɡɵɜɚɟɦɵɣ ɜɥɚɝɚɥɢɳɧɵɣ ɨɬɪɨɫɬɨɤ processus vaginalis peritonei) ɪɢɫ .

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ɯɨɜɨɝɨ ɤɚɧɚɥɚ ɢ ɧɚɱɢɧɚɟɬ ɜɵɩɹɱɢɜɚɬɶ ɜɩɟɪɟɞɢ ɫɟɛɹ ɛɪɸɲɢɧɭ Ɂɚɬɟɦ ɹɢɱɤɨ ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɦɵɲɟɱɧɨ-ɚɩɨɧɟɜɪɨɬɢɱɟɫɤɢɟ ɫɥɨɢ ɩɟɪɟɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɨɛɪɚɡɭɹ ɜ ɧɢɯ ɩɚɯɨɜɨɣ ɤɚɧɚɥ ɢ ɧɚ -ɦ ɦɟɫɹɰɟ ɜɫɬɭɩɚɟɬ ɜ ɦɨɲɨɧɤɭ ɉɪɨɜɨɞ ɧɢɤ ɹɢɱɤɚ ɤ ɷɬɨɦɭ ɜɪɟɦɟɧɢ ɚɬɪɨɮɢɪɭɟɬɫɹ

ȼ ɦɨɲɨɧɤɟ ɹɢɱɤɨ ɨɤɚɡɵɜɚɟɬɫɹ ɩɨɤɪɵɬɵɦ ɞɜɭɦɹ ɥɢɫɬɤɚɦɢ ɛɪɸɲɢɧɵ ɨɛ ɪɚɡɭɸɳɢɦɢ tunica vaginalis (propria) testis. Ɉɞɢɧ ɢɡ ɷɬɢɯ ɥɢɫɬɤɨɜ ± ɜɢɫɰɟɪɚɥɶ

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ɧɵɣ ± ɫɪɚɳɟɧ ɫ ɛɟɥɨɱɧɨɣ ɨɛɨɥɨɱɤɨɣ ɹɢɱɤɚ ɞɪɭɝɨɣ ± ɩɚɪɢɟɬɚɥɶɧɵɣ ± ɹɜɥɹɟɬ ɫɹ ɱɚɫɬɶɸ ɜɥɚɝɚɥɢɳɧɨɝɨ ɨɬɪɨɫɬɤɚ ɛɪɸɲɢɧɵ Ɇɟɠɞɭ ɞɜɭɦɹ ɥɢɫɬɤɚɦɢ ɛɪɸ ɲɢɧɵ ɩɨɤɪɵɜɚɸɳɢɦɢ ɹɢɱɤɨ ɨɫɬɚɟɬɫɹ ɧɟɛɨɥɶɲɚɹ ɳɟɥɶ ɚ ɜɵɲɟ ɹɢɱɤɚ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɜɵɩɹɬɢɜɲɚɹɫɹ ɱɚɫɬɶ ɛɪɸɲɢɧɧɨɝɨ ɦɟɲɤɚ (processus vaginalis peritonei) ɤ ɦɨɦɟɧɬɭ ɪɨɠɞɟɧɢɹ ɨɛɵɱɧɨ ɡɚɪɚɫɬɚɟɬ ɂɧɨɝɞɚ ɷɬɨɝɨ ɡɚɪɚɳɟɧɢɹ ɧɟ ɩɪɨɢɫɯɨɞɢɬ ɢ ɬɨɝɞɚ ɩɨɥɨɫɬɶ ɛɪɸɲɢɧɵ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɫɨɨɛɳɚɟɬɫɹ ɫ ɩɨɥɨɫɬɶɸ ɦɨɲɨɧɤɢ

ɋɨɞɟɪɠɢɦɵɦ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɭ ɦɭɠɱɢɧ ɹɜɥɹɟɬɫɹ ɫɟɦɟɧɧɨɣ ɤɚɧɚɬɢɤ funiculus spermaticus ɩɨɞɜɡɞɨɲɧɨ-ɩɚɯɨɜɵɣ ɧɟɪɜ ɩ ilioinguinalis ɩɪɨ ɯɨɞɹɳɢɣ ɩɨ ɩɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɤɚɧɚɬɢɤɚ ɢ ɩɨɥɨɜɚɹ ɜɟɬɜɶ ɛɟɞɪɟɧɧɨɩɨɥɨɜɨɝɨ ɧɟɪɜɚ ramus genitalis n. genito-femoralis ɍ ɠɟɧɳɢɧ ɱɟɪɟɡ ɩɚ ɯɨɜɵɣ ɤɚɧɚɥ ɩɪɨɯɨɞɹɬ ɬɟ ɠɟ ɞɜɚ ɧɟɪɜɚ ɢ ɤɪɭɝɥɚɹ ɫɜɹɡɤɚ ɦɚɬɤɢ lig. teres uteri.

ɉɪɨɯɨɞɹɳɚɹ ɭ ɠɟɧɳɢɧ ɱɟɪɟɡ ɩɚɯɨɜɵɣ ɤɚɧɚɥ ɤɪɭɝɥɚɹ ɦɚɬɨɱɧɚɹ ɫɜɹɡɤɚ ɨɤɪɭɠɟɧɚ ɮɚɫɰɢɚɥɶɧɨɣ ɨɛɨɥɨɱɤɨɣ ɡɚ ɫɱɟɬ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫɰɢɢ ɚɧɚɥɨɝɢɱɧɨɣ ɜɧɭɬɪɟɧɧɟɣ ɫɟɦɟɧɧɨɣ ɮɚɫɰɢɢ ɭ ɦɭɠɱɢɧ ɉɨ ɜɵɯɨɞɟ ɢɡ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɫɜɹɡ ɤɚ ɨɬɞɟɥɶɧɵɦɢ ɜɨɥɨɤɧɚɦɢ ɡɚɤɚɧɱɢɜɚɟɬɫɹ ɜ ɤɥɟɬɱɚɬɤɟ ɛɨɥɶɲɢɯ ɩɨɥɨɜɵɯ ɝɭɛ ɚ ɞɪɭɝɢɦɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɥɨɛɤɨɜɵɦ ɤɨɫɬɹɦ Ɋɹɞɨɦ ɫ ɤɪɭɝɥɨɣ ɫɜɹɡɤɨɣ ɩɪɨɯɨ ɞɢɬ ɬɚɤ ɠɟ ɤɚɤ ɢ ɭ ɦɭɠɱɢɧ ɡɚɪɚɳɟɧɧɵɣ ɜɥɚɝɚɥɢɳɧɵɣ ɨɬɪɨɫɬɨɤ ɛɪɸɲɢɧɵ ɩɟɪɢɮɟɪɢɱɟɫɤɢɣ ɤɨɧɟɰ ɤɨɬɨɪɨɝɨ ɞɨɫɬɢɝɚɟɬ ɜɟɪɯɧɟɣ ɱɚɫɬɢ ɛɨɥɶɲɨɣ ɩɨɥɨɜɨɣ ɝɭɛɵ ɉɪɢ ɧɟɡɚɪɚɳɟɧɢɢ ɨɬɪɨɫɬɤɚ ɧɚ ɟɝɨ ɦɟɫɬɟ ɨɛɪɚɡɭɟɬɫɹ ɤɚɧɚɥ ɬɚɤ ɧɚɡɵɜɚɟ ɦɵɣ canalis Nuckii ɡɚ ɫɱɟɬ ɤɨɬɨɪɨɝɨ ɦɨɝɭɬ ɜɨɡɧɢɤɚɬɶ ɤɢɫɬɵ ɛɨɥɶɲɢɯ ɩɨɥɨɜɵɯ ɝɭɛ ɢɥɢ ɜɪɨɠɞɟɧɧɵɟ ɩɚɯɨɜɵɟ ɝɪɵɠɢ

ɋɟɦɟɧɧɨɣ ɤɚɧɚɬɢɤ, funiculus spermaticus ɫɨɫɬɨɢɬ ɢɡ ɨɛɨɥɨɱɟɤ ɢ ɷɥɟ ɦɟɧɬɨɜ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ Ʉ ɨɛɨɥɨɱɤɚɦ ɨɬɧɨɫɢɬɫɹ ɧɚɪɭɠɧɚɹ ɫɟɦɟɧɧɚɹ ɮɚɫɰɢɹ fascia spermatica externa ɮɚɫɰɢɹ ɦɵɲɰɵ ɩɨɞɧɢɦɚɸɳɟɣ ɹɢɱɤɨ fascia cremasterica ɦɵɲɰɚ ɩɨɞɧɢɦɚɸɳɚɹ ɹɢɱɤɨ m. cremaster), ɢ ɜɧɭɬɪɟɧɧɹɹ ɫɟɦɟɧɧɚɹ ɮɚɫɰɢɹ fascia spermatica interna) ± ɩɪɨɢɡɜɨɞɧɚɹ ɩɨɩɟɪɟɱɧɨɣ ɮɚɫ ɰɢɢ ȼ ɫɨɫɬɚɜ ɷɥɟɦɟɧɬɨɜ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɜɯɨɞɹɬ ɫɟɦɹɜɵɧɨɫɹɳɢɣ ɩɪɨɬɨɤ (ductus deferens ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɩɢɬɚɸɳɢɟ ɩɪɨɬɨɤ ɹɢɱɤɨ ɚ ɬɚɤɠɟ ɫɥɟɞɵ ɜɥɚɝɚɥɢɳɧɨɝɨ ɨɬɪɨɫɬɤɚ ɛɪɸɲɢɧɵ vestigium processus vaginalis Ʉ ɫɨɫɭɞɚɦ ɨɬɧɨɫɹɬɫɹ ɹɢɱɤɨɜɚɹ ɚɪɬɟɪɢɹ a. testicularis ɨɬɯɨɞɹɳɚɹ ɨɬ ɛɪɸɲɧɨɣ ɚɨɪɬɵ ɩɪɚɜɚɹ ɹɢɱɤɨɜɚɹ ɚɪɬɟɪɢɹ ± ɢɧɨɝɞɚ ɨɬɯɨɞɢɬ ɨɬ ɩɪɚɜɨɣ ɩɨɱɟɱɧɨɣ ɚɪɬɟɪɢɢ ɚɪɬɟ ɪɢɹ ɫɟɦɹɜɵɧɨɫɹɳɟɝɨ ɩɪɨɬɨɤɚ a. ductus deferens ɨɬɯɨɞɹɳɚɹ ɨɬ ɧɢɠɧɟɣ ɩɭ ɡɵɪɧɨɣ ɚɪɬɟɪɢɢ ɢ ɚɪɬɟɪɢɹ ɦɵɲɰɵ ɩɨɞɧɢɦɚɸɳɟɣ ɹɢɱɤɨ a. cremasterica ɩɢ ɬɚɸɳɚɹ ɨɛɨɥɨɱɤɢ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɨɬɯɨɞɢɬ ɨɬ ɧɢɠɧɟɣ ɧɚɞɱɪɟɜɧɨɣ ɚɪɬɟ ɪɢɢ

ȼɟɧɵ ɜɵɯɨɞɹɳɢɟ ɢɡ ɹɢɱɤɚ ɨɛɪɚɡɭɸɬ ɥɨɡɨɜɢɞɧɵɟ ɫɩɥɟɬɟɧɢɹ (plexus pampiniformis ɩɟɪɟɯɨɞɹɳɢɟ ɡɚɬɟɦ ɜ ɹɢɱɤɨɜɭɸ ɜɟɧɭ v. testicularis Ʌɟɜɚɹ

26

ɹɢɱɤɨɜɚɹ ɜɟɧɚ ɜɩɚɞɚɟɬ ɜ ɩɨɱɟɱɧɭɸ ɜɟɧɭ ɚ ɩɪɚɜɚɹ ɹɢɱɤɨɜɚɹ ɜɟɧɚ ± ɧɟɩɨɫɪɟɞ ɫɬɜɟɧɧɨ ɜ ɧɢɠɧɸɸ ɩɨɥɭɸ ɜɟɧɭ

ɂɧɧɟɪɜɚɰɢɹ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɡɚ ɫɱɟɬ ɧɟɪɜɧɵɯ ɫɩɥɟ ɬɟɧɢɣ ɨɤɪɭɠɚɸɳɢɯ ɚɪɬɟɪɢɢ ɢ ɫɟɦɹɜɵɧɨɫɹɳɢɣ ɩɪɨɬɨɤ ɹɢɱɤɨɜɨɟ ɫɩɥɟɬɟɧɢɟ ɢ ɫɩɥɟɬɟɧɢɟ ɫɟɦɹɜɵɧɨɫɹɳɟɝɨ ɩɪɨɬɨɤɚ plexus testicularis et plexus differentialis).

ɏɢɪɭɪɝɢɱɟɫɤɚɹ ɚɧɚɬɨɦɢɹ ɩɚɯɨɜɵɯ ɝɪɵɠ ɇɚɪɭɠɧɵɟ ɝɪɵɠɢ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɜ ɯɢɪɭɪɝɢɢ ɨɛɨɡɧɚɱɚɟɬɫɹ ɤɚɤ ɜɵ

ɯɨɠɞɟɧɢɟ ɜɧɭɬɪɟɧɧɨɫɬɟɣ ɱɟɪɟɡ ɨɬɜɟɪɫɬɢɹ ɳɟɥɢ ɤɚɧɚɥɵ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɢɥɢ ɱɟɪɟɡ ɞɟɮɟɤɬɵ ɜ ɦɵɲɟɱɧɨ-ɚɩɨɧɟɜɪɨɬɢɱɟɫɤɢɯ ɫɥɨɹɯ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɫ ɫɨɯɪɚɧɟɧɢɟɦ ɰɟɥɨɫɬɧɨɫɬɢ ɩɚɪɢɟɬɚɥɶɧɨɝɨ ɥɢɫɬɤɚ ɛɪɸɲɢɧɵ ɪɢɫ Ⱦɥɹ ɝɪɵɠɢ ɛɪɸɲɧɨɣ ɫɬɟɧɤɢ ɯɚɪɚɤɬɟɪɧɨ ɧɚɥɢɱɢɟ ɝɪɵɠɟɜɵɯ ɜɨɪɨɬ ɨɬɜɟɪɫɬɢɟ ɱɟ ɪɟɡ ɤɨɬɨɪɨɟ ɝɪɵɠɚ ɜɵɯɨɞɢɬ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ ɜɵɩɹɱɢɜɚɧɢɟ ɩɚɪɢɟɬɚɥɶɧɨɣ ɛɪɸɲɢɧɵ , ɝɪɵɠɟɜɨɝɨ ɫɨɞɟɪɠɢɦɨɝɨ ɤɢɲɤɢ ɫɚɥɶɧɢɤ ɢ ɩɪ ɢ ɝɪɵɠɟɜɵɯ ɨɛɨɥɨɱɟɤ ɪɚɫɩɨɥɚɝɚɸɳɢɯɫɹ ɤɧɚɪɭɠɢ ɨɬ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ

Ɋɢɫ ɇɚɪɭɠɧɚɹ ɝɪɵɠɚ ɫɯɟɦɚ

1 ² ɩɟɬɥɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɝɪɵ ɠɟɜɨɟ ɫɨɞɟɪɠɢɦɨɟ 2 ² ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ

3 ² ɩɚɪɢɟɬɚɥɶɧɚɹ ɮɚɫɰɢɹ

4 ² ɦɵɲɟɱɧɨ-ɚɩɨɧɟɜɪɨɬɢɱɟɫ ɤɢɣ ɫɥɨɣ ² ɫɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ ² ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ² ɤɨɠɚ ² ɝɪɵ ɠɟɜɨɣ ɦɟɲɨɤ ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ² ɝɪɵɠɟɜɵɟ ɜɨ ɪɨɬɚ ² ɲɟɣɤɚ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ

ɑɚɳɟ ɝɪɵɠɟɜɵɟ ɜɵɩɹɱɢɜɚɧɢɹ ɜɫɬɪɟɱɚɸɬɫɹ ɜ ɨɛɥɚɫɬɢ ɦɟɞɢɚɥɶɧɵɯ ɢ ɨɫɨ ɛɟɧɧɨ ɥɚɬɟɪɚɥɶɧɵɯ ɩɚɯɨɜɵɯ ɹɦɨɤ ȼ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɬɨɝɨ ɱɟɪɟɡ ɤɚɤɭɸ ɹɦɤɭ ɛɭɞɟɬ ɩɪɨɧɢɤɚɬɶ ɝɪɵɠɟɜɨɟ ɜɵɩɹɱɢɜɚɧɢɟ ɨɛɪɚɡɭɸɬɫɹ ɩɪɹɦɵɟ ɢɥɢ ɤɨɫɵɟ ɩɚ ɯɨɜɵɟ ɝɪɵɠɢ

Ʉɨɫɚɹ ɩɚɯɨɜɚɹ ɝɪɵɠɚ hernia inguinalis obliqua) ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɥɚɬɟ ɪɚɥɶɧɭɸ ɩɚɯɨɜɭɸ ɹɦɤɭ ɢ ɞɚɥɟɟ ɱɟɪɟɡ ɩɚɯɨɜɵɣ ɤɚɧɚɥ ɢ ɜɵɯɨɞɢɬ ɱɟɪɟɡ ɩɨ ɜɟɪɯɧɨɫɬɧɨɟ ɤɨɥɶɰɨ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɪɢɫ 7). ȼ ɧɚɱɚɥɶɧɨɣ ɫɬɚɞɢɢ ɪɚɡɜɢɬɢɹ ɝɪɵɠɚ ɧɟ ɨɩɭɫɤɚɟɬɫɹ ɡɚ ɩɪɟɞɟɥɵ ɩɚɯɨɜɨɝɨ ɤɚɧɚɥɚ ɚ ɩɨ ɦɟɪɟ ɭɜɟɥɢɱɟɧɢɹ ɜɵ ɯɨɞɢɬ ɱɟɪɟɡ ɧɚɪɭɠɧɨɟ ɩɚɯɨɜɨɟ ɤɨɥɶɰɨ ɢ ɡɚɬɟɦ ɨɩɭɫɤɚɟɬɫɹ ɜ ɦɨɲɨɧɤɭ Ʉɨɫɵɟ ɩɚɯɨɜɵɟ ɝɪɵɠɢ ɦɨɝɭɬ ɛɵɬɶ ɩɪɢɨɛɪɟɬɟɧɧɵɦɢ ɢ ɜɪɨɠɞɟɧɧɵɦɢ

ɉɪɢɨɛɪɟɬɟɧɧɚɹ ɩɚɯɨɜɚɹ ɝɪɵɠɚ ɨɛɪɚɡɭɟɬɫɹ ɜ ɬɟɯ ɫɥɭɱɚɹɯ ɤɨɝɞɚ ɩɨɞ ɜɨɡ ɞɟɣɫɬɜɢɟɦ ɜɧɭɬɪɢɛɪɸɲɧɨɝɨ ɞɚɜɥɟɧɢɹ ɜɧɭɬɪɟɧɧɨɫɬɢ ɩɪɨɬɚɥɤɢɜɚɹ ɜɩɟɪɟɞɢ ɫɟɛɹ ɩɚɪɢɟɬɚɥɶɧɵɣ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɡɚ ɫɱɟɬ ɤɨɬɨɪɨɣ ɨɛɪɚɡɭɟɬɫɹ ɝɪɵɠɟɜɨɣ

27

ɦɟɲɨɤ ɩɪɨɧɢɤɚɸɬ ɜ ɩɚɯɨɜɵɣ ɤɚɧɚɥ ɢ ɞɚɥɟɟ ɜ ɦɨɲɨɧɤɭ (ɤɥɟɬɱɚɬɤɭ ɛɨɥɶɲɢɯ ɩɨɥɨɜɵɯ ɝɭɛ).

Ɇɟɯɚɧɢɡɦ ɨɛɪɚɡɨɜɚɧɢɹ ɜɪɨɠɞɟɧɧɵɯ ɩɚɯɨɜɵɯ ɝɪɵɠ ɧɟɫɤɨɥɶɤɨ ɢɧɨɣ ȼɥɚ ɝɚɥɢɳɧɵɣ ɨɬɪɨɫɬɨɤ ɛɪɸɲɢɧɵ ɤ ɤɨɧɰɭ ɜɧɭɬɪɢɭɬɪɨɛɧɨɣ ɠɢɡɧɢ ɨɛɥɢɬɟɪɢɪɭɟɬ ɫɹ ɟɫɥɢ ɠɟ ɨɛɥɢɬɟɪɚɰɢɹ ɧɟ ɩɪɨɢɫɯɨɞɢɬ ɜɨɡɧɢɤɚɸɬ ɩɪɟɞɩɨɫɵɥɤɢ ɞɥɹ ɩɪɨɧɢɤ ɧɨɜɟɧɢɹ ɜɧɭɬɪɟɧɧɨɫɬɟɣ ɜ ɩɨɥɨɫɬɶ ɫɨɛɫɬɜɟɧɧɨ ɜɥɚɝɚɥɢɳɧɨɣ ɨɛɨɥɨɱɤɢ ɹɜɥɹ ɸɳɟɣɫɹ ɜ ɞɚɧɧɨɦ ɫɥɭɱɚɟ ɝɨɬɨɜɵɦ ɝɪɵɠɟɜɵɦ ɦɟɲɤɨɦ. ɉɪɢ ɜɪɨɠɞɟɧɧɨɣ ɩɚɯɨ ɜɨɣ ɝɪɵɠɟ ɹɢɱɤɨ ɢɧɬɢɦɧɨ ɫɩɚɹɧɨ ɫ ɝɪɵɠɟɜɵɦ ɦɟɲɤɨɦ

Ɍ ɤ ɜɪɨɠɞɟɧɧɚɹ ɢ ɩɪɢɨɛɪɟɬɟɧɧɚɹ ɤɨɫɵɟ ɩɚɯɨɜɵɟ ɝɪɵɠɢ ɩɪɨɯɨɞɹɬ ɜɧɭɬɪɢ ɨɛɨɥɨɱɟɤ ɫɟɦɟɧɧɨɝɨ ɤɚɧɚɬɢɤɚ ɬɨ ɟɫɬɟɫɬɜɟɧɧɨ ɱɬɨ ɢ ɨɛɨɥɨɱɤɢ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ ɛɭɞɭɬ ɨɞɧɢ ɢ ɬɟ ɠɟ ɜɧɭɬɪɟɧɧɹɹ ɫɟɦɟɧɧɚɹ ɮɚɫɰɢɹ ɦɵɲɰɚ ɩɨɞɧɢɦɚɸ ɳɚɹ ɹɢɱɤɨ ɢ ɮɚɫɰɢɹ ɦɵɲɰɵ ɩɨɞɧɢɦɚɸɳɟɣ ɹɢɱɤɨ

Ɋɢɫ 7 Ʉɨɫɚɹ ɩɚɯɨɜɚɹ ɝɪɵɠɚ ɫɯɟɦɚ

1 ² ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ

2 ² ɚ testicularis; 3 ² ductus deferens; 4 ² ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ 5 ² ɦɵɲɟɱɧɨ-ɚɩɨɧɟɜɪɨɬɢɱɟɫ- ɤɢɣ ɫɥɨɣ ² ɫɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ ² ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ 8 ² ɤɨɠɚ ² ɹɢɱɤɨ 10 ² ɜɥɚɝɚɥɢɳɧɚɹ ɨɛɨɥɨɱɤɚ ɹɢɱɤɚ ² fascia spermatica interna; 12 ² ɩɟɬɥɹ ɬɨɧɤɨɣ ɤɢɲ ɤɢ ɝɪɵɠɟɜɨɟ ɫɨɞɟɪɠɢɦɨɟ 13 ² ɝɪɵɠɟɜɨɣ ɦɟɲɨɤ ɩɚɪɢɟ

ɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ² ɝɪɵ ɠɟɜɵɟ ɜɨɪɨɬɚ 15 ² a. epigastrica inferior; 16 ² ɨɛɥɢɬɟɪɢɪɨɜɚɧɧɚɹ a. umbilicalis;

17 ² plica umbilicalis medialis;

18 ² fossa inguinalis medialis;

19 ² plica umbilicalis lateralis;

20 ² ɲɟɣɤɚ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ.

ɉɪɹɦɚɹ ɩɚɯɨɜɚɹ ɝɪɵɠɚ hernia inguinalis directa)(ɪɢɫ 8) ɨɛɪɚɡɭɟɬ ɫɹ ɜ ɬɟɯ ɫɥɭɱɚɹɯ ɤɨɝɞɚ ɝɪɵɠɟɜɨɟ ɜɵɩɹɱɢɜɚɧɢɟ ɩɪɨɯɨɞɢɬ ɜ ɨɛɥɚɫɬɢ ɦɟɞɢɚɥɶ ɧɨɣ ɩɚɯɨɜɨɣ ɹɦɤɢ ɚ ɬ ɤ ɩɪɨɟɤɰɢɹ ɦɟɞɢɚɥɶɧɨɣ ɹɦɤɢ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɩɨɜɟɪɯ ɧɨɫɬɧɨɦɭ ɩɚɯɨɜɨɦɭ ɤɨɥɶɰɭ ɬɨ ɝɪɵɠɟɜɨɟ ɜɵɩɹɱɢɜɚɧɢɟ ɢɦɟɟɬ ɩɪɹɦɨɣ ɯɨɞ Ⱦɥɢɧɚ ɝɪɵɠɟɜɨɝɨ ɤɚɧɚɥɚ ɩɪɢ ɩɪɹɦɨɣ ɝɪɵɠɟ ɧɚɦɧɨɝɨ ɤɨɪɨɱɟ ɱɟɦ ɩɪɢ ɤɨɫɨɣ ɋɟɦɟɧɧɨɣ ɤɚɧɚɬɢɤ ɨɛɵɱɧɨ ɪɚɫɩɨɥɨɠɟɧ ɫɧɚɪɭɠɢ ɨɬ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ ɧɟ ɢɦɟɹ ɧɢɤɚɤɨɣ ɫɜɹɡɢ ɫ ɝɪɵɠɟɜɵɦ ɦɟɲɤɨɦ Ɉɛɨɥɨɱɤɨɣ ɝɪɵɠɟɜɨɝɨ ɦɟɲɤɚ ɹɜɥɹ ɟɬɫɹ ɩɨɩɟɪɟɱɧɚɹ ɮɚɫɰɢɹ ɉɪɹɦɚɹ ɩɚɯɨɜɚɹ ɝɪɵɠɚ ɛɵɜɚɟɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɞɜɭɫɬɨɪɨɧɧɟɣ ɢ ɬɨɥɶɤɨ ɩɪɢɨɛɪɟɬɟɧɧɨɣ

28

ȼ ɦɟɫɬɚɯ ɩɟɪɟɯɨɞɚ ɛɪɸɲɢɧɵ ɫɨ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɧɚ ɨɪɝɚɧ ɢɥɢ ɫ ɨɪɝɚɧɚ ɧɚ ɨɪɝɚɧ ɨɛɪɚɡɭɸɬɫɹ ɫɜɹɡɤɢ ligg. peritonei) ɢɥɢ ɛɪɵɠɟɣɤɢ mesos) ɇɟɤɨɬɨɪɵɟ ɢɡ ɧɢɯ ɯɨɪɨɲɨ ɜɵɪɚɠɟɧɵ ɧɚɩɪɢɦɟɪ ɛɪɵɠɟɣɤɚ ɬɨɧɤɨɣ ɩɨɩɟɪɟɱɧɨɨɛɨɞɨɱɧɨɣ ɢ ɫɢɝɦɨɜɢɞɧɨɣ ɤɢɲɨɤ

ɉɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ɪɢɫ 9) ɜɵɫɬɢɥɚɟɬ ɢɡɧɭɬɪɢ ɩɟɪɟɞɧɸɸ ɢ ɛɨɤɨ ɜɵɟ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɜɜɟɪɯɭ ɨɧɚ ɩɟɪɟɯɨɞɢɬ ɧɚ ɞɢɚɮɪɚɝɦɭ ɜɧɢɡɭ ± ɜ ɨɛɥɚɫɬɶ ɛɨɥɶɲɨɝɨ ɢ ɦɚɥɨɝɨ ɬɚɡɚ ɫɡɚɞɢ ɧɟɫɤɨɥɶɤɨ ɧɟ ɞɨɯɨɞɢɬ ɞɨ ɩɨɡɜɨɧɨɱɧɢɤɚ ɨɝɪɚ ɧɢɱɢɜɚɹ ɡɚɛɪɸɲɢɧɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ Ɉɬɧɨɲɟɧɢɟ ɜɢɫɰɟɪɚɥɶɧɨɣ ɛɪɸɲɢɧɵ ɤ ɨɪɝɚɧɚɦ ɧɟ ɜɨ ɜɫɟɯ ɫɥɭɱɚɹɯ ɨɞɢɧɚɤɨɜɨ Ɉɞɧɢ ɨɪɝɚɧɵ ɩɨɤɪɵɬɵ ɟɸ ɫɨ ɜɫɟɯ ɫɬɨ ɪɨɧ ɢ ɪɚɫɩɨɥɨɠɟɧɵ ɢɧɬɪɚɩɟɪɢɬɨɧɟɚɥɶɧɨ ɷɬɨ ɠɟɥɭɞɨɤ ɫɟɥɟɡɟɧɤɚ ɬɨɧɤɚɹ ɫɥɟɩɚɹ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɢ ɫɢɝɦɨɜɢɞɧɵɟ ɤɢɲɤɢ ɢɧɨɝɞɚ ɠɟɥɱɧɵɣ ɩɭ ɡɵɪɶ Ɉɧɢ ɩɨɥɧɨɫɬɶɸ ɩɨɤɪɵɬɵ ɛɪɸɲɢɧɨɣ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɭɡɤɨɣ ɩɨɥɨɫɵ ɧɚ ɠɟɥɭɞɤɟ ɜɞɨɥɶ ɦɚɥɨɣ ɢ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɧɚ ɬɨɧɤɨɣ ɤɢɲɤɟ ɜɞɨɥɶ ɦɟɫɬɚ ɩɪɢɤɪɟɩɥɟɧɢɹ ɛɪɵɠɟɣɤɢ ɱɚɫɬɶ ɨɪɝɚɧɚ ɥɢɲɟɧɧɚɹ ɫɟɪɨɡɧɨɝɨ ɩɨɤɪɨɜɚ ɧɚɡɵɜɚ ɟɬɫɹ pars nuda ɑɚɫɬɶ ɨɪɝɚɧɚ ɩɨɤɪɵɬɚ ɜɢɫɰɟɪɚɥɶɧɨɣ ɛɪɸɲɢɧɨɣ ɫ ɬɪɟɯ ɫɬɨɪɨɧ ɬɨ ɟɫɬɶ ɪɚɫɩɨɥɨɠɟɧɵ ɨɧɢ ɦɟɡɨɩɟɪɢɬɨɧɟɚɥɶɧɨ ɩɟɱɟɧɶ ɠɟɥɱɧɵɣ ɩɭɡɵɪɶ ɜɨɫ ɯɨɞɹɳɚɹ ɢ ɧɢɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɵɟ ɤɢɲɤɢ ɧɚɱɚɥɶɧɵɣ ɢ ɤɨɧɟɱɧɵɣ ɨɬɞɟɥɵ - ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɇɟɤɨɬɨɪɵɟ ɨɪɝɚɧɵ ɩɨɤɪɵɬɵ ɛɪɸɲɢɧɨɣ ɬɨɥɶɤɨ ɫ ɨɞɧɨɣ ɫɬɨ ɪɨɧɵ ± ɷɤɫɬɪɚɩɟɪɢɬɨɧɟɚɥɶɧɨ -ɩɟɪɫɬɧɚɹ ɤɢɲɤɚ ɩɨɞɠɟɥɭɞɨɱɧɚɹ ɠɟɥɟɡɚ ɢɧɨɝɞɚ ɠɟɥɱɧɵɣ ɩɭɡɵɪɶ ɩɨɱɤɢ Ɉɪɝɚɧɵ ɩɨɤɪɵɬɵɟ ɛɪɸɲɢɧɨɣ ɷɤɫɬɪɚɩɟɪɟɬɨ ɧɢɚɥɶɧɨ ɧɚɯɨɞɹɬɫɹ ɜ ɡɚɛɪɸɲɢɧɧɨɦ ɩɪɨɫɬɪɚɧɫɬɜɟ

ȼɢɫɰɟɪɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ɩɨɤɪɵɜɚɹ ɞɢɚɮɪɚɝɦɚɥɶɧɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɩɟɱɟ ɧɢ ɩɟɪɟɯɨɞɢɬ ɧɚ ɟɟ ɧɢɠɧɸɸ ɩɨɜɟɪɯɧɨɫɬɶ Ʌɢɫɬɤɢ ɛɪɸɲɢɧɵ ɢɞɭɳɢɟ ɨɞɢɧ ɨɬ ɩɟɪɟɞɧɟɣ ɱɚɫɬɢ ɧɢɠɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɟɱɟɧɢ ɞɪɭɝɨɣ ± ɨɬ ɡɚɞɧɟɣ ɭ ɜɨɪɨɬ ɜɫɬɪɟɱɚɸɬɫɹ ɢ ɨɩɭɫɤɚɸɬɫɹ ɜɧɢɡ ɩɨ ɧɚɩɪɚɜɥɟɧɢɸ ɤ ɦɚɥɨɣ ɤɪɢɜɢɡɧɟ ɠɟɥɭɞɤɚ ɢ ɧɚɱɚɥɶɧɨɣ ɱɚɫɬɢ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɨɛɪɚɡɭɹ ɫɜɹɡɤɢ ɦɚɥɨɝɨ ɫɚɥɶɧɢɤɚ ɩɟɱɟ ɧɨɱɧɨ-ɠɟɥɭɞɨɱɧɭɸ lig. hepatogastricum ɢ ɤɚɤ ɩɪɨɞɨɥɠɟɧɢɟ ɟɟ ɩɟɱɟɧɨɱɧɨ-

ɞɭɨɞɟɧɚɥɶɧɭɸ lig. hepatoduodenale).

Ʌɢɫɬɤɢ ɦɚɥɨɝɨ ɫɚɥɶɧɢɤɚ ɭ ɦɚɥɨɣ ɤɪɢɜɢɡɧɵ ɠɟɥɭɞɤɚ ɪɚɫɯɨɞɹɬɫɹ ɩɨɤɪɵ ɜɚɸɬ ɠɟɥɭɞɨɤ ɫɩɟɪɟɞɢ ɢ ɫɡɚɞɢ ɢ ɭ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɜɧɨɜɶ ɫɨɟɞɢɧɢɜɲɢɫɶ ɨɩɭɫɤɚɸɬɫɹ ɤɧɢɡɭ ɨɛɪɚɡɭɹ ɩɟɪɟɞɧɸɸ ɩɥɚɫɬɢɧɤɭ ɛɨɥɶɲɨɝɨ ɫɚɥɶɧɢɤɚ omentum majus ɋɩɭɫɬɢɜɲɢɫɶ ɜɧɢɡ ɩɨɪɨɣ ɞɨ ɥɨɛɤɨɜɨɝɨ ɫɢɦɮɢɡɚ ɥɢɫɬɤɢ ɡɚɜɨɪɚ ɱɢɜɚɸɬɫɹ ɢ ɧɚɩɪɚɜɥɹɸɬɫɹ ɜɜɟɪɯ ɨɛɪɚɡɭɹ ɡɚɞɧɸɸ ɫɬɟɧɤɭ ɛɨɥɶɲɨɝɨ ɫɚɥɶɧɢɤɚ Ⱦɨɫɬɢɝɧɭɜ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɥɢɫɬɤɢ ɛɪɸɲɢɧɵ ɨɝɢɛɚɸɬ ɟɟ ɩɟ ɪɟɞɧɟɜɟɪɯɧɸɸ ɩɨɜɟɪɯɧɨɫɬɶ ɢ ɧɚɩɪɚɜɥɹɸɬɫɹ ɤ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɛɪɸɲɧɨɣ ɩɨɥɨ ɫɬɢ ɝɞɟ ɪɚɫɯɨɞɹɬɫɹ ɢ ɨɞɢɧ ɢɡ ɧɢɯ ɩɨɞɧɢɦɚɟɬɫɹ ɤɜɟɪɯɭ ɩɨɤɪɵɜɚɹ ɩɨɞɠɟɥɭ ɞɨɱɧɭɸ ɠɟɥɟɡɭ ɡɚɞɧɸɸ ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɱɚɫɬɢɱɧɨ ɞɢɚɮɪɚɝɦɭ ɩɚɪɢɟɬɚɥɶɧɵɣ ɥɢɫɬɨɤ ɢ ɞɨɫɬɢɝɧɭɜ ɡɚɞɧɟɧɢɠɧɟɝɨ ɤɪɚɹ ɩɟɱɟɧɢ ɩɟɪɟɯɨɞɢɬ ɧɚ ɟɟ ɧɢɠɧɸɸ ɩɨɜɟɪɯɧɨɫɬɶ Ⱦɪɭɝɨɣ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɡɚɜɨɪɚɱɢɜɚɟɬɫɹ ɢ ɢɞɟɬ ɜ ɨɛɪɚɬɧɨɦ ɧɚɩɪɚɜɥɟɧɢɢ ɬ ɟ ɨɬ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɤ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɟ ɤɨɬɨɪɭɸ ɨɯɜɚɬɵɜɚɟɬ ɢ ɜɧɨɜɶ ɜɨɡɜɪɚɳɚɟɬɫɹ ɤ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɠɢɜɨɬɚ Ɍɚɤ ɨɛɪɚ ɡɭɟɬɫɹ ɛɪɵɠɟɣɤɚ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ mesocolon transversum ɫɨ ɫɬɨɹɳɚɹ ɢɡ ɱɟɬɵɪɟɯ ɥɢɫɬɤɨɜ ɛɪɸɲɢɧɵ

Ɉɬ ɤɨɪɧɹ ɛɪɵɠɟɣɤɢ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɨɩɭɫɤɚɟɬɫɹ ɜɧɢɡ ɢ ɭɠɟ ɜ ɤɚɱɟɫɬɜɟ ɩɚɪɢɟɬɚɥɶɧɨɣ ɛɪɸɲɢɧɵ ɜɵɫɬɢɥɚɟɬ ɡɚɞɧɸɸ

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