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

ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɡɚɬɟɦ ɫ ɬɪɟɯ ɫɬɨɪɨɧ ɩɨɤɪɵɜɚɟɬ ɜɨɫɯɨɞɹɳɭɸ ɫɩɪɚɜɚ ɢ ɧɢɫɯɨ ɞɹɳɭɸ ɫɥɟɜɚ ɨɛɨɞɨɱɧɵɟ ɤɢɲɤɢ Ʉɧɭɬɪɢ ɨɬ ɜɨɫɯɨɞɹɳɟɣ ɢ ɧɢɫɯɨɞɹɳɟɣ ɤɢɲ ɤɢ ɩɚɪɢɟɬɚɥɶɧɵɣ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɩɨɤɪɵɜɚɟɬ ɨɪɝɚɧɵ ɡɚɛɪɸɲɢɧɧɨɝɨ ɩɪɨ ɫɬɪɚɧɫɬɜɚ ɢ ɩɨɞɯɨɞɹ ɤ ɬɨɧɤɨɣ ɤɢɲɤɟ ɨɛɪɚɡɭɟɬ ɟɟ ɛɪɵɠɟɣɤɭ ɨɤɭɬɵɜɚɹ ɭ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ ɋ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɩɚɪɢɟɬɚɥɶɧɵɣ ɥɢɫɬɨɤ ɛɪɸɲɢɧɵ ɨɩɭɫɤɚ ɟɬɫɹ ɜ ɩɨɥɨɫɬɶ ɬɚɡɚ ɝɞɟ ɩɨɤɪɵɜɚɟɬ ɧɚɱɚɥɶɧɵɟ ɨɬɞɟɥɵ ɩɪɹɦɨɣ ɤɢɲɤɢ ɡɚɬɟɦ ɜɵɫɬɢɥɚɟɬ ɫɬɟɧɤɢ ɦɚɥɨɝɨ ɬɚɡɚ ɢ ɩɟɪɟɯɨɞɢɬ ɧɚ ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ ɭ ɠɟɧɳɢɧ ɜɧɚɱɚɥɟ ɩɨɤɪɵɜɚɟɬ ɦɚɬɤɭ ɩɨɤɪɵɜɚɹ ɟɝɨ ɫɡɚɞɢ ɫ ɛɨɤɨɜ ɢ ɫɜɟɪɯɭ ɋ ɜɟɪɯɭɲɤɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɛɪɸɲɢɧɚ ɩɟɪɟɯɨɞɢɬ ɧɚ ɩɟɪɟɞɧɸɸ ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɡɚɦɵɤɚɹ ɛɪɸɲɢɧɧɭɸ ɩɨɥɨɫɬɶ

Ɋɢɫ 9. ɏɨɞ ɛɪɸɲɢɧɵ ɜ ɫɚ ɝɢɬɬɚɥɶɧɨɣ ɩɥɨɫɤɨɫɬɢ ɫɯɟɦɚ

1 ± ɫɟɪɩɨɜɢɞɧɚɹ ɫɜɹɡɤɚ ɩɟɱɟɧɢ lig. falciforme hepatis; 2 ± ɩɟɱɟɧɶ hepar; 3 ± ɦɚɥɵɣ ɫɚɥɶɧɢɤ omentum minus; 4 ± ɫɚɥɶɧɢɤɨɜɚɹ ɫɭɦɤɚ bursa omentalis; 5 ± ɠɟɥɭɞɨɤ gaster; 6 ±

ɩɨɞɠɟɥɭɞɨɱɧɚɹ ɠɟɥɟɡɚ pancreas;

7 ± ɛɪɵɠɟɣɤɚ ɩɨɩɟɪɟɱɧɨ-ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ mesocolon; 8 ± ɞɜɟɧɚɞɰɚɬɢ ɩɟɪɫɬɧɚɹ ɤɢɲɤɚ duodenum;

9 ± ɛɪɵɠɟɣɤɚ ɬɨɧɤɨɣ ɤɢɲɤɢ mesenterium; 10 ± ɛɪɵɠɟɣɤɚ ɫɢɝɦɨɜɢɞɧɨɣ ɤɢɲɤɢ mesosigma; 11 ± ɩɪɹɦɚɹ ɤɢɲɤɚ rectum; 12 ± ɩɪɹɦɨɤɢɲɟɱɧɨɦɚɬɨɱɧɨɟ ɭɝɥɭɛɥɟɧɢɟ Ⱦɭɝɥɚɫɨɜɨ excavation rectouterina (Douglassi); 13 ± ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ vesica urinaria; 14 ± ɩɭɡɵɪɧɨ-ɦɚɬɨɱɧɨɟ ɭɝɥɭɛɥɟɧɢɟ excavation vesicouterina; 15 ± ɦɚɬɤɚ uterus; 16 ± ɛɨɥɶɲɨɣ ɫɚɥɶɧɢɤ omentum majus; 17 ± ɠɟɥɭɞɨɱɧɨ-

ɨɛɨɞɨɱɧɚɹ ɫɜɹɡɤɚ lig. gastrocolicum

ɉɨɫɪɟɞɫɬɜɨɦ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɢ ɟɟ ɛɪɵɠɟɣɤɢ ɛɪɸɲɧɚɹ ɩɨ ɥɨɫɬɶ ɞɟɥɢɬɫɹ ɧɚ ɞɜɚ ɷɬɚɠɚ ɜɟɪɯɧɢɣ ɢ ɧɢɠɧɢɣ ɪɢɫ.1.20). Ʉɨɪɟɧɶ ɛɪɵɠɟɣɤɢ ɡɚɧɢɦɚɟɬ ɩɨɩɟɪɟɱɧɨɟ ɩɨɥɨɠɟɧɢɟ ɢ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɧɚ ɭɪɨɜɧɟ ɜɟɪɯɧɟɝɨ ɤɪɚɹ II ɩɨɹɫɧɢɱɧɨɝɨ ɩɨɡɜɨɧɤɚ ɢɞɹ ɫɩɪɚɜɚ ɧɚɥɟɜɨ ɬ ɟ ɨɬ ɜɟɪɯɧɟɝɨ ɩɨɥɸɫɚ ɩɪɚɜɨɣ ɩɨɱɤɢ ɤ ɜɟɪɯɧɟɦɭ ɩɨɥɸɫɭ ɥɟɜɨɣ Ȼɪɵɠɟɣɤɚ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɩɟɪɟɫɟɤɚɟɬ ɧɢɫɯɨɞɹɳɭɸ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɨɞɠɟɥɭɞɨɱɧɭɸ ɠɟɥɟɡɭ ɢ 12-ɩɟɪɫɬɧɨ-ɬɨɳɢɣ ɢɡɝɢɛ Ⱦɥɢɧɚ ɛɪɵɠɟɣɤɢ ɜ ɫɪɟɞɧɢɯ ɨɬɞɟɥɚɯ ɞɨɫɬɢɝɚɟɬ -16

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ɫɦ ɛɥɢɠɟ ɤ ɢɡɝɢɛɚɦ ± 2- ɫɦ Ⱦɥɢɧɚ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɤɨɥɟɛɥɟɬ ɫɹ ɨɬ ɞɨ ɫɦ ɜ ɫɪɟɞɧɟɦ ɫɦ

ȼ ɜɟɪɯɧɟɦ ɷɬɚɠɟ ɪɚɫɩɨɥɨɠɟɧɵ ɩɟɱɟɧɶ ɠɟɥɱɧɵɣ ɩɭɡɵɪɶ, ɫɟɥɟɡɟɧɤɚ ɛɪɸɲɧɚɹ ɱɚɫɬɶ ɩɢɳɟɜɨɞɚ ɠɟɥɭɞɨɤ ɢ ɜɟɪɯɧɹɹ ɱɚɫɬɶ 12-ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɜ ɧɢɠɧɟɦ ± ɧɢɠɧɹɹ ɝɨɪɢɡɨɧɬɚɥɶɧɚɹ ɢ ɜɨɫɯɨɞɹɳɚɹ ɱɚɫɬɢ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɬɨɧɤɚɹ ɢ ɬɨɥɫɬɚɹ ɤɢɲɤɢ

Ɋɢɫ 20. ȼɟɪɯɧɢɣ ɷɬɚɠ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ

1 ² hepar; 2 ² lig. teres hepatis;

3 ² foramen omentale; 4 ² vesica biliaris; 5 ² colon transversum;

6 ² colon ascendens; 7 ² lig. falciforme hepatis; 8 ² lig. hepatoduodenalis; 9 ² gaster; 10 ² omentum minus; 11 ² splen; 12 ² lig. gastrocolicum; 13 ² omentum majus.

ɉɨ ɛɨɤɚɦ ɨɬ ɜɨɫɯɨɞɹɳɟɣ ɢ ɧɢɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɪɚɫɩɨɥɨɠɟɧɵ

ɩɪɚɜɚɹ ɢ ɥɟɜɚɹ ɨɤɨɥɨɨɛɨɞɨɱɧɨ-ɤɢɲɟɱɧɵɟ ɛɨɪɨɡɞɵ, ɱɚɫɬɨ ɧɚɡɵɜɚɟɦɵɟ ɛɨɤɨ ɜɵɦɢ ɤɚɧɚɥɚɦɢ ɨɛɪɚɡɨɜɚɧɧɵɟ ɜɫɥɟɞɫɬɜɢɟ ɩɟɪɟɯɨɞɚ ɛɪɸɲɢɧɵ ɫ ɛɨɤɨɜɨɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɧɚ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ ɪɢɫ ɚ ɋ ɩɪɚɤɬɢɱɟɫɤɨɣ ɬɨɱɤɢ ɡɪɟ ɧɢɹ ɧɚɢɛɨɥɟɟ ɜɚɠɟɧ ɩɪɚɜɵɣ ɤɚɧɚɥ ɬ ɤ ɩɨ ɧɟɦɭ ɜɟɪɯɧɢɣ ɷɬɚɠ ɫɨɨɛɳɚɟɬɫɹ ɫ ɧɢɠɧɢɦ ɢ ɜ ɫɥɭɱɚɹɯ ɩɟɪɮɨɪɚɰɢɢ ɹɡɜɵ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢɥɢ ɠɟɥɭɞɤɚ ɜ ɨɛ ɥɚɫɬɢ ɩɪɢɜɪɚɬɧɢɤɚ ɢɡɥɢɜɲɟɟɫɹ ɜ ɛɪɸɲɧɭɸ ɩɨɥɨɫɬɶ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɟ ɫɨ ɞɟɪɠɢɦɨɟ ɦɨɠɟɬ ɩɪɨɧɢɤɧɭɬɶ ɜ ɩɪɚɜɭɸ ɩɨɞɜɡɞɨɲɧɭɸ ɨɛɥɚɫɬɶ ɢ ɜɫɥɟɞɫɬɜɢɟ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɦɟɫɬɧɨɝɨ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɦɨɠɟɬ ɫɬɢɦɭɥɢɪɨɜɚɬɶ ɜɨɫɩɚɥɟɧɢɟ ɱɟɪɜɟɨɛɪɚɡɧɨɝɨ ɨɬɪɨɫɬɤɚ ± ɚɩɩɟɧɞɢɰɢɬ ɉɨ ɥɟɜɨɦɭ ɤɚɧɚɥɭ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɫɜɹɡɶ ɜɟɪɯɧɟɝɨ ɷɬɚɠɚ ɫ ɧɢɠɧɢɦ ɨɬɫɭɬɫɬɜɭɟɬ ɢɡ-ɡɚ ɧɚɥɢ ɱɢɹ ɞɢɮɪɚɝɦɚɥɶɧɨ-ɨɛɨɞɨɱɧɨɣ ɫɜɹɡɤɢ lig. phrenicocolicum) ɧɚɬɹɧɭɬɵɦ ɦɟɠɞɭ ɥɟɜɵɦ ɢɡɝɢɛɨɦ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɢ ɞɢɚɮɪɚɝɦɨɣ ɋɨɨɛɳɟɧɢɟ ɜɟɪɯɧɟɝɨ ɷɬɚɠɚ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɫ ɧɢɠɧɢɦ ɜɨɡɦɨɠɧɨ ɟɳɟ ɱɟɪɟɡ ɭɡɤɭɸ ɳɟɥɶ ɦɟɠɞɭ ɩɨɩɟ ɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɢ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɨɣ ɠɢɜɨɬɚ

Ʉɪɨɦɟ ɛɨɪɨɡɞ ɤɚɧɚɥɨɜ) ɜ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɪɚɡɥɢɱɚɸɬ ɛɪɵɠɟɟɱɧɵɟ ɫɢɧɭɫɵ. Ɍɨɥɫɬɚɹ ɤɢɲɤɚ ɫɜɨɢɦ ɜɨɫɯɨɞɹɳɢɦ ɩɨɩɟɪɟɱɧɨ-ɨɛɨɞɨɱɧɵɦ ɢ ɧɢɫɯɨ ɞɹɳɢɦ ɨɬɞɟɥɚɦɢ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɩɪɹɦɨɭɝɨɥɶɧɢɤ ɩɨ ɞɢɚɝɨɧɚɥɢ ɤɨɬɨɪɨɝɨ ɫɜɟɪɯɭ ɜɧɢɡ ɫɥɟɜɚ ɧɚɩɪɚɜɨ ɩɪɨɯɨɞɢɬ ɛɪɵɠɟɣɤɚ ɬɨɧɤɨɣ ɤɢɲɤɢ ɪɢɫ ɚ .

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Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɨɛɪɚɡɭɸɬɫɹ ɞɜɟ ɩɚɡɭɯɢ ɬɪɟɭɝɨɥɶɧɨɣ ɮɨɪɦɵ ± ɩɪɚɜɚɹ ɢ ɥɟɜɚɹ ɉɪɚɜɚɹ ɨɝɪɚɧɢɱɟɧɚ ɫɩɪɚɜɚ ± ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɫɜɟɪɯɭ ± ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɫɥɟɜɚ ± ɤɚɤ ɛɵ ɝɢɩɨɬɟɧɭɡɨɣ ɬɪɟɭɝɨɥɶɧɢɤɚ ± ɛɪɵɠɟɣɤɨɣ ɬɨɧɤɨɣ ɤɢɲɤɢ Ʌɟɜɚɹ ɩɚɡɭɯɚ ɨɝɪɚɧɢɱɟɧɚ ɫɥɟɜɚ ± ɧɢɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɫɧɢɡɭ ± ɜɯɨɞɨɦ ɜ ɩɨɥɨɫɬɶ ɦɚɥɨɝɨ ɬɚɡɚ ɢ ɫɩɪɚɜɚ ± ɛɪɵ ɠɟɣɤɨɣ ɬɨɧɤɨɣ ɤɢɲɤɢ

Ɋɢɫ ɚ ɋɢɧɭɫɵ ɢ ɨɤɨ ɥɨɨɛɨɞɨɱɧɵɟ ɛɨɪɨɡɞɵ ɧɢɠɧɟɝɨ ɷɬɚɠɚ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ

1 ² vesica biliaris;

2 ² sinus mesentericus dexter;

3,6²canalis abdominalis dextra et sinistra

4 ² sinus mesentericus sinister;

5 ² radix mesenterium;

7 ² gaster;

8 ² splen;

9 ² hepar;

10 ² lig. coronarium hepatis.

ȼ ɜɟɪɯɧɟɦ ɷɬɚɠɟ ɜ ɩɨɥɨɫɬɢ ɛɪɸɲɢɧɵ ɪɚɡɥɢɱɚɸɬ ɧɟɫɤɨɥɶɤɨ ɨɝɪɚɧɢɱɟɧ ɧɵɯ ɩɪɨɫɬɪɚɧɫɬɜ: ɫɚɥɶɧɢɤɨɜɚɹ ɫɭɦɤɚ (bursa omentalis ɩɨɞɞɢɚɮɪɚɝɦɚɥɶɧɨɟ ɩɨɞɩɟɱɟɧɨɱɧɨɟ ɢ ɩɟɱɟɧɨɱɧɨ-ɩɨɱɟɱɧɨɟ ɭɝɥɭɛɥɟɧɢɹ ɤɚɪɦɚɧɵ

ɋɚɥɶɧɢɤɨɜɚɹ ɫɭɦɤɚ ɪɢɫ 1.19, 1.21) ɫɩɟɪɟɞɢ ɨɝɪɚɧɢɱɟɧɚ ɦɚɥɵɦ ɫɚɥɶɧɢ ɤɨɦ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɠɟɥɭɞɤɚ ɢ ɠɟɥɭɞɨɱɧɨ-ɨɛɨɞɨɱɧɨɣ ɫɜɹɡɤɨɣ lig. gastrocolicum), ɫɡɚɞɢ ± ɩɪɢɫɬɟɧɨɱɧɨɣ ɛɪɸɲɢɧɨɣ ɩɨɤɪɵɜɚɸɳɟɣ ɩɨɞɠɟɥɭɞɨɱɧɭɸ ɠɟɥɟɡɭ ɢ ɡɚɞɧɸɸ ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɫɜɟɪɯɭ ± ɩɟɱɟɧɶɸ ɢ ɞɢɚɮɪɚɝɦɨɣ ɫɧɢɡɭ ± ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɢ ɟɟ ɛɪɵɠɟɣɤɨɣ ɫɥɟɜɚ ± ɠɟɥɭɞɨɱɧɨɫɟɥɟɡɟɧɨɱɧɨɣ ɢ ɞɢɚɮɪɚɝɦɚɥɶɧɨ-ɫɟɥɟɡɟɧɨɱɧɨɣ ɫɜɹɡɤɚɦɢ ligg. gastrolienale et phrenicolienale ɋ ɨɛɳɟɣ ɩɨɥɨɫɬɶɸ ɛɪɸɲɢɧɵ ɷɬɚ ɫɭɦɤɚ ɫɨɨɛɳɚɟɬɫɹ ɩɨɫɪɟɞ ɫɬɜɨ ɫɚɥɶɧɢɤɨɜɨɝɨ ɨɬɜɟɪɫɬɢɹ foramen epiploicum ± Winslovi ɨɝɪɚɧɢɱɟɧɧɨɝɨ ɫɜɹɡɤɚɦɢ ɫɩɟɪɟɞɢ ± ɫɜɨɛɨɞɧɵɦ ɤɪɚɟɦ ɩɟɱɟɧɨɱɧɨ-ɞɭɨɞɟɧɚɥɶɧɨɣ ɫɜɹɡɤɢ ɫɧɢɡɭ

± ɞɭɨɞɟɧɚɥɶɧɨ-ɩɨɱɟɱɧɨɣ ɫɜɹɡɤɨɣ lig. duodenorenale), ɫɡɚɞɢ ± ɩɟɱɟɧɨɱɧɨ-

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ɩɨɱɟɱɧɨɣ ɫɜɹɡɤɨɣ lig. hepatorenale), ɫɜɟɪɯɭ ± ɯɜɨɫɬɚɬɨɣ ɞɨɥɟɣ ɩɟɱɟɧɢ lobus caudatus ± ). ȼɟɥɢɱɢɧɚ ɨɬɜɟɪɫɬɢɹ - ɫɦ

Ɋɢɫ 1.21 Ɂɚɞɧɹɹ ɫɬɟɧɤɚ ɫɚɥɶɧɢɤɨɜɨɣ ɫɭɦɤɢ ɩɨ ɋɢɧɟɥɶɧɢɤɨɜɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² duodenum; 2 ² flexura coli dextra; 3 ² recessus inferior bursae omentalis; 4 ² pylorus; 5 ² vesica biliaris; 6 ² ɡɨɧɞ ɜɜɟɞɺɧɧɵɣ ɜ foramen omentale; 7 ² hepar; 8 ² diaphragma;

9 ² lig. hepatoduodenale; 10 - lig. hepatogastricum; 11 ² lobus caudatus hepatis; 12 ² recessus superior bursae omentalis; 13 ² lobus sinister hepatis; 14 ² plica gastropancreatica; 15 ² pancreas; 16 ² gaster; 17 ² mesocolon transversum; 18 ² recessus splenicus bursae omentalis;

19 ² lig. gastrosplenicum; 20 ² splen; 21 ² mesocolon transversum; 22 ² lig. phrenicocolicum; 23 ² flexura coli sinistra; 24 ² flexura duodenojejunalis; 25 ² recessus duodenojejunalis superior; 26 ² ren sinister; 27 ² pars ascendens duodeni.

ȼ ɧɢɠɧɟɦ ɷɬɚɠɟ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɩɚɪɢɟɬɚɥɶɧɚɹ ɛɪɸɲɢɧɚ ɜɵɫɬɢɥɚɸ ɳɚɹ ɡɚɞɧɸɸ ɫɬɟɧɤɭ ɠɢɜɨɬɚ ɩɪɢ ɩɟɪɟɯɨɞɟ ɫ ɨɞɧɨɝɨ ɨɬɞɟɥɚ ɤɢɲɟɱɧɢɤɚ ɜ ɞɪɭ ɝɨɣ ɨɛɪɚɡɭɟɬ ɭɝɥɭɛɥɟɧɢɟ ɤɚɪɦɚɧɵ ɢɦɟɸɳɢɟ ɩɪɚɤɬɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɬ ɤ ɨɧɢ ɦɨɝɭɬ ɛɵɬɶ ɦɟɫɬɨɦ ɨɛɪɚɡɨɜɚɧɢɹ ɜɧɭɬɪɟɧɧɢɯ ɝɪɵɠ ɠɢɜɨɬɚ Ɍɚɤɢɯ ɤɚɪɦɚ ɧɨɜ ɨɛɵɱɧɨ ɛɵɜɚɟɬ ɩɹɬɶ

ɉɟɪɜɵɣ ɤɚɪɦɚɧ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɧɟɛɨɥɶɲɭɸ ɹɦɤɭ ɪɚɫɩɨɥɨɠɟɧɧɭɸ ɫ ɥɟɜɨɣ ɫɬɨɪɨɧɵ ɬɟɥɚ II ɩɨɹɫɧɢɱɧɨɝɨ ɩɨɡɜɨɧɤɚ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɦɟɫɬɭ ɩɟɪɟɯɨɞɚ 12-ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɜ ɬɨɳɭɸ ɜɟɪɯɧɟɟ -ɩɟɪɫɬɧɨ-ɬɨɳɟɤɢɲɟɱɧɨɟ ɭɝɥɭɛɥɟɧɢɟ (recessus duodenojejunalis ɗɬɨɬ ɤɚɪɦɚɧ ɫɩɪɚɜɚ ɨɝɪɚɧɢɱɟɧ -ɩɟɪɫɬɧɨ-ɬɨɳɢɦ ɢɡɝɢɛɨɦ flexura duodenojejunalis ɫɜɟɪɯɭ ɢ ɫɥɟɜɚ ± ɫɤɥɚɞɤɨɣ ɛɪɸɲɢɧɵ ɜ ɤɨ ɬɨɪɨɣ ɩɪɨɯɨɞɢɬ ɧɢɠɧɹɹ ɛɪɵɠɟɟɱɧɚɹ ɜɟɧɚ v. mesenterica inferior) (ɪɢɫ ɚ).

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Ɋɢɫ ɚ ȼɟɪɯɧɟɟ ɞɭɨɞɟ ɧɚɥɶɧɨɟ ɭɝɥɭɛɥɟɧɢɟ ɩɨ ɇɟɬ ɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² colon transversum; 2 ² mesocolon transversum; 3 ² plica duodenalis superior; 4 ² recessus duodenalis superior; 5 ² recessus duodenalis inferior; 6 ² plica duodenalis inferior; 7 ² a. mesenterica superior; 8 ² a., v. mesenterica inferior; 9 ² aorta abdominalis.

ȼɬɨɪɨɣ ɤɚɪɦɚɧ ɪɚɫɩɨɥɨɠɟɧ ɜɵɲɟ ɦɟɫɬɚ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɜ ɜɨɫɯɨ ɞɹɳɭɸ ɢ ɧɚɡɵɜɚɟɬɫɹ ɜɟɪɯɧɢɦ ɢɥɟɨɰɟɤɚɥɶɧɵɦ ɭɝɥɭɛɥɟɧɢɟɦ recessus iliocaecalis superior ȼɜɟɪɯɭ ɨɧ ɨɝɪɚɧɢɱɟɧ ɩɨɞɜɡɞɨɲɧɨ-ɨɛɨɞɨɱɧɨɣ ɫɤɥɚɞɤɨɣ plica iliocolica), ɫɧɢɡɭ ± ɤɨɧɟɱɧɵɦ ɨɬɞɟɥɨɦ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ɢ ɫɧɚɪɭɠɢ ± ɧɚɱɚɥɶɧɵɦ ɨɬɞɟɥɨɦ ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ

Ɍɪɟɬɢɣ ɤɚɪɦɚɧ ɧɚɢɛɨɥɟɟ ɩɨɫɬɨɹɧɧɵɣ ɪɚɫɩɨɥɨɠɟɧ ɧɢɠɟ ɦɟɫɬɚ ɜɩɚɞɟɧɢɹ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ± ɧɢɠɧɟɟ ɢɥɟɨɰɟɤɚɥɶɧɨɟ ɭɝɥɭɛɥɟɧɢɟ recessus iliocaecalis inferior ȼɜɟɪɯɭ ɨɧ ɨɝɪɚɧɢɱɟɧ ɤɨɧɟɱɧɵɦ ɨɬɞɟɥɨɦ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ɫɡɚɞɢ

± ɛɪɵɠɟɣɤɨɣ ɱɟɪɜɟɨɛɪɚɡɧɨɝɨ ɨɬɪɨɫɬɤɚ ɫɩɟɪɟɞɢ ± ɧɟɛɨɥɶɲɨɣ ɢɥɟɨɰɟɤɚɥɶɧɨɣ ɫɤɥɚɞɤɨɣ ɛɪɸɲɢɧɵ plica iliocaecalis ɢɞɭɳɟɣ ɨɬ ɬɨɧɤɨɣ ɤɢɲɤɢ ɤ ɦɟɞɢɚɥɶɧɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɫɥɟɩɨɣ ɤɢɲɤɢ

ɑɟɬɜɟɪɬɵɣ ɤɚɪɦɚɧ ɧɚɯɨɞɢɬɫɹ ɩɨɡɚɞɢ ɫɥɟɩɨɣ ɤɢɲɤɢ ± ɩɨɡɚɞɢ ɫɥɟɩɨɤɢ ɲɟɱɧɨɟ ɭɝɥɭɛɥɟɧɢɟ recessus retrocaecalis Ɉɧ ɨɝɪɚɧɢɱɟɧ ɫɩɟɪɟɞɢ ɫɥɟɩɨɣ ɤɢɲɤɨɣ ɫɡɚɞɢ ± ɩɚɪɢɟɬɚɥɶɧɨɣ ɛɪɸɲɢɧɨɣ ɫɧɚɪɭɠɢ ± ɫɤɥɚɞɤɨɣ ɛɪɸɲɢɧɵ ɦɟɠɞɭ ɩɨɜɟɪɯɧɨɫɬɶɸ ɫɥɟɩɨɣ ɤɢɲɤɢ ɢ ɛɪɸɲɧɨɣ ɫɬɟɧɤɨɣ plica caecalis).

ɉɹɬɵɣ ɤɚɪɦɚɧ ɧɚɯɨɞɢɬɫɹ ɧɚ ɥɟɜɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɤɨɪɧɹ ɛɪɵɠɟɣɤɢ ɫɢɝɦɨ ɜɢɞɧɨɣ ɤɢɲɤɢ ± ɦɟɠɫɢɝɦɨɜɢɞɧɨɟ ɭɝɥɭɛɥɟɧɢɟ recessus intersigmoideus).

ȼɧɭɬɪɟɧɧɢɟ ɝɪɵɠɟɜɵɟ ɭɳɟɦɥɟɧɢɹ ɜɫɬɪɟɱɚɸɬɫɹ ɱɚɳɟ ɜ -ɩɟɪɫɬɧɨ- ɬɨɳɟɦ ɢɡɝɢɛɟ ɩɨɡɚɞɢɫɥɟɩɨɤɢɲɟɱɧɨɦ ɢ ɜ ɧɢɠɧɟɦ ɢɥɢɨɰɟɤɚɥɶɧɨɦ ɭɝɥɭɛɥɟɧɢ ɹɯ ȼɧɭɬɪɟɧɧɢɟ ɝɪɵɠɢ ɨɬɧɨɫɹɬɫɹ ɤ ɪɟɞɤɨɣ ɩɚɬɨɥɨɝɢɢ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɧɨ ɩɪɟɞɫɬɚɜɥɹɸɬ ɛɨɥɶɲɨɣ ɢɧɬɟɪɟɫ ɬ ɤ ɭɳɟɦɥɟɧɢɟ ɢɯ ɬɪɟɛɭɟɬ ɫɪɨɱɧɨɝɨ ɨɩɟɪɚ ɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ Ɍɨɱɧɨ ɪɚɫɩɨɡɧɚɬɶ ɯɚɪɚɤɬɟɪ ɡɚɛɨɥɟɜɚɧɢɹ ɞɨ ɨɩɟɪɚɰɢɢ ɢɫɤɥɸɱɢɬɟɥɶɧɨ ɬɪɭɞɧɨ

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ɧɨ ɫ ɧɟɣ ɫɨɩɪɢɤɚɫɚɟɬɫɹ ɇɚ ɩɟɱɟɧɢ ɜ ɷɬɨɦ ɦɟɫɬɟ ɢɦɟɟɬɫɹ impressio oesophageale.

Ɂɞɟɫɶ ɜɨɡɦɨɠɧɨ ɜɧɟɞɪɟɧɢɟ ɩɪɨɝɥɨɱɟɧɧɵɯ ɢɧɨɪɨɞɧɵɯ ɬɟɥ ɱɟɪɟɡ ɫɬɟɧɤɭ ɩɢɳɟɜɨɞɚ ɜ ɩɟɱɟɧɶ ȼɦɟɫɬɟ ɫɬɟɦ ɨɩɭɯɨɥɶ ɪɚɡɜɢɜɚɸɳɚɹɫɹ ɜɥɟɜɨɣ ɞɨɥɟ ɩɟɱɟɧɢ ɦɨɠɟɬ ɫɞɚɜɥɢɜɚɬɶ ɩɢɳɟɜɨɞ

ɉɪɚɜɵɣ ɤɪɚɣ ɩɢɳɟɜɨɞɚ ɩɥɚɜɧɨ ɩɟɪɟɯɨɞɢɬ ɜ ɦɚɥɭɸ ɤɪɢɜɢɡɧɭ ɠɟɥɭɞɤɚ ɚ ɥɟɜɵɣ ɤɪɚɣ ɨɛɪɚɡɭɟɬ ɫ ɞɧɨɦ ɠɟɥɭɞɤɚ ɭɝɥɭɛɥɟɧɢɟ ɤɚɪɞɢɚɥɶɧɭɸ ɜɵɪɟɡɤɭ incisure cardialis ɢɥɢ ɭɝɨɥ Ƚɢɫɚ >His] ɪɢɫ .

ɉɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɛɪɸɲɧɨɝɨ ɨɬɞɟɥɚ ɩɢɳɟɜɨɞɚ ɩɪɢɤɪɵɬɚ ɥɢɫɬɤɨɦ ɛɪɸɲɢɧɵ ɩɟɪɟɯɨɞɹɳɢɦ ɧɚ ɧɟɝɨ ɫ ɞɢɚɮɪɚɝɦɵ ɉɨɞ ɥɢɫɬɤɨɦ ɛɪɸɲɢɧɵ ɧɚ ɩɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɛɪɸɲɧɨɣ ɱɚɫɬɢ ɩɢɳɟɜɨɞɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɟɪɟɞɧɢɣ ɛɥɭɠɞɚɸɳɢɣ ɫɬɜɨɥ truncus vagalis anterior, ɚ ɧɚ ɡɚɞɧɟɣ ² ɡɚɞɧɢɣ ɛɥɭɠɞɚɸ ɳɢɣ ɫɬɜɨɥ truncus vagalis posterior Ɂɚɞɧɹɹ ɫɬɟɧɤɚ ɩɢɳɟɜɨɞɚ ɩɪɢɦɵɤɚɸɳɚɹ ɤ ɞɢɚɮɪɚɝɦɟ ɱɚɫɬɨ ɥɢɲɟɧɚ ɛɪɸɲɢɧɧɨɝɨ ɩɨɤɪɨɜɚ

ɀɟɥɭɞɨɤ ventriculus, s. gaster)

Ȼɨɥɶɲɟɣ ɫɜɨɟɣ ɱɚɫɬɶɸ (5/6) ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɥɟɜɨɣ ɱɚɫɬɢ ɜɟɪɯɧɟɝɨ ɷɬɚɠɚ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ

Ƚɨɥɨɬɨɩɢɹ ɥɟɜɨɟ ɩɨɞɪɟɛɟɪɶɟ ɢ ɱɚɫɬɢɱɧɨ - ɷɩɢɝɚɫɬɪɚɥɶɧɚɹ ɨɛɥɚɫɬɶ. Ⱥɧɚɬɨɦɢɱɟɫɤɢ ɜ ɠɟɥɭɞɤɟ ɪɚɡɥɢɱɚɸɬ ɤɚɪɞɢɚɥɶɧɭɸ ɱɚɫɬɶ ɫɜɨɞ ɠɟɥɭɞɤɚ

ɬɟɥɨ ɢ ɩɪɢɜɪɚɬɧɢɤɨɜɭɸ ɱɚɫɬɶ ɪɢɫ ɦɚɥɭɸ ɢ ɛɨɥɶɲɭɸ ɤɪɢɜɢɡɧɭ ɚ ɬɚɤɠɟ ɩɟɪɟɞɧɸɸ ɢ ɡɚɞɧɸɸ ɫɬɟɧɤɢ. Ʉɚɪɞɢɚɥɶɧɚɹ ɱɚɫɬɶ ɠɟɥɭɞɤɚ ɪɚɫɩɨɥɨɠɟɧɚ ɧɚ ɭɪɨɜɧɟ X-XI ɝɪɭɞɧɵɯ ɩɨɡɜɨɧɤɨɜ ɩɪɢɜɪɚɬɧɢɤɨɜɚɹ ± ɧɚ ɭɪɨɜɧɟ I ɩɨɹɫɧɢɱɧɨɝɨ ɩɨɡɜɨɧɤɚ ɉɪɢɜɪɚɬɧɢɤɨɜɚɹ ɱɚɫɬɶ ɠɟɥɭɞɤɚ ɪɚɡɞɟɥɹɟɬɫɹ ɧɚ ɚɧɬɪɨɥɶɧɵɣ ɨɬɞɟɥ ɢ ɩɢɥɨɪɢɱɟɫɤɢɣ ɤɚɧɚɥ

Ɋɢɫ. 1.22. Ɉɬɞɟɥɵ ɠɟɥɭɞɤɚ (ɫɯɟ ɦɚ).

1 ² oesophagus; 2 ² incisure cardialis; 3 ² fundus gastricus; 4 ² corpus gastricum; 5 ² pars pylorica; 6 ² canalis pyloricus; 7 ² antrum pyloricum; 8 ² duodenum; 9 ² pylorus; 10 ² incisura angularis; 11 ² curvatura minor; 12 ² pars cardiaca

ȼ ɩɭɫɬɨɦ ɫɨɫɬɨɹɧɢɢ ɠɟɥɭɞɨɤ ɫɨɤɪɚɳɚɹɫɶ ɭɯɨɞɢɬ ɜ ɝɥɭɛɢɧɭ ɟɝɨ ɦɟɫɬɨ ɡɚɩɨɥɧɹɟɬɫɹ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɉɨ ɦɟɪɟ ɫɨɤɪɚɳɟɧɢɹ ɠɟɥɭɞɤɚ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɡɚɜɨɪɚɱɢɜɚɹɫɶ ɜɜɟɪɯ ɥɨɠɢɬɫɹ ɜɩɟɪɟɞɢ ɠɟɥɭɞ ɤɚ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɨɞ ɞɢɚɮɪɚɝɦɨɣ Ɉɛ ɷɬɨɦ ɧɟɨɛɯɨɞɢɦɨ ɩɨɦɧɢɬɶ ɤɥɢɧɢ ɰɢɫɬɚɦ ɩɪɢ ɨɛɫɥɟɞɨɜɚɧɢɢ ɛɨɥɶɧɨɝɨ

ɀɟɥɭɞɨɤ ɩɨɤɪɵɬ ɛɪɸɲɢɧɨɣ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɦɚɥɨɣ ɢ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɝɞɟ ɦɟɠɞɭ ɞɜɭɦɹ ɥɢɫɬɤɚɦɢ ɛɪɸɲɢɧɵ ɩɪɨɯɨɞɹɬ ɤɪɭɩɧɵɟ ɤɪɨɜɟɧɨɫɧɵɟ ɫɨɫɭɞɵ

37

Ȼɪɸɲɢɧɚ ɩɟɪɟɯɨɞɹ ɫ ɠɟɥɭɞɤɚ ɧɚ ɫɨɫɟɞɧɢɟ ɨɪɝɚɧɵ ɨɛɪɚɡɭɟɬ ɫɜɹɡɤɢ ɩɟ ɱɟɧɨɱɧɨ-ɠɟɥɭɞɨɱɧɭɸ ɠɟɥɭɞɨɱɧɨ-ɨɛɨɞɨɱɧɭɸ ɠɟɥɭɞɨɱɧɨ-ɫɟɥɟɡɟɧɨɱɧɭɸ ɠɟ ɥɭɞɨɱɧɨ-ɞɢɚɮɪɚɝɦɚɥɶɧɭɸ ɠɟɥɭɞɨɱɧɨ-ɩɨɞɠɟɥɭɞɨɱɧɭɸ lig. gastropancreaticum) ɢ ɩɪɢɜɪɚɬɧɢɤɨɜɨ-ɩɨɞɠɟɥɭɞɨɱɧɭɸ lig. pyloropancreaticum).

Ɏɢɤɫɚɰɢɹ ɠɟɥɭɞɤɚ ɨɛɟɫɩɟɱɢɜɚɟɬɫɹ ɩɪɨɱɧɵɦ ɫɪɚɳɟɧɢɟɦ ɩɢɳɟɜɨɞɚ ɫ ɞɢɚ ɮɪɚɝɦɨɣ ɚ ɬɚɤɠɟ ɠɟɥɭɞɨɱɧɨ-ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɢ ɩɪɢɜɪɚɬɧɢɤɨɜɨ-ɩɨɞɠɟ- ɥɭɞɨɱɧɨɣ ɫɜɹɡɤɚɦɢ

ɋɬɟɧɤɢ ɠɟɥɭɞɤɚ ɫɨɫɬɨɹɬ ɢɡ ɫɟɪɨɡɧɨɣ tun. serosa), ɦɵɲɟɱɧɨɣ tun. muscularis ɨɛɨɥɨɱɟɤ ɩɨɞɫɥɢɡɢɫɬɨɣ tela submucosa) ɨɫɧɨɜɵ ɢ ɫɥɢɡɢɫɬɨɣ tun. mucosa ɨɛɨɥɨɱɤɢ

ɋɥɢɡɢɫɬɚɹ ɨɛɨɥɨɱɤɚ ɠɟɥɭɞɤɚ ɨɛɪɚɡɭɟɬ ɦɧɨɠɟɫɬɜɨ ɫɤɥɚɞɨɤ ȼ ɨɛɥɚɫɬɢ ɩɪɢɜɪɚɬɧɢɤɚ ɢɦɟɟɬɫɹ ɯɨɪɨɲɨ ɜɵɪɚɠɟɧɧɚɹ ɫɤɥɚɞɤɚ valvula pylorica Ɉɧɚ ɫɨ ɨɬɜɟɬɫɬɜɭɟɬ ɦɟɫɬɭ ɫɤɨɩɥɟɧɢɹ ɦɵɲɟɱɧɵɯ ɜɨɥɨɤɨɧ ɨɛɪɚɡɭɸɳɢɯ ɩɥɨɬɧɨɟ ɦɵ ɲɟɱɧɨɟ ɤɨɥɶɰɨ ɧɚɡɵɜɚɟɦɨɟ ɫɮɢɧɤɬɟɪɨɦ m. sphincter pylori Ɇɵɲɟɱɧɵɣ ɫɥɨɣ ɫɨɫɬɨɢɬ ɢɡ ɩɪɨɞɨɥɶɧɵɯ ɤɨɫɵɯ ɢ ɰɢɪɤɭɥɹɪɧɵɯ ɜɨɥɨɤɨɧ

Ʉɪɨɜɨɫɧɚɛɠɟɧɢɟ ɠɟɥɭɞɤɚ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɡɚ ɫɱɟɬ ɜɟɬɜɟɣ ɱɪɟɜɧɨɝɨ ɫɬɜɨ ɥɚ truncus coeliacus), ɨɬɯɨɞɹɳɟɝɨ ɨɬ ɛɪɸɲɧɨɣ ɚɨɪɬɵ ɧɚ ɭɪɨɜɧɟ ɝɪɭɞɧɨɝɨ ɩɨɡɜɨɧɤɚ ɑɪɟɜɧɵɣ ɫɬɜɨɥ ɜɟɫɶɦɚ ɤɨɪɨɬɤɢɣ ɨɬ ɧɟɝɨ ɨɬɯɨɞɹɬ ɬɪɢ ɨɫɧɨɜɧɵɟ ɚɪ ɬɟɪɢɢ ɥɟɜɚɹ ɠɟɥɭɞɨɱɧɚɹ ɨɛɳɚɹ ɩɟɱɟɧɨɱɧɚɹ ɢ ɫɟɥɟɡɟɧɨɱɧɚɹ a. gastrica sinistra, a. hepatica communis et a. lienalis).

Ʌɟɜɚɹ ɠɟɥɭɞɨɱɧɚɹ ɚɪɬɟɪɢɹ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜɞɨɥɶ ɦɚɥɨɣ ɤɪɢɜɢɡɧɵ ɠɟɥɭɞ ɤɚ ɧɚɱɢɧɚɹ ɨɬ ɤɚɪɞɢɚɥɶɧɨɣ ɟɝɨ ɱɚɫɬɢ ɢ ɫɨɫɬɨɢɬ ɢɡ ɞɜɭɯ ɨɬɞɟɥɨɜ ɜɨɫɯɨɞɹɳɟ ɝɨ ɢ ɧɢɫɯɨɞɹɳɟɝɨ Ɉɬ ɨɛɳɟɣ ɩɟɱɟɧɨɱɧɨɣ ɚɪɬɟɪɢɢ ɨɬɯɨɞɹɬ ɫɨɛɫɬɜɟɧɧɚɹ ɩɟɱɟ ɧɨɱɧɚɹ ɚɪɬɟɪɢɹ a. hepatica propria ɢɞɭɳɚɹ ɜ ɩɟɱɟɧɨɱɧɨ-ɞɭɨɞɟɧɚɥɶɧɨɣ ɫɜɹɡɤɟ ɤ ɩɟɱɟɧɢ ɩɪɚɜɚɹ ɠɟɥɭɞɨɱɧɚɹ ɚɪɬɟɪɢɹ a. gastrica dextra ɩɢɬɚɸɳɚɹ ɩɪɚɜɭɸ ɩɨɥɨɜɢɧɭ ɦɚɥɨɣ ɤɪɢɜɢɡɧɵ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɥɟɜɨɣ ɠɟɥɭɞɨɱɧɨɣ ɚɪɬɟɪɢɢ ɨɛ ɪɚɡɭɹ ɚɪɬɟɪɢɚɥɶɧɭɸ ɞɭɝɭ ɦɚɥɨɣ ɤɪɢɜɢɡɧɵ ɢ ɝɚɫɬɪɨɞɭɨɞɟɧɚɥɶɧɚɹ ɚɪɬɟɪɢɹ a. gastroduodenalis ɤɨɬɨɪɚɹ ɞɟɥɢɬɫɹ ɧɚ ɜɟɪɯɧɸɸ ɩɚɧɤɪɟɚɬɨɞɭɨɞɟɧɚɥɶɧɭɸ ɚɪɬɟ ɪɢɸ ɢ ɩɪɚɜɭɸ ɠɟɥɭɞɨɱɧɨ-ɫɚɥɶɧɢɤɨɜɭɸ ɚɪɬɟɪɢɸ (a. pancreaticoduodenalis superior et gastroepiploica dextra ɩɨɫɥɟɞɧɹɹ ɤɪɨɜɨɫɧɚɛɠɚɟɬ ɩɪɚɜɭɸ ɩɨɥɨɜɢɧɭ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɠɟɥɭɞɤɚ ɋɟɥɟɡɟɧɨɱɧɚɹ ɚɪɬɟɪɢɹ ɧɚɩɪɚɜɥɹɟɬɫɹ ɤ ɜɨɪɨɬɚɦ ɫɟɥɟɡɟɧɤɢ ɩɨ ɜɟɪɯɧɟɦɭ ɤɪɚɸ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ Ɉɬ ɧɟɟ ɨɬɯɨɞɢɬ ɥɟɜɚɹ ɠɟɥɭɞɨɱɧɨ-ɫɚɥɶɧɢɤɨɜɚɹ ɚɪɬɟɪɢɹ a. gastroepiploica sinistra ɩɢɬɚɸɳɚɹ ɥɟɜɭɸ ɩɨɥɨɜɢɧɭ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɠɟɥɭɞɤɚ Ɉɧɚ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɩɪɚɜɨɣ ɠɟɥɭ ɞɨɱɧɨ-ɫɚɥɶɧɢɤɨɜɨɣ ɚɪɬɟɪɢɟɣ ɨɛɪɚɡɭɹ ɚɪɬɟɪɢɚɥɶɧɭɸ ɞɭɝɭ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ Ʉɪɨɦɟ ɬɨɝɨ ɨɬ ɫɟɥɟɡɟɧɨɱɧɨɣ ɚɪɬɟɪɢɢ ɨɬɯɨɞɹɬ ɠɟɥɭɞɨɱɧɵɟ ɚɪɬɟɪɢɢ aa. gastricae brevis ɧɚɩɪɚɜɥɹɸɳɢɟɫɹ ɤɨ ɞɧɭ ɠɟɥɭɞɤɚ

ȼɟɧɨɡɧɵɣ ɨɬɬɨɤ ɠɟɥɭɞɤɚ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɩɨ ɩɹɬɢ ɜɟɧɚɦ ɥɟɜɚɹ ɢ ɩɪɚɜɚɹ ɠɟɥɭɞɨɱɧɵɟ ɢ ɩɪɟɞɩɪɢɜɪɚɬɧɢɤɨɜɚɹ v. gastrica sinistra et dextra et v. praepylorica ɜɩɚɞɚɸɬ ɜ ɜɨɪɨɬɧɭɸ ɜɟɧɭ ɩɪɚɜɚɹ ɠɟɥɭɞɨɱɧɨ-ɫɚɥɶɧɢɤɨɜɚɹ v. gastroepiploica dextra) ± ɜ ɜɟɪɯɧɸɸ ɛɪɵɠɟɟɱɧɭɸ ɜɟɧɭ ɢ ɥɟɜɚɹ ɠɟɥɭɞɨɱɧɨɫɚɥɶɧɢɤɨɜɚɹ v. gastroepiploica sinistra) ± ɜ ɫɟɥɟɡɟɧɨɱɧɭɸ ɜɟɧɭ

Ⱥɧɚɫɬɨɦɨɡ ɜ ɫɬɟɧɤɟ ɤɚɪɞɢɚɥɶɧɨɝɨ ɨɬɞɟɥɚ ɠɟɥɭɞɤɚ ɢ ɛɪɸɲɧɨɣ ɱɚɫɬɢ ɩɢɳɟɜɨɞɚ ɪɢɫ ɚ).

38

Ɉɬ ɜɟɧɨɡɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ɝɪɭɞɧɨɣ ɱɚɫɬɢ ɩɢɳɟɜɨɞɚ YY HVRSKDJHDles ɜɩɚ ɞɚɸɬ ɜ Y D]\JRV ɢ ɜ Y KHPLD]\JRV ɫɢɫɬɟɦɚ ɜɟɪɯɧɟɣ ɩɨɥɨɣ ɜɟɧɵ ɨɬ ɛɪɸɲɧɨɣ ɱɚɫɬɢ - ɜ Y. JDVWULFD VLQLVWUD ɤɨɬɨɪɚɹ ɹɜɥɹɟɬɫɹ ɩɪɢɬɨɤɨɦ ɜɨɪɨɬɧɨɣ ɜɟɧɵ ɉɪɢ ɩɨɪɬɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɜ ɧɢɠɧɟɦ ɨɬɞɟɥɟ ɩɢɳɟɜɨɞɚ ɱɪɟɡɜɵɱɚɣɧɨ ɪɚɫɲɢɪɹɟɬɫɹ ɩɪɢɨɛɪɟɬɚɟɬ ɯɚɪɚɤɬɟɪ ɭɡɥɨɜ ɥɟɝɤɨ ɬɪɚɜɦɢɪɭɸ ɳɢɯɫɹ ɩɪɢ ɩɪɨɯɨɠɞɟɧɢɢ ɩɢɳɢ ɢ ɞɵɯɚɬɟɥɶɧɵɯ ɷɤɫɤɭɪɫɢɹɯ ɞɢɚɮɪɚɝɦɵ Ɋɚɫ ɲɢɪɟɧɢɟ ɜɟɧ ɩɢɳɟɜɨɞɚ ɪɟɡɤɨ ɧɚɪɭɲɚɟɬ ɮɭɧɤɰɢɸ ɤɚɪɞɢɚɥɶɧɨɝɨ ɫɮɢɧɤɬɟɪɚ ɜɫɥɟɞɫɬɜɢɟ ɱɟɝɨ ɧɚɫɬɭɩɚɟɬ ɡɢɹɧɢɟ ɤɚɪɞɢɢ ɢ ɡɚɛɪɚɫɵɜɚɧɢɟ ɤɢɫɥɨɝɨ ɠɟɥɭɞɨɱ ɧɨɝɨ ɫɨɞɟɪɠɢɦɨɝɨ ɜ ɩɢɳɟɜɨɞ ɉɨɫɥɟɞɧɟɟ ɜɵɡɵɜɚɟɬ ɢɡɴɹɡɜɥɟɧɢɟ ɭɡɥɨɜ ɱɬɨ ɦɨɠɟɬ ɩɪɢɜɟɫɬɢ ɤ ɫɦɟɪɬɟɥɶɧɨɦɭ ɤɪɨɜɨɬɟɱɟɧɢɸ

Ɋɢɫ ɚ ɋɯɟɦɚ ɚɧɚɫɬɨɦɨɡɚ ɜ ɨɛɥɚ ɫɬɢ ɤɚɪɞɢɚɥɵɸɝɨ ɨɬɞɟɥɚ ɠɟɥɭɞɤɚ ɢ ɛɪɸɲɧɨɣ ɱɚɫɬɢ ɩɢɳɟɜɨɞɚ.

1 - v. cava superior:,

2 - v. azygos;

3 - vv. esophageales;

4 - v. gastrica sinistra.

5 - v. portae.

Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɜɞɨɥɶ ɤɪɨɜɟ ɧɨɫɧɵɯ ɫɨɫɭɞɨɜ ɠɟɥɭɞɤɚ ɫ ɪɟɝɢɨɧɚɪɧɵɦɢ ɥɢɦɮɚɬɢɱɟɫɤɢɦɢ ɭɡɥɚɦɢ ɩɨɪɹɞɤɚ ɜ ɨɫɧɨɜɧɨɦ ɫɤɨɧɰɟɧɬɪɢɪɨɜɚɧɧɵɟ ɜ ɬɪɟɯ ɨɬɞɟɥɚɯ ɩɨ ɦɚɥɨɣ ɤɪɢɜɢɡɧɟ ɜɞɨɥɶ ɥɟɜɨɣ ɠɟɥɭɞɨɱɧɨɣ ɚɪɬɟɪɢɢ ɭ ɜɨɪɨɬ ɫɟɥɟɡɟɧɤɢ ɢ ɯɜɨɫɬɚ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɩɪɢɧɢɦɚɟɬ ɥɢɦɮɭ ɨɬ ɥɟɜɨɣ ɬɪɟɬɢ ɞɧɚ ɢ ɬɟɥɚ ɠɟɥɭɞɤɚ ɞɨ ɫɟɪɟɞɢɧɵ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɩɨ ɯɨɞɭ ɩɪɚɜɨɣ ɠɟɥɭɞɨɱɧɨɣ ɚɪɬɟɪɢɢ ɜɛɥɢɡɢ ɩɪɢɜɪɚɬ ɧɢɤɚ ɩɪɢɧɢɦɚɟɬ ɥɢɦɮɭ ɨɬ ɩɪɚɜɨɣ ɩɨɥɨɜɢɧɵ ɛɨɥɶɲɨɣ ɤɪɢɜɢɡɧɵ ɠɟɥɭɞɤɚ (ɪɢɫ 23).

Ɉɬ ɠɟɥɭɞɤɚ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɧɚɩɪɚɜɥɹɸɬɫɹ ɱɟɪɟɡ ɱɪɟɜɧɵɟ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜɨɡɥɟ ɱɪɟɜɧɨɝɨ ɫɬɜɨɥɚ Ʉɪɨɦɟ ɬɨɝɨ ɥɢɦɮɚɬɢɱɟɫɤɚɹ ɫɢɫɬɟɦɚ ɠɟɥɭɞɤɚ ɢɦɟɟɬ ɦɧɨɝɨɱɢɫɥɟɧɧɵɟ ɫɜɹɡɢ ɫ ɫɨɫɟɞɧɢɦɢ ɨɪɝɚɧɚɦɢ ɱɬɨ ɢɦɟɟɬ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɜ ɩɚɬɨɥɨɝɢɢ ɨɪɝɚɧɨɜ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ

ɀɟɥɭɞɨɤ ɢɧɧɟɪɜɢɪɭɟɬɫɹ ɜɟɬɜɹɦɢ ɛɥɭɠɞɚɸɳɢɯ ɫɬɜɨɥɨɜ ɩɟɪɟɞɧɟɝɨ ɢ ɡɚɞ ɧɟɝɨ ɢ ɱɪɟɜɧɵɦ ɫɩɥɟɬɟɧɢɟɦ.

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