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

ɇɢɫɯɨɞɹɳɚɹ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɞɥɢɧɨɣ - ɫɦ ɹɜɥɹɟɬɫɹ ɧɚɢɛɨɥɟɟ ɲɢɪɨɤɨɣ ɟɟ ɱɚɫɬɶɸ ɩɨɤɪɵɬɨɣ ɛɪɸɲɢɧɨɣ ɬɨɥɶɤɨ ɫɩɟɪɟɞɢ ɢ ɭ ɩɪɚɜɨɝɨ ɤɪɚɹ ɬɟɥɚ III-IV ɩɨɹɫɧɢɱɧɵɯ ɩɨɡɜɨɧɤɨɜ Ɉɧɚ ɨɛɪɚɡɭɟɬ ɧɢɠɧɢɣ ɢɡɝɢɛ flexura duodeni inferior ɩɟɪɟɯɨɞɢɬ ɜ ɧɢɠɧɸɸ ɝɨɪɢɡɨɧɬɚɥɶɧɭɸ ɱɚɫɬɶ pars horizontalis inferior) ɪɢɫ .

ɉɪɢɦɟɪɧɨ ɧɚ ɫɟɪɟɞɢɧɟ ɧɢɫɯɨɞɹɳɟɝɨ ɨɬɞɟɥɚ ɧɚ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɜ - ɩɟɪɫɬɧɭɸ ɤɢɲɤɭ ɜɩɚɞɚɸɬ ɨɛɳɢɣ ɠɟɥɱɧɵɣ ɢ ɩɚɧɤɪɟɚɬɢɱɟɫɤɢɣ ɩɪɨɬɨɤɢ

ɇɢɠɧɹɹ ɝɨɪɢɡɨɧɬɚɥɶɧɚɹ ɱɚɫɬɶ ɤɢɲɤɢ ɞɥɢɧɨɣ ɨɬ ɞɨ ɫɦ ɧɚɩɪɚɜɥɹɟɬɫɹ ɫɩɪɚɜɚ ɧɚɥɟɜɨ ɢ ɪɚɫɩɨɥɨɠɟɧɚ ɷɤɫɬɪɚɩɟɪɢɬɨɧɟɚɥɶɧɨ

ȼɨɫɯɨɞɹɳɚɹ ɱɚɫɬɶ ɤɢɲɤɢ ɞɥɢɧɨɣ - ɫɦ ɧɚ ɭɪɨɜɧɟ II ɩɨɹɫɧɢɱɧɨɝɨ ɩɨ ɡɜɨɧɤɚ ɫɥɟɜɚ ɩɟɪɟɯɨɞɢɬ ɜ ɬɨɳɭɸ ɤɢɲɤɭ ɨɛɪɚɡɭɹ ɪɟɡɤɢɣ -ɩɟɪɫɬɧɨ-ɬɨɳɢɣ ɢɡɝɢɛ flexura duodenojejunalis ɍ ɦɟɫɬɚ ɩɟɪɟɯɨɞɚ ɜ ɬɨɳɭɸ ɤɢɲɤɭ ɜɨɫɯɨɞɹ ɳɚɹ ɱɚɫɬɶ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ

Ɋɢɫ 1.32. Ɍɨɩɨɝɪɚɮɢɹ ɞɜɟɧɚɞɰɚɬɢɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² hepar; 2 ² lig. hepatoduodenale ɢ ɩɨɪɬɚɥɶɧɚɹ ɬɪɢɚɞɚ (ductus choledochus, v. portae, a. hepatica propria); 3 ² rcn ct gl. suprarenalis dextrae; 4 ² pylorus; 5 ² duodenum (pars superior); 6 ² duodenum (pars descendens); 7 ² ɧɚɱɚɥɨ mesocolon transversum; 8 ² flexura coli dextra; 9 ² colon transversum; 10 ² duodenum (pars horizontal is); 11 ² ɧɚɱɚɥɨ mesenterium; 12 ² v. cava inferior; 13 ² aorta abdominalis; 14 ² a. mesenterica inferior; 15 ² caput pancreatis; 16 ² a. et v. mesentericae superior; 17 ² plica et recessus duodenalis inferior; 18 ² duodenum (pars ascendens); 19 ² flexura duodenojejunal et jejunum; 20 ² colon transversum; 21 ² flexura coli sinistra; 22 ² mesocolon transversum; 23 ² pancreas; 24 ² a. splenica; 25 ² gl. suprarenalis sinistra; 26 ² v. cava inferior.

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ɋɜɹɡɤɢ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɩɟɱɟɧɨɱɧɨ-ɞɭɨɞɟɧɚɥɶɧɚɹ lig. hepatoduodenale ɢɞɭɳɚɹ ɨɬ ɜɨɪɨɬ ɩɟɱɟɧɢ ɤ ɜɟɪɯɧɟɣ ɱɚɫɬɢ ɤɢɲɤɢ ɨɝɪɚɧɢɱɢɜɚɟɬ ɫɚɥɶɧɢ ɤɨɜɨɟ ɨɬɜɟɪɫɬɢɟ ɫɩɟɪɟɞɢ ɞɭɨɞɟɧɚɥɶɧɨ-ɩɨɱɟɱɧɚɹ ɫɜɹɡɤɚ lig. duodenorenale) ɪɚɫɩɨɥɨɠɟɧɚ ɦɟɠɞɭ ɡɚɞɧɟɜɟɪɯɧɢɦ ɤɪɚɟɦ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢ ɩɪɚɜɨɣ ɩɨɱ ɤɨɣ ɢ ɨɝɪɚɧɢɱɢɜɚɟɬ ɫɚɥɶɧɢɤɨɜɨɟ ɨɬɜɟɪɫɬɢɟ ɫɧɢɡɭ ɩɨɞɞɟɪɠɢɜɚɸɳɚɹ ɫɜɹɡɤɚ 12-ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢɥɢ ɫɜɹɡɤɚ Ɍɪɟɣɰɚ lig. suspensorium duodeni s. lig. Treitz ɛɟɪɭɳɚɹ ɧɚɱɚɥɨ ɢɡ ɤɨɥɶɰɟɜɨɣ ɦɭɫɤɭɥɚɬɭɪɵ ɤɢɲɤɢ ɜ ɨɛɥɚɫɬɢ - ɩɟɪɫɬɧɨ-ɬɨɳɟɝɨ ɢɡɝɢɛɚ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɭ ɤɨɪɧɹ ɜɟɪɯɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ɱɪɟɜɧɨɝɨ ɫɬɜɨɥɚ ɢ ɩɪɚɜɵɯ ɧɨɠɟɤ ɞɢɚɮɪɚɝɦɵ ɪɢɫ .

Ɋɢɫ 1.33. Ɇɵɲɰɚ Ɍɪɟɣɬɰɚ ɢ flexura duodenojejunalis ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² v. cava inferior; 2 ² oesophagus; 3 ² eras dextrum diaphragmatis ɫɩɪɚɜɚ ɨɬ ɩɢɳɟɜɨɞɚ ² cms dextrum diaphragmatis ɫɥɟɜɚ ɨɬ ɩɢɳɟɜɨɞɚ -ɫrus sinistrum diaphragmatis; 6 ²truncus coeliacus;

ɑɚɫɬɶ ɤɢɲɤɢ ɪɚɫɩɨɥɨɠɟɧɧɚɹ ɜ ɜɟɪɯɧɟɦ ɷɬɚɠɟ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɤɪɨɜɨ ɫɧɚɛɠɚɟɬɫɹ ɡɚ ɫɱɟɬ ɜɟɪɯɧɟɣ ɩɚɧɤɪɟɚɬɨɞɭɨɞɟɧɚɥɶɧɨɣ ɚɪɬɟɪɢɢ a. pancreaticoduodenalis superior ɢɫɬɨɱɧɢɤɨɦ ɤɨɬɨɪɨɣ ɹɜɥɹɟɬɫɹ ɜɟɬɜɶ ɱɪɟɜɧɨɝɨ ɫɬɜɨɥɚ ± a. gastro-duodenalis ɚ ɱɚɫɬɶ ɤɢɲɤɢ ɧɚɯɨɞɹɳɚɹɫɹ ɜ ɧɢɠɧɟɦ ɷɬɚɠɟ - ɡɚ ɫɱɟɬ ɧɢɠɧɟɣ ɩɚɧɤɪɟɚɬɨ-ɞɭɨɞɟɧɚɥɶɧɨɣ ɚɪɬɟɪɢɢ a. pancreaticoduodenalis inferior ɢɡ ɫɢɫɬɟɦɵ ɜɟɪɯɧɟɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ

ȼɟɧɵ 12-ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɜɩɚɞɚɸɬ ɜ ɜɨɪɨɬɧɭɸ ɜɟɧɭ Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɫɨɩɪɨɜɨɠɞɚɸɬ ɤɪɨɜɟɧɨɫɧɵɟ ɫɨɫɭɞɵ ɢ ɲɢɪɨɤɨ

ɚɧɚɫɬɨɦɨɡɢɪɭɸɬ ɫ ɥɢɦɮɚɬɢɱɟɫɤɢɦɢ ɫɨɫɭɞɚɦɢ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ Ʌɢɦɮɚ

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ɢɡ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɨɬɜɨɞɢɬɫɹ ɜ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜɩɟɪɟɞɢ ɢ ɩɨɡɚɞɢ ɝɨɥɨɜɤɢ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɢ ɡɚɬɟɦ ɜ ɱɪɟɜɧɵɟ

ɂɧɧɟɪɜɚɰɢɹ ɤɢɲɤɢ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɡɚ ɫɱɟɬ ɜɟɝɟɬɚɬɢɜɧɨɣ ɫɢɫɬɟɦɵ ɢɡ ɱɪɟɜɧɨɝɨ ɢ ɜɟɪɯɧɟɝɨ ɛɪɵɠɟɟɱɧɨɝɨ ɫɩɥɟɬɟɧɢɹ plexus coeliacus et plexus mesentericus superior ɚ ɬɚɤɠɟ ɢɡ ɩɪɚɜɨɝɨ ɛɥɭɠɞɚɸɳɟɝɨ ɧɟɪɜɚ ± ɱɪɟɜɧɵɟ ɜɟɬɜɢ n. vagus dexter rami coelici).

Ɍɨɳɢɣ ɢ ɩɨɞɜɡɞɨɲɧɵɣ ɨɬɞɟɥɵ ɬɨɧɤɨɣ ɤɢɲɤɢ ɩɨ ɫɜɨɢɦ ɮɭɧɤɰɢɹɦ ɫɬɪɨɟɧɢɸ ɢ ɪɚɡɜɢɬɢɸ ɢɞɟɧɬɢɱɧɚ ɩɨ ɜɧɟɲɧɢɦ ɩɪɢɡɧɚɤɚɦ ɪɚɡɥɢɱɢɬɶ ɢɯ ɬɪɭɞɧɨ ɪɚɡɥɢɱɚɸɬ ɬɨɥɶɤɨ ɩɨ ɜɧɭɬɪɟɧɧɟɦɭ ɫɬɪɨɟɧɢɸ ɩɨɷɬɨɦɭ ɨɧɢ ɨɛɴɟɞɢɧɟɧɵ ɜ ɨɞɢɧ ɨɛɳɢɣ ɨɬɞɟɥ ± ɛɪɵɠɟɟɱɧɵɣ intestinum tenue mesenteriale).

Ⱦɥɢɧɚ ɬɨɧɤɨɣ ɤɢɲɤɢ -7 ɦ ɩɪɢɱɟɦ ɫɨɫɬɚɜɥɹɟɬ ɬɨɳɚɹ ɤɢɲɤɚ ɢ ± ɩɨɞɜɡɞɨɲɧɚɹ Ɋɚɫɩɨɥɚɝɚɟɬɫɹ ɬɨɧɤɚɹ ɤɢɲɤɚ ɤɧɢɡɭ ɨɬ ɩɨɩɟɪɟɱɧɨ-ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɩɪɢɱɟɦ ɩɟɬɥɢ ɬɨɳɟɣ ɤɢɲɤɢ ɡɚɧɢɦɚɸɬ ɝɨɪɢɡɨɧɬɚɥɶɧɨɟ ɩɨɥɨɠɟɧɢɟ ɫɥɟɜɚ ɢ ɜɜɟɪɯɭ ɚ ɩɟɬɥɢ ɩɨɞɜɡɞɨɲɧɨɣ ɤɢɲɤɢ ± ɜɟɪɬɢɤɚɥɶɧɨɟ ɩɨɥɨɠɟɧɢɟ ɫɩɪɚ ɜɚ ɢ ɜɧɢɡɭ ɉɟɬɥɢ ɬɨɧɤɨɣ ɤɢɲɤɢ ɨɛɵɱɧɨ ɩɪɢɤɪɵɬɵ ɛɨɥɶɲɢɦ ɫɚɥɶɧɢɤɨɦ ɫɩɭɫɤɚɸɳɢɦɫɹ ɜ ɜɢɞɟ ɮɚɪɬɭɤɚ

ɋɬɟɧɤɚ ɬɨɧɤɨɣ ɤɢɲɤɢ ɫɨɫɬɨɢɬ ɢɡ ɫɟɪɨɡɧɨɣ ɨɛɨɥɨɱɤɢ tunica serosa), ɦɵɲɟɱɧɨɣ ɨɛɨɥɨɱɤɢ tunica muscularis) ɩɨɞɫɥɢɡɢɫɬɨɣ ɨɫɧɨɜɵ tela submucosa ɢ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɢ tunica mucosa).

Ȼɪɸɲɢɧɚ ɩɨɤɪɵɜɚɸɳɚɹ ɬɨɧɤɭɸ ɤɢɲɤɭ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ ɜ ɜɢɞɟ ɞɭɛɥɢɤɚ ɬɭɪɵ ɨɛɪɚɡɭɟɬ ɟɟ ɛɪɵɠɟɣɤɭ ȼ ɧɚɱɚɥɶɧɵɯ ɨɬɞɟɥɚɯ ɬɨɧɤɨɣ ɤɢɲɤɢ ɞɥɢɧɚ ɛɪɵ ɠɟɣɤɢ ɤɨɥɟɛɥɟɬɫɹ ɜ ɩɪɟɞɟɥɚɯ - ɫɦ ɜ ɫɪɟɞɧɢɣ ɢ ɨɫɨɛɟɧɧɨ ɤɨɧɟɱɧɵɯ ɞɨ ɫɬɢɝɚɟɬ ɫɦ Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɤɨɧɟɱɧɵɟ ɨɬɞɟɥɵ ɬɨɧɤɨɣ ɤɢɲɤɢ ɧɚɢɛɨɥɟɟ ɩɨ ɞɜɢɠɧɵ ɜ ɪɟɡɭɥɶɬɚɬɟ ɱɟɝɨ ɨɧ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɹɜɥɹɟɬɫɹ ɫɨɞɟɪɠɢɦɵɦ ɩɚɯɨɜɵɯ ɢ ɛɟɞɪɟɧɧɵɯ ɝɪɵɠ Ʉɪɨɦɟ ɬɨɝɨ ɜɫɥɟɞɫɬɜɢɟ ɛɨɥɶɲɨɣ ɩɨɞɜɢɠɧɨɫɬɢ ɜɨɡɦɨɠɧɵ ɩɟɪɟɤɪɭɱɢɜɚɧɢɹ ɛɪɵɠɟɣɤɢ ɡɚɜɨɪɨɬɵ

ɑɚɫɬɶ ɛɪɵɠɟɣɤɢ ɤɨɬɨɪɚɹ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɭ ɡɚɞɧɟɣ ɫɬɟɧɤɢ ɠɢɜɨɬɚ ɧɚɡɵ ɜɚɟɬɫɹ ɤɨɪɧɟɦ radix mesenterii Ʉɨɪɟɧɶ ɛɪɵɠɟɣɤɢ ɡɚɧɢɦɚɟɬ ɤɨɫɨɟ ɩɨɥɨɠɟ ɧɢɟ ɧɚɱɢɧɚɟɬɫɹ ɜɜɟɪɯɭ ɧɚ ɭɪɨɜɧɟ II ɩɨɹɫɧɢɱɧɨɝɨ ɩɨɡɜɨɧɤɚ ɫɥɟɜɚ ɦɟɫɬɨ ɩɟ ɪɟɯɨɞɚ 12-ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɜ ɬɨɳɭɸ ɢ ɧɚɩɪɚɜɥɹɟɬɫɹ ɜɧɢɡ ɤ ɩɪɚɜɨɦɭ ɤɪɟɫɰɨ ɜɨ-ɩɨɞɜɡɞɨɲɧɨɦɭ ɫɨɱɥɟɧɟɧɢɸ ɝɞɟ ɩɨɞɜɡɞɨɲɧɚɹ ɤɢɲɤɚ ɜɩɚɞɚɟɬ ɜ ɜɨɫɯɨɞɹ ɳɭɸ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ Ʉɨɪɟɧɶ ɛɪɵɠɟɣɤɢ ɩɟɪɟɫɟɤɚɟɬ ɬɟɥɨ III ɩɨɹɫɧɢɱɧɨɝɨ ɩɨɡɜɨɧɤɚ ɛɪɸɲɧɭɸ ɚɨɪɬɭ ɭ ɦɟɫɬɚ ɞɟɥɟɧɢɹ ɟɟ ɧɚ ɨɛɳɢɟ ɩɨɞɡɜɞɨɲɧɵɟ ɚɪɬɟ ɪɢɢ aa. iliacae communes) ɧɢɠɧɸɸ ɩɨɥɭɸ ɜɟɧɭ ɩɪɚɜɵɣ ɦɨɱɟɬɨɱɧɢɤ ɢ ɩɪɚɜɭɸ ɹɢɱɤɨɜɭɸ ɚɪɬɟɪɢɸ ɢ ɜɟɧɭ a. et v. testicularis dextra Ⱦɥɢɧɚ ɤɨɪɧɹ ɛɪɵɠɟɣɤɢ - ɫɦ

Ʉɪɨɜɨɫɧɚɛɠɟɧɢɟ ɬɨɧɤɨɣ ɤɢɲɤɢ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɡɚ ɫɱɟɬ ɜɟɪɯɧɟɣ ɛɪɵɠɟ ɟɱɧɨɣ ɚɪɬɟɪɢɢ a. mesenterica superior ɤɨɬɨɪɚɹ ɨɬɯɨɞɢɬ ɨɬ ɚɨɪɬɵ ɧɚ - ɫɦ ɧɢɠɟ ɱɪɟɜɧɨɝɨ ɫɬɜɨɥɚ truncus coeliacus ɱɬɨ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɬɟɥɭ I ɩɨɹɫɧɢɱɧɨ ɝɨ ɩɨɡɜɨɧɤɚ Ⱥɪɬɟɪɢɹ ɧɚɩɪɚɜɥɹɟɬɫɹ ɜɧɢɡ ɢ ɜɥɟɜɨ ɩɨɡɚɞɢ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟ ɥɟɡɵ ɡɚɬɟɦ ɜɵɣɞɹ ɦɟɠɞɭ ɧɢɠɧɢɦ ɤɪɚɟɦ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɢ ɜɟɪɯɧɢɦ ɤɪɚɟɦ ɧɢɠɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɱɚɫɬɢ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɜɫɬɭɩɚɟɬ ɜ ɤɨɪɟɧɶ ɛɪɵɠɟɣɤɢ ɭ -ɩɟɪɫɬɧɨ-ɬɨɳɟɝɨ ɢɡɝɢɛɚ Ɉɬ ɜɟɪɯɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ɜ ɧɚɱɚɥɶɧɵɯ ɟɟ ɨɬɞɟɥɚɯ ɨɬɯɨɞɢɬ ɧɢɠɧɹɹ ɩɚɧɤɪɟɚɬɨɞɭɨɞɟɧɚɥɶɧɚɹ ɚɪɬɟɪɢɹ ɩɢ

54

ɬɚɸɳɚɹ ɧɢɠɧɸɸ ɝɨɪɢɡɨɧɬɚɥɶɧɭɸ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢ ɩɨɞɠɟɥɭɞɨɱ ɧɭɸ ɠɟɥɟɡɭ Ʉ ɬɨɧɤɨɣ ɤɢɲɤɟ ɤɪɨɜɶ ɩɪɢɬɟɤɚɟɬ ɩɨ ɬɨɳɟɤɢɲɟɱɧɵɦ ɢ ɩɨɞɡɜ ɞɨɲɧɨɤɢɲɟɱɧɵɦ ɚɪɬɟɪɢɹɦ aa. jejunales et aa. ileales) (16ɤɨɬɨɪɵɟ ɩɪɨɯɨ ɞɹɬ ɦɟɠɞɭ ɥɢɫɬɤɚɦɢ ɛɪɵɠɟɣɤɢ ȼ ɬɨɥɳɟ ɛɪɵɠɟɣɤɢ ɷɬɢ ɜɟɬɜɢ ɲɢɪɨɤɨ ɚɧɚ ɫɬɨɦɨɡɢɪɭɸɬ ɦɟɠɞɭ ɫɨɛɨɣ ɨɛɪɚɡɭɸɬ ɞɭɝɢ ɚɪɤɚɞɵ ɩɟɪɜɨɝɨ ɜɬɨɪɨɝɨ ɢ ɬɪɟɬɶ ɟɝɨ ɩɨɪɹɞɤɨɜ ȼ ɨɞɧɢɯ ɫɥɭɱɚɹɯ ɷɬɢ ɚɧɚɫɬɨɦɨɡɵ ɛɵɜɚɸɬ ɩɟɬɥɢɫɬɵɦɢ ɜ ɞɪɭɝɢɯ

± ɤɭɫɬɢɫɬɵɦɢ ɱɬɨ ɢɝɪɚɟɬ ɛɨɥɶɲɭɸ ɪɨɥɶ ɜ ɫɥɭɱɚɹɯ ɦɨɛɢɥɢɡɚɰɢɢ ɬɨɧɤɨɣ ɤɢɲ ɤɢ ɞɥɹ ɨɛɪɚɡɨɜɚɧɢɹ ɢɫɤɭɫɫɬɜɟɧɧɨɝɨ ɩɢɳɟɜɨɞɚ ɋɨɫɭɞɵ ɩɨɞɯɨɞɹ ɤ ɤɢɲɤɟ ɨɛ ɪɚɡɭɸɬ ɧɚ ɟɟ ɩɨɜɟɪɯɧɨɫɬɢ ɝɭɫɬɭɸ ɚɪɬɟɪɢɚɥɶɧɭɸ ɫɟɬɶ ɪɢɫ .

ȼɟɧɵ ɫɨɩɪɨɜɨɠɞɚɸɬ ɚɪɬɟɪɢɢ ɢ ɫɨɛɢɪɚɸɬɫɹ ɜ ɜɟɪɯɧɸɸ ɛɪɵɠɟɟɱɧɭɸ ɜɟɧɭ (v. mesenterica superior ɤɨɬɨɪɚɹ ɥɟɠɢɬ ɫɩɪɚɜɚ ɨɬ ɚɪɬɟɪɢɢ ɭɱɚɫɬɜɭɟɬ ɜ ɨɛɪɚ ɡɨɜɚɧɢɢ ɜɨɪɨɬɧɨɣ ɜɟɧɵ

Ɋɢɫ 1.34.. ɋɨɫɭɞɵ ɛɪɵɠɟɣɤɢ ɬɨɧɤɨɣ ɤɢɲɤɢ ɩɨ ɋɢɧɟɥɶɧɢɤɨɜɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² ɩɨɫɥɟɞɧɢɣ ɪɹɞ ɚɪɬɟɪɢɚɥɶɧɵɯ ɚɪɤɚɞ; 2 ² ɚɚ. rectae; 3 ² tunica muscularis (stratum longitudinale); 4 ² tunica muscularis (stratum circulare); 5 ² tunica mucosa; 6 ² tunica submucosa; 7 ² mesenterium; 8 ² nodi lymphoidei; 9 ² v. intestinalis; 10 ² a. intestinalis

Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɪɚɫɩɨɥɚɝɚɹɫɶ ɦɟɠɞɭ ɥɢɫɬɤɚɦɢ ɛɪɸɲɢɧɵ ɫɨ ɩɪɨɜɨɠɞɚɸɬ ɤɪɨɜɟɧɨɫɧɵɟ ɫɨɫɭɞɵ ɢ ɜɩɚɞɚɸɬ ɜ ɛɪɵɠɟɟɱɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɡɚɥɟɝɚɸɳɢɟ ɜ ɛɪɵɠɟɣɤɟ ɜ ɛɨɥɶɲɨɦ ɤɨɥɢɱɟɫɬɜɟ Ɉɬ ɛɪɵɠɟɟɱɧɵɯ ɥɢɦ

55

ɮɚɬɢɱɟɫɤɢɯ ɭɡɥɨɜ ɥɢɦɮɚ ɨɬɬɟɤɚɟɬ ɜ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜɨɡɥɟ ɜɨɪɨɬɧɨɣ ɜɟ ɧɵ ɚ ɬɚɤɠɟ ɩɨ ɯɨɞɭ ɚɨɪɬɵ ɢ ɧɢɠɧɟɣ ɩɨɥɨɣ ɜɟɧɵ ɢ ɞɚɥɟɟ ɜ ɰɢɫɬɟɪɧɵ ɝɪɭɞɧɨ ɝɨ ɩɪɨɬɨɤɚ cysterna chyli) ɢ ɝɪɭɞɧɨɣ ɩɪɨɬɨɤ ductus thoracicus).

ɂɧɧɟɪɜɚɰɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɡɚ ɫɱɟɬ ɜɟɝɟɬɚɬɢɜɧɨɣ ɧɟɪɜɧɨɣ ɫɢɫɬɟɦɵ ȼ ɫɬɟɧɤɟ ɤɢɲɤɢ ɪɚɫɩɨɥɨɠɟɧɵ ɬɪɢ ɧɟɪɜɧɵɯ ɫɩɥɟɬɟɧɢɹ ɩɨɞɫɟɪɨɡɧɨɟ ɦɵɲɟɱɧɨɟ plexus subserosus et myentericus Auerbachi ɢ ɩɨɞɫɥɢɡɢɫɬɨɟ plexus submucosus Meissneri).

Ɍɨɧɤɚɹ ɤɢɲɤɚ ɜɩɚɞɚɟɬ ɜ ɬɨɥɫɬɭɸ

Ɍɨɥɫɬɚɹ ɤɢɲɤɚ intestinum crassum)

Ɉɛɳɚɹ ɞɥɢɧɚ ɟɟ ɨɬ ɞɨ ɦ Ɉɬɥɢɱɚɟɬɫɹ ɨɬ ɬɨɧɤɨɣ ɩɨ ɰɟɥɨɦɭ ɪɹɞɭ ɜɧɟɲɧɢɯ ɩɪɢɡɧɚɤɨɜ ɉɪɨɫɜɟɬ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɤɚɤ ɩɪɚɜɢɥɨ ɛɨɥɶɲɟ ɱɟɦ ɬɨɧ ɤɨɣ ȼɞɨɥɶ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɧɚɱɢɧɚɹ ɨɬ ɫɥɟɩɨɣ ɢ ɤɨɧɱɚɹ ɦɟɫɬɨɦ ɩɟɪɟɯɨɞɚ ɫɢɝ ɦɨɜɢɞɧɨɣ ɜ ɩɪɹɦɭɸ ɩɪɨɯɨɞɹɬ ɬɪɢ ɩɪɨɞɨɥɶɧɵɟ ɥɟɧɬɵ tenuɚe), ɩɪɟɞɫɬɚɜɥɹɸ ɳɢɟ ɫɨɛɨɣ ɫɤɨɧɰɟɧɬɪɢɪɨɜɚɧɧɵɟ ɜɨɥɨɤɧɚ ɝɥɚɞɤɨɣ ɩɪɨɞɨɥɶɧɨɣ ɦɭɫɤɭɥɚɬɭɪɵ ȼɫɥɟɞɫɬɜɢɟ ɫɨɤɪɚɳɟɧɢɹ ɩɪɨɞɨɥɶɧɵɯ ɜɨɥɨɤɨɧ ɷɬɢɯ ɦɵɲɟɱɧɵɯ ɩɭɱɤɨɜ ɚ ɬɚɤ ɠɟ ɧɟɪɚɜɧɨɦɟɪɧɨɝɨ ɪɚɡɜɢɬɢɹ ɰɢɪɤɭɥɹɪɧɨɣ ɦɭɫɤɭɥɚɬɭɪɵ ɨɛɪɚɡɭɸɬɫɹ ɩɟɪɟɯɜɚ ɬɵ ɚ ɦɟɠɞɭ ɧɢɦɢ ɜɵɩɹɱɢɜɚɧɢɹ haustra ɩɪɢɞɚɸɳɢɟ ɬɨɥɫɬɨɣ ɤɢɲɤɟ ɱɟɬɤɨ ɨɛɪɚɡɧɵɣ ɜɢɞ ɉɨɞ ɫɟɪɨɡɧɵɦ ɩɨɤɪɨɜɨɦ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɦɟɫɬɚɦɢ ɜɫɬɪɟɱɚɸɬɫɹ ɦɟɲɤɨɨɛɪɚɡɧɵɟ ɜɵɩɹɱɢɜɚɧɢɹ ɜ ɜɢɞɟ ɩɪɢɞɚɬɤɨɜ ɞɥɢɧɨɣ - ɫɦ ɧɚɩɨɥɧɟɧ ɧɵɟ ɠɢɪɨɦ ɧɚɡɵɜɚɟɦɵɟ ɫɚɥɶɧɢɤɨɜɵɦɢ ɨɬɪɨɫɬɤɚɦɢ appendices epiploicae). ɇɚ ɜɨɫɯɨɞɹɳɟɣ ɢ ɧɢɫɯɨɞɹɳɟɣ ɤɢɲɤɟ ɷɬɢ ɩɪɢɞɚɬɤɢ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɜ ɞɜɚ ɪɹɞɚ

± ɜɞɨɥɶ ɫɜɨɛɨɞɧɨɣ ɢ ɛɪɵɠɟɟɱɧɨɣ ɥɟɧɬ ɇɚ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɟ ɨɧɢ ɨɛɪɚɡɭɸɬ ɬɨɥɶɤɨ ɨɞɢɧ ɪɹɞ ɚ ɧɚ ɬɨɧɤɨɣ ɤɢɲɤɟ ɜɨɨɛɳɟ ɨɬɫɭɬɫɬɜɭɸɬ

ɋɬɟɧɤɚ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɫɨɫɬɨɢɬ ɢɡ ɬɚɤɢɯ ɠɟ ɫɥɨɟɜ ɤɚɤ ɢ ɬɨɧɤɨɣ Ɉɞɧɚɤɨ ɜ ɮɭɧɤɰɢɨɧɚɥɶɧɨɦ ɨɬɧɨɲɟɧɢɢ ɨɧɢ ɪɟɡɤɨ ɨɬɥɢɱɚɸɬɫɹ ɞɪɭɝ ɨɬ ɞɪɭɝɚ ɬ ɤ ɜ ɬɨɥ ɫɬɨɣ ɤɢɲɤɟ ɩɨɱɬɢ ɨɬɫɭɬɫɬɜɭɟɬ ɩɪɨɰɟɫɫ ɩɟɪɟɜɚɪɢɜɚɧɢɹ ɢ ɨɫɥɚɛɥɟɧ ɩɪɨɰɟɫɫ ɜɫɚɫɵɜɚɧɢɹ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɜɨɞɵ Ʉɪɨɦɟ ɬɨɝɨ ɜ ɬɨɥɫɬɨɣ ɤɢɲɤɟ ɩɪɨɢɫɯɨɞɢɬ ɮɨɪɦɢɪɨɜɚɧɢɟ ɤɚɥɨɜɵɯ ɦɚɫɫ ɢɡ ɧɟɩɟɪɟɜɚɪɟɧɧɵɯ ɨɫɬɚɬɤɨɜ ɩɢɳɢ ɢ ɜɵɜɟɞɟɧɢɟ ɢɯ ɧɚɪɭɠɭ

ȼ ɬɨɥɫɬɨɣ ɤɢɲɤɟ ɪɚɡɥɢɱɚɸɬ ɫɥɟɩɭɸ ɤɢɲɤɭ ɫ ɱɟɪɜɟɨɛɪɚɡɧɵɦ ɨɬɪɨɫɬɤɨɦ ɨɛɨɞɨɱɧɭɸ ɜɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɧɢɫɯɨɞɹɳɚɹ ɨɛɨ ɞɨɱɧɚɹ ɫɢɝɦɨɜɢɞɧɚɹ ɨɛɨɞɨɱɧɚɹ) ɢ ɩɪɹɦɭɸ ɤɢɲɤɭ ɹɜɥɹɸɳɭɸɫɹ ɤɨɧɟɱɧɵɦ ɨɬɞɟɥɨɦ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɪɚɫɩɨɥɨɠɟɧɧɧɨɣ ɜ ɦɚɥɨɦ ɬɚɡɭ

ɋɥɟɩɚɹ ɤɢɲɤɚ caecum)

Ɋɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɩɪɚɜɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɛɥɚɫɬɢ ɉɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɫɥɟ ɩɨɣ ɦɟɲɨɤ ɨɛɪɚɡɨɜɚɧɧɵɣ ɜɫɥɟɞɫɬɜɢɟ ɬɨɝɨ ɱɬɨ ɩɨɞɡɜɞɨɲɧɚɹ ɤɢɲɤɚ ɜɩɚɞɚɟɬ ɜ ɬɨɥɫɬɭɸ ɧɟɫɤɨɥɶɤɨ ɜɵɲɟ ɧɢɠɧɟɝɨ ɨɬɞɟɥɚ ɬɨɥɫɬɨɣ ɤɢɲɤɢ Ⱦɥɢɧɚ ɫɥɟɩɨɣ ɤɢɲ ɤɢ - ɫɦ ɲɢɪɢɧɚ - ɫɦ ɉɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɫɥɟɩɚɹ ɤɢɲɤɚ ɩɪɢɥɟɠɢɬ ɤ ɩɟɪɟɞɧɟɣ ɫɬɟɧɤɟ ɠɢɜɨɬɚ ɫɡɚɞɢ ɨɬ ɫɥɟɩɨɣ ɤɢɲɤɢ ɥɟɠɢɬ ɩɨɞɡɞɨɲɧɨɩɨɹɫɧɢɱɧɚɹ ɦɵɲɰɚ m. iliopsoas).

ɇɚ ɩɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɫɥɟɩɨɣ ɤɢɲɤɢ ɩɪɨɯɨɞɢɬ ɩɪɨɞɨɥɶɧɚɹ ɥɟɧɬɚ ɩɟ ɪɟɯɨɞɹɳɚɹ ɧɚ ɱɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ ɢ ɫɥɭɠɚɳɚɹ ɨɪɢɟɧɬɢɪɨɦ ɩɪɢ ɧɚɯɨɠ ɞɟɧɢɢ ɟɝɨ ɜɨ ɜɪɟɦɹ ɨɩɟɪɚɰɢɢ

56

ɋɥɟɩɚɹ ɤɢɲɤɚ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɫɨ ɜɫɟɯ ɫɬɨ ɪɨɧ ɱɟɦ ɢ ɨɛɴɹɫɧɹɟɬɫɹ ɫɪɚɜɧɢɬɟɥɶɧɨ ɯɨɪɨɲɚɹ ɟɟ ɩɨɞɜɢɠɧɨɫɬɶ ɩɨɡɜɨɥɹɸɳɚɹ ɩɪɢ ɨɩɟɪɚɰɢɹɯ ɢɡɜɥɟɱɶ ɤɢɲɤɭ ɢɡ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɜ ɨɩɟɪɚɰɢɨɧɧɭɸ ɪɚɧɭ ɂɧɨɝɞɚ ɤɢɲɤɚ ɢɦɟɟɬ ɯɨɪɨɲɨ ɜɵɪɚɠɟɧɧɭɸ ɛɪɵɠɟɣɤɭ mesocaecum ɛɥɚɝɨɞɚ ɪɹ ɱɟɦɭ ɨɧɚ ɫɬɚɧɨɜɢɬɫɹ ɛɨɥɟɟ ɩɨɞɜɢɠɧɨɣ caecum mobile Ɉɞɧɚɤɨ ɧɚɛɥɸɞɚ ɸɬɫɹ ɫɥɭɱɚɢ ɤɨɝɞɚ ɡɚɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɫɥɟɩɨɣ ɤɢɲɤɢ ɜɨɨɛɳɟ ɥɢɲɟɧɚ ɛɪɸ ɲɢɧɧɨɝɨ ɩɨɤɪɨɜɚ ɢ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɫɜɹɡɚɧɚ ɫ ɡɚɞɧɟɣ ɛɪɸɲɧɨɣ ɫɬɟɧɤɨɣ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɨɜ ɉɨɥɨɠɟɧɢɟ ɫɥɟɩɨɣ ɤɢɲɤɢ ɛɵɜɚɟɬ ɧɟɨɞɢɧɚɤɨɜɵɦ Ɋɚɡɥɢ ɱɚɸɬ ɜɵɫɨɤɨɟ ɩɨɥɨɠɟɧɢɟ ɤɨɝɞɚ ɫɥɟɩɚɹ ɤɢɲɤɚ ɧɚɯɨɞɢɬɫɹ ɩɨɞ ɩɟɱɟɧɶɸ ɢ ɧɢɡ ɤɨɟ ɤɨɝɞɚ ɨɧɚ ɫɩɭɫɤɚɟɬɫɹ ɜ ɬɚɡ ɇɨ ɱɚɳɟ ɨɧɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɩɪɚɜɨɣ ɩɨɞ ɜɡɞɨɲɧɨɣ ɨɛɥɚɫɬɢ

ɍ ɦɟɫɬɚ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɜ ɜɨɫɯɨɞɹɳɭɸ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ ɨɛɪɚ ɡɭɟɬɫɹ ɢɥɟɨɰɟɤɚɥɶɧɵɣ ɤɥɚɩɚɧ valva ileocaecalis ɜɨɤɪɭɝ ɤɨɬɨɪɨɝɨ ɡɚɥɟɝɚɟɬ ɦɵɲɟɱɧɨɟ ɤɨɥɶɰɨ ɨɯɜɚɬɵɜɚɸɳɟɟ ɜ ɜɢɞɟ ɠɨɦɚ ɤɨɧɟɰ ɩɨɞɡɜɞɨɲɧɨɣ ɤɢɲɤɢ ɍɤɚɡɚɧɧɵɣ ɤɥɚɩɚɧ ɫɜɨɛɨɞɧɨ ɩɪɨɩɭɫɤɚɟɬ ɫɨɞɟɪɠɢɦɨɟ ɢɡ ɬɨɧɤɨɣ ɤɢɲɤɢ ɜ ɬɨɥ ɫɬɭɸ ɢ ɫɥɭɠɢɬ ɩɪɟɩɹɬɫɬɜɢɟɦ ɞɥɹ ɟɝɨ ɨɛɪɚɬɧɨɝɨ ɩɨɫɬɭɩɥɟɧɢɹ ɜ ɦɨɦɟɧɬ ɫɨ ɤɪɚɳɟɧɢɹ ɢ ɫɭɠɟɧɢɹ ɬɨɥɫɬɨɣ ɤɢɲɤɢ

ɑɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ appendix vermiformis , s. processus vermicularis) ± ɷɬɨ ɩɪɢɞɚɬɨɤ ɫɥɟɩɨɣ ɤɢɲɤɢ ɨɬɯɨɞɹɳɢɣ ɨɬ ɟɟ ɦɟɞɢɚɥɶɧɨ-ɡɚɞɧɟɣ ɩɨ ɜɟɪɯɧɨɫɬɢ ɜ ɬɨɦ ɦɟɫɬɟ ɝɞɟ ɫɯɨɞɹɬɫɹ ɜɫɟ ɬɪɢ ɬɹɠɚ Ɉɫɧɨɜɚɧɢɟ ɨɬɪɨɫɬɤɚ ɪɚɫɩɨ ɥɚɝɚɟɬɫɹ ɧɚ - ɫɦ ɧɢɠɟ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ Ɉɞɧɚɤɨ ɦɨɝɭɬ ɛɵɬɶ ɢ ɨɬ ɤɥɨɧɟɧɢɹ Ⱦɥɢɧɚ ɢ ɩɨɥɨɠɟɧɢɟ ɱɟɪɜɟɨɛɪɚɡɧɨɝɨ ɨɬɪɨɫɬɤɚ ɜɟɫɶɦɚ ɪɚɡɧɨɨɛɪɚɡɧɵɨɬ ɞɨ ɫɦ ɉɨɥɨɠɟɧɢɟ ɟɝɨ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɡɚɜɢɫɢɬ ɨɬ ɬɨɩɨɝɪɚ ɮɢɢ ɫɥɟɩɨɣ ɤɢɲɤɢ ɇɚɢɛɨɥɟɟ ɬɢɩɢɱɧɵɦ ɫɱɢɬɚɟɬɫɹ ɩɨɥɨɠɟɧɢɟ ɩɪɢ ɤɨɬɨɪɨɦ ɨɬɪɨɫɬɨɤ ɫɜɨɢɦ ɧɢɠɧɢɦ ɤɨɧɰɨɦ ɫɜɨɛɨɞɧɨ ɫɜɢɫɚɟɬ ɜɧɢɡ ɧɢɫɯɨɞɹɳɟɟ ɩɨɥɨɠɟ ɧɢɟ ȼɨɡɦɨɠɧɵ ɢ ɞɪɭɝɢɟ ɜɚɪɢɚɧɬɵ ɧɚɩɪɢɦɟɪ ɥɚɬɟɪɚɥɶɧɨɟ ɩɨɥɨɠɟɧɢɟ ɤɨɝɞɚ ɱɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ ɧɚɩɪɚɜɥɹɟɬɫɹ ɜɛɨɤ ɢ ɤɜɟɪɯɭ ȼ ɬɚɤɢɯ ɫɥɭɱɚɹɯ ɨɬɪɨ ɫɬɨɤ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɦɟɠɞɭ ɩɟɪɟɞɧɟɛɨɤɨɜɨɣ ɫɬɟɧɤɨɣ ɠɢɜɨɬɚ ɫɩɟɪɟɞɢ ɩɚɯɨɜɨɣ ɫɜɹɡɤɨɣ ɢ ɝɪɟɛɧɟɦ ɩɨɞɜɡɞɨɲɧɨɣ ɤɨɫɬɢ ɫɧɚɪɭɠɢ ɫɥɟɩɨɣ ɤɢɲɤɨɣ ɢɡɧɭɬɪɢ ɢ ɩɨɞɡɜɞɨɲɧɨɣ ɦɵɲɰɟɣ m. iliacus) ɫ ɟɟ ɮɚɫɰɢɟɣ ɢ ɛɪɸɲɢɧɨɣ ± ɫɡɚɞɢ ɉɪɢ ɦɟ ɞɢɚɥɶɧɨɦ ɩɨɥɨɠɟɧɢɢ ɱɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ ɧɚɩɪɚɜɥɹɟɬɫɹ ɜɥɟɜɨ ɬ ɟ ɤɧɭɬ ɪɢ ɨɬ ɫɥɟɩɨɣ ɤɢɲɤɢ ɢ ɩɨɦɟɳɚɟɬɫɹ ɫɪɟɞɢ ɩɟɬɟɥɶ ɬɨɧɤɨɣ ɤɢɲɤɢ ȼɫɬɪɟɱɚɸɬɫɹ ɫɥɭɱɚɢ ɤɨɝɞɚ ɨɬɪɨɫɬɨɤ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨɡɚɞɢ ɫɥɟɩɨɣ ɤɢɲɤɢ ɪɟɬɪɨɰɟɤɚɥɶɧɨ ɩɪɢɱɟɦ ɫɜɨɛɨɞɧɵɦ ɤɨɧɰɨɦ ɦɨɠɟɬ ɩɨɞɧɹɬɶɫɹ ɤɜɟɪɯɭ ɜɩɥɨɬɶ ɞɨ ɩɟɱɟɧɢ ɜɨɫ ɯɨɞɹɳɟɟ ɩɨɥɨɠɟɧɢɟ

ɑɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ ɩɨɤɪɵɬ ɛɪɸɲɢɧɨɣ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ ɢ ɢɦɟɟɬ ɯɨ ɪɨɲɨ ɜɵɪɚɠɟɧɧɭɸ ɛɪɵɠɟɣɤɭ mesoappendix ɋɬɪɨɟɧɢɟ ɫɬɟɧɤɢ ɱɟɪɜɟɨɛɪɚɡ ɧɨɝɨ ɨɬɪɨɫɬɤɚ ɦɚɥɨ ɱɟɦ ɨɬɥɢɱɚɟɬɫɹ ɨɬ ɫɬɪɨɟɧɢɹ ɫɬɟɧɤɢ ɤɢɲɤɢ ɋɥɢɡɢɫɬɚɹ ɨɛɨɥɨɱɤɚ ɜ ɨɫɨɛɟɧɧɨɫɬɢ ɩɨɞɫɥɢɡɢɫɬɵɣ ɫɥɨɣ ɛɨɝɚɬɚ ɥɢɦɮɨɢɞɧɨɣ ɬɤɚɧɶɸ ɝɪɭɩɩɨɜɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɮɨɥɥɥɢɤɭɥɵ ɱɟɪɜɟɨɛɪɚɡɧɨɝɨ ɨɬɪɨɫɬɤɚ ɚɩɩɟɧɞɢɤ ɫɵ folliculi lymphatici aggregati appendicis vermiformis) ɉɨ ɦɧɟɧɢɸ ɧɟɤɨɬɨ ɪɵɯ ɚɜɬɨɪɨɦ ɥɢɦɮɨɢɞɧɚɹ ɬɤɚɧɶ ɡɚɞɟɪɠɢɜɚɟɬ ɢ ɭɧɢɱɬɨɠɚɟɬ ɩɚɬɨɝɟɧɧɵɟ ɦɢɤ ɪɨɨɪɝɚɧɢɡɦɵ ɱɟɦ ɢ ɨɛɴɹɫɧɹɟɬɫɹ ɱɚɫɬɨɟ ɜɨɡɧɢɤɧɨɜɟɧɢɟ ɚɩɩɟɧɞɢɰɢɬɚ

57

Ɋɢɫ 1.35. ɋɥɟɩɚɹ ɤɢɲɤɚ ɢ ɢɥɟ-ɰɟɤɚɥɶɧɵɣ ɭɝɨɥɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹ ɦɢ

1 ² taenia libera;

2 ² haustrae coli;

3 ² colon ascendens;

4 ² ostium valvae ilealis;

5 ² ileum;

6 ² caecum;

7 ² appendix vermiformis.

ȼɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ colon ascendens) ɹɜɥɹɟɬɫɹ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɵɦ ɩɪɨɞɨɥɠɟɧɢɟɦ ɫɥɟɩɨɣ ɤɢɲɤɢ ɉɨɞɧɢɦɚɹɫɶ ɩɨ ɩɪɚɜɨɣ ɩɨɥɨɜɢɧɟ ɠɢɜɨɬɚ ɤɜɟɪɯɭ ɨɧɚ ɫɜɨɟɣ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɫɨɩɪɢɤɚɫɚɟɬɫɹ ɫ ɩɨɞɜɡɞɨɲɧɨɣ ɢ ɤɜɚɞɪɚɬɧɨɣ ɦɵɲɰɚɦɢ ɩɨɹɫɧɢɰɵ m. iliacus et m. quadratus lumborum ɚ ɬɚɤɠɟ ɫ ɩɪɚɜɨɣ ɩɨɱɤɨɣ ɢ ɧɢɫɯɨɞɹɳɟɣ ɱɚɫɬɶɸ -ɩɟɪɫɬɧɨɣ ɤɢɲ ɤɢ Ƚɪɚɧɢɰɟɣ ɦɟɠɞɭ ɫɥɟɩɨɣ ɤɢɲɤɨɣ ɢ ɧɚɱɚɥɶɧɨɣ ɱɚɫɬɶɸ ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱ ɧɨɣ ɤɢɲɤɢ ɫɥɭɠɢɬ ɦɟɫɬɨ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɉɨɞɧɢɦɚɹɫɶ ɤɜɟɪɯɭ ɜɨɫ ɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɭ ɧɢɠɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɟɱɟɧɢ ɨɛɪɚɡɭɟɬ ɩɪɚɜɵɣ ɢɡɝɢɛ flexura coli dextra ɢ ɩɟɪɟɯɨɞɢɬ ɜ ɩɨɩɟɪɟɱɧɨ-ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ

ȼɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɫ ɬɪɟɯ ɫɬɨɪɨɧ ± ɫɩɟɪɟɞɢ ɢ ɫ ɛɨɤɨɜ Ɂɚɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɤɢɲɤɢ ɛɪɸɲɢɧɨɣ ɧɟ ɩɨɤɪɵɬɚ pars nuda Ɇɟɠɞɭ ɡɚɞɧɟɣ ɫɬɟɧɤɨɣ ɠɢɜɨɬɚ ɢ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɡɚɥɟɝɚɟɬ ɫɥɨɣ ɨɤɨɥɨɨɛɨɞɨɱɧɨɣ ɤɥɟɬɱɚɬɤɢ paracolon ɱɬɨ ɫɩɨɫɨɛɫɬɜɭɟɬ ɩɟɪɟɯɨɞɭ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ ɫ ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɜ ɡɚɛɪɸɲɢɧɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ȼ ɪɟɞɤɢɯ ɫɥɭɱɚɹɯ ɜɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱ ɧɚɹ ɤɢɲɤɚ ɢɦɟɟɬ ɩɨɥɧɵɣ ɛɪɸɲɢɧɧɵɣ ɩɨɤɪɨɜ ɢ ɛɪɵɠɟɣɤɭ ɋɪɟɞɧɹɹ ɞɥɢɧɚ ɜɨɫɯɨɞɹɳɟɝɨ ɨɬɞɟɥɚ ɫɦ

ɉɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ colon transversum), ɧɚɱɢɧɚɹɫɶ ɨɬ ɩɪɚ ɜɨɝɨ ɢɡɝɢɛɚ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ flexura coliɫɚ dextra ɧɚɩɪɚɜɥɹɟɬɫɹ ɫɩɪɚɜɚ ɧɚɥɟɜɨ ɡɚɧɢɦɚɹ ɩɨɩɟɪɟɱɧɨɟ ɩɨɥɨɠɟɧɢɟ ɞɨɯɨɞɢɬ ɞɨ ɧɢɠɧɟɝɨ ɤɨɧɰɚ ɫɟɥɟɡɟɧ ɤɢ ɝɞɟ ɪɟɡɤɨ ɩɨɜɨɪɚɱɢɜɚɹ ɜɧɢɡ ɨɛɪɚɡɭɟɬ ɥɟɜɵɣ ɢɡɝɢɛ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ (flexura colica sinistra ɢ ɩɟɪɟɯɨɞɢɬ ɜ ɧɢɫɯɨɞɹɳɭɸ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ Ɇɟɠɞɭ ɢɡɝɢɛɚɦɢ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɧɟ ɢɞɟɬ ɫɬɪɨɝɨ ɩɨɩɟɪɟɱɧɨ ɚ ɨɛɪɚɡɭɟɬ ɩɨɥɨɝɭɸ ɞɭɝɭ ɨɛɪɚɳɟɧɧɭɸ ɜɵɩɭɤɥɨɫɬɶɸ ɤɧɢɡɭ Ʉ ɬɨɦɭ ɠɟ ɥɟɜɵɣ ɢɡɝɢɛ ɪɚɫ ɩɨɥɨɠɟɧ ɜɵɲɟ ɩɪɚɜɨɝɨ ɜɫɥɟɞɫɬɜɢɟ ɱɟɝɨ ɩɨɥɨɠɟɧɢɟ ɤɢɲɤɢ ɢɦɟɟɬ ɜɨɫɯɨɞɹɳɟɟ ɧɚɩɪɚɜɥɟɧɢɟ ɫɩɪɚɜɚ ɧɚɥɟɜɨ ɋɩɟɪɟɞɢ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɩɪɢɤɪɵɬɚ

58

ɛɨɥɶɲɢɦ ɫɚɥɶɧɢɤɨɦ ɋɜɟɪɯɭ ɫ ɧɟɣ ɫɨɩɪɢɤɚɫɚɟɬɫɹ ɩɟɱɟɧɶ ɠɟɥɱɧɵɣ ɩɭɡɵɪɶ ɠɟɥɭɞɨɤ ɯɜɨɫɬ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɢ ɫɟɥɟɡɟɧɤɚ ɋɡɚɞɢ ɩɨɩɟɪɟɱɧɚɹ ɨɛɨ ɞɨɱɧɚɹ ɤɢɲɤɚ ɩɟɪɟɫɟɤɚɟɬ ɧɢɫɯɨɞɹɳɭɸ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢ ɝɨɥɨɜɤɭ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ

ɉɨɩɟɪɟɱɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɫɨ ɜɫɟɯ ɫɬɨɪɨɧ ɢ ɩɨ ɫɪɟɞɫɬɜɨɦ ɛɪɵɠɟɣɤɢ mesocolon transversum ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɠɢɜɨɬɚ

ɇɢɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ colon descendens) ɫɥɟɞɭɟɬ ɨɬ ɥɟɜɨɝɨ ɢɡɝɢɛɚ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɩɨ ɥɟɜɨɣ ɩɨɥɨɜɢɧɟ ɠɢɜɨɬɚ ɨɩɭɫɤɚɟɬɫɹ ɤɧɢɡɭ ɢ ɧɚ ɭɪɨɜɧɟ ɥɟɜɨɝɨ ɤɪɟɫɬɰɨɜɨ-ɩɨɞɜɡɞɨɲɧɨɝɨ ɫɭɫɬɚɜɚ ɩɟɪɟɯɨɞɢɬ ɜ ɫɢɝɦɨɜɢɞɧɭɸ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ colon sygmoideum).

ɋɜɨɟɣ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɧɟ ɩɨɤɪɵɬɨɣ ɛɪɸɲɢɧɨɣ ɧɢɫɯɨɞɹɳɚɹ ɨɛɨ ɞɨɱɧɚɹ ɤɢɲɤɚ ɩɪɢɥɟɠɢɬ ɤ ɤɜɚɞɪɚɬɧɨɣ ɦɵɲɰɟ ɩɨɹɫɧɢɰɵ ɢ ɩɨɩɟɪɟɱɧɵɦ ɦɵɲ ɰɚɦ ɠɢɜɨɬɚ ɪɚɫɩɨɥɚɝɚɹɫɶ ɤɧɚɪɭɠɢ ɨɬ ɛɨɥɶɲɨɣ ɩɨɹɫɧɢɱɧɨɣ ɦɵɲɰɵ ȼ ɜɟɪɯ ɧɢɯ ɨɬɞɟɥɚɯ ɧɢɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɫɨɩɪɢɤɚɫɚɟɬɫɹ ɫ ɥɟɜɨɣ ɩɨɱɤɨɣ Ʉɚɤ ɢ ɜɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɧɢɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɫ ɬɪɟɯ ɫɬɨɪɨɧ ± ɫɩɟɪɟɞɢ ɢ ɫ ɛɨɤɨɜ ɦɟɡɨɩɟɪɢɬɨɧɟɚɥɶɧɨ Ɇɟɠɞɭ ɤɜɚɞɪɚɬɧɨɣ ɦɵɲɰɟɣ ɩɨɹɫɧɢɰɵ ɢ ɩɨɩɟɪɟɱɧɨɣ ɦɵɲɰɟɣ ɠɢɜɨɬɚ ɩɨɤɪɵɬɵɯ ɜɧɭ ɬɪɢɛɪɸɲɧɨɣ ɮɚɫɰɢɟɣ ɫ ɨɞɧɨɣ ɫɬɨɪɨɧɵ ɢ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɧɢɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ± ɫ ɞɪɭɝɨɣ ɡɚɥɟɝɚɟɬ ɫɥɨɣ ɪɵɯɥɨɣ ɨɤɨɥɨɨɛɨɞɨɱɧɨɣ ɤɥɟɬɱɚɬ ɤɢ Ⱦɥɢɧɚ ɧɢɫɯɨɞɹɳɟɝɨ ɨɬɞɟɥɚ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɫɦ

ɋɢɝɦɨɜɢɞɧɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ colon sygmoideum) ɧɚɱɢɧɚɟɬɫɹ ɧɚ ɭɪɨɜɧɟ ɥɟɜɨɝɨ ɤɪɟɫɬɰɨɜɨ-ɩɨɞɡɞɨɲɧɨɝɨ ɫɭɫɬɚɜɚ ɢ ɧɚ ɭɪɨɜɧɟ II-III ɤɪɟɫɰɨɜɵɯ ɩɨɡɜɨɧɤɨɜ ɩɟɪɟɯɨɞɢɬ ɜ ɩɪɹɦɭɸ ɤɢɲɤɭ ɋɨ ɜɫɟɯ ɫɬɨɪɨɧ ɩɨɤɪɵɬɚ ɛɪɸɲɢɧɨɣ ɢ ɢɦɟɟɬ ɯɨɪɨɲɨ ɜɵɪɚɠɟɧɧɭɸ ɛɪɵɠɟɣɤɭ ɜ ɪɟɡɭɥɶɬɚɬɟ ɱɟɝɨ ɨɬɥɢɱɚɟɬɫɹ ɛɨɥɶɲɨɣ ɩɨɞɜɢɠɧɨɫɬɶɸ ɢ ɪɚɡɥɢɱɧɵɦ ɩɨɥɨɠɟɧɢɟɦ ɉɨɥɨɠɟɧɢɟ ɫɢɝɦɨɜɢɞɧɨɣ ɤɢɲɤɢ ɦɟɧɹɟɬɫɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɨɫɬɨɹɧɢɹ ɢ ɧɚɩɨɥɧɟɧɢɹ ɫɨɫɟɞɧɢɯ ɨɪɝɚɧɨɜ ɉɪɢ ɩɭɫɬɵɯ ɦɨɱɟɜɨɦ ɩɭɡɵɪɟ ɢ ɩɪɹɦɨɣ ɤɢɲɤɟ ɨɧɚ ɦɨɠɟɬ ɪɚɫɩɨɥɚɝɚɬɶɫɹ ɜ ɦɚɥɨɦ ɬɚɡɭ ɜ ɫɥɭɱɚɟ ɩɟɪɟɩɨɥɧɟɧɢɹ ɝɚɡɚɦɢ ɦɨɠɟɬ ɜɵɯɨɞɢɬɶ ɡɚ ɩɪɟɞɟɥɵ ɛɨɥɶɲɨɝɨ ɬɚ ɡɚ

Ⱦɥɢɧɚ ɛɪɵɠɟɣɤɢ ɫɢɝɦɨɜɢɞɧɨɣ ɤɢɲɤɢ - ɫɦ Ʉɨɪɟɧɶ ɛɪɵɠɟɣɤɢ ɩɪɢ ɤɪɟɩɥɹɟɬɫɹ ɤ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɢ ɡɚɧɢɦɚɟɬ ɤɨɫɨɟ ɩɨɥɨɠɟɧɢɟ ɧɚɩɪɚɜɥɹɹɫɶ ɫɧɚɪɭɠɢ ɜɧɭɬɪɶ ɩɟɪɟɫɟɤɚɹ ɩɨɞɜɡɞɨɲɧɭɸ ɛɨɥɶɲɭɸ ɩɨɹɫɧɢɱɧɵɟ ɦɵɲɰɵ ɥɟɜɵɣ ɦɨɱɟɬɨɱɧɢɤ ɥɟɜɭɸ ɨɛɳɭɸ ɩɨɞɜɡɞɨɲɧɭɸ ɚɪɬɟɪɢɸ ɢ ɜɟɧɭ ɢ ɨɤɚɧɱɢɜɚɟɬɫɹ ɧɚ ɩɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥ I ɢ II ɤɪɟɫɰɨɜɵɯ ɩɨɡɜɨɧɤɨɜ ɩɟɪɟ ɯɨɞɹ ɡɚɬɟɦ ɜ ɛɪɵɠɟɣɤɭ ɩɪɹɦɨɣ ɤɢɲɤɢ mesorectum Ⱦɥɢɧɚ ɫɢɝɦɨɜɢɞɧɨɣ ɤɢɲɤɢ ɤɨɥɟɛɥɟɬɫɹ ɨɬ ɞɨ ɫɦ ɜ ɫɪɟɞɧɟɦ ɫɦ

ɇɚɱɚɥɶɧɵɟ ɨɬɞɟɥɵ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɤɪɨɜɨɫɧɚɛɠɚɸɬɫɹ ɡɚ ɫɱɟɬ ɜɟɪɯɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ Ʉ ɦɟɫɬɭ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɜ ɬɨɥɫɬɭɸ ɩɨɞɯɨɞɢɬ ɩɨɞɡɜɞɨɲɧɨ-ɨɛɨɞɨɱɧɚɹ ɚɪɬɟɪɢɹ a.ileocolica ɨɬ ɤɨɬɨɪɨɣ ɨɬɯɨɞɹɬ ɜɟɬɜɢ ɩɢ ɬɚɸɳɢɟ ɬɟɪɦɢɧɚɥɶɧɵɣ ɨɬɞɟɥ ɬɨɧɤɨɣ ɤɢɲɤɢ ɧɢɠɧɢɟ ɢ ɫɪɟɞɧɢɟ ɨɬɞɟɥɵ ɜɨɫ ɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɚ ɬɚɤɠɟ ɚɪɬɟɪɢɹ ɱɟɪɜɟɨɛɪɚɡɧɨɝɨ ɨɬɪɨɫɬɤɚ ɩɢɬɚ ɸɳɚɹ ɱɟɪɜɟɨɛɪɚɡɧɵɣ ɨɬɪɨɫɬɨɤ Ʉ ɜɟɪɯɧɢɦ ɨɬɞɟɥɚɯ ɜɨɫɯɨɞɹɳɟɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɢ ɩɪɚɜɨɦɭ ɢɡɝɢɛɭ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɩɨɞɯɨɞɢɬ ɩɪɚɜɚɹ ɨɛɨɞɨɱɧɚɹ ɚɪɬɟ ɪɢɹ ɢ ɧɚɤɨɧɟɰ ɤ ɞɜɭɦ ɬɪɟɬɹɦ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ± ɫɪɟɞɧɹɹ ɨɛɨ

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ɞɨɱɧɚɹ ɚɪɬɟɪɢɹ colica media) Ɉɫɬɚɥɶɧɵɟ ɨɬɞɟɥɵ ɩɢɬɚɸɬɫɹ ɡɚ ɫɱɟɬ ɧɢɠɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ a. mesenterica inferior) ɨɬɯɨɞɹɳɢɟ ɨɬ ɛɪɸɲɧɨɣ ɚɨɪɬɵ ɧɚ ɭɪɨɜɧɟ III-IV ɩɨɹɫɧɢɱɧɵɯ ɩɨɡɜɨɧɤɨɜ ɇɢɠɧɹɹ ɛɪɵɠɟɟɱɧɚɹ ɚɪɬɟɪɢɹ ɨɬɞɚɟɬ ɜɟɬɜɢ ɥɟɜɭɸ ɨɛɨɞɨɱɧɭɸ ɚɪɬɟɪɢɸ a. colica sinistra ɩɢɬɚɸɳɭɸ ɥɟɜɵɣ ɢɡɝɢɛ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɢ ɧɢɫɯɨɞɹɳɭɸ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ ɫɢɝɦɨɜɢɞɧɭɸ ɚɪɬɟɪɢɸ (a. sygmoideae ɫɧɚɛɠɚɸɳɭɸ ɫɢɝɦɨɜɢɞɧɭɸ ɤɢɲɤɭ ɜɟɪɯɧɸɸ ɩɪɹɦɨɤɢɲɟɱ ɧɭɸ ɚɪɬɟɪɢɸ a. rectalis superior ɹɜɥɹɸɳɭɸɫɹ ɤɨɧɟɱɧɨɣ ɜɟɬɜɶɸ ɧɢɠɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ɢ ɩɢɬɚɸɳɟɭɸ ɧɚɱɚɥɶɧɵɟ ɨɬɞɟɥɵ ɩɪɹɦɨɣ ɤɢɲɤɢ Ɇɟɠɞɭ ɥɢɫɬɤɚɦɢ ɛɪɵɠɟɣɤɢ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɜɟɬɜɢ ɫɪɟɞɧɟɣ ɨɛɨɞɨɱɧɨɣ ɚɪɬɟɪɢɢ ɢ ɥɟɜɨɣ ɨɛɨɞɨɱɧɨɣ ɚɪɬɟɪɢɢ ɫɥɢɜɚɸɬɫɹ ɢ ɨɛɪɚɡɭɸɬ ɞɭɝɨɨɛɪɚɡɧɵɣ ɚɧɚɫɬɨɦɨɡ ± ɞɭɝɭ Ɋɢɨɥɚɧɚ arcus Riolani).

ȼɟɧɵ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɫɨɩɪɨɜɨɠɞɚɸɬ ɨɞɧɨɢɦɟɧɧɵɟ ɚɪɬɟɪɢɢ ɢ ɜɩɚɞɚɸɬ ɱɟ ɪɟɡ ɜɟɪɯɧɸɸ ɢ ɧɢɠɧɸɸ ɛɪɵɠɟɟɱɧɵɟ ɜɟɧɵ ɜ ɜɨɪɨɬɧɭɸ ɜɟɧɭ

Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɬɨɥɫɬɨɣ ɤɢɲɤɢ ɜɩɚɞɚɸɬ ɜ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜɞɨɥɶ ɚɪɬɟɪɢɣ ɩɢɬɚɸɳɢɯ ɤɢɲɤɭ ɢ ɧɨɫɹɳɢɯ ɨɛɳɟɟ ɧɚɡɜɚɧɢɟ ɛɪɵɠɟɟɱɧɨɨɛɨɞɨɱɧɵɟ nodi lymphatici mesocolici ȼɫɟɝɨ ɨɤɨɥɨ - ɭɡɥɨɜ ɉɨ ɩɪɢɧɚɞ ɥɟɠɧɨɫɬɢ ɭɡɥɵ ɞɟɥɹɬ ɧɚ ɬɪɢ ɝɪɭɩɩɵ ɩɨɞɜɡɞɨɲɧɨ-ɨɛɨɞɨɱɧɵɟ lnn. ileocolici); ɨɛɨɞɨɱɧɵɟ ɩɪɚɜɵɟ ɫɪɟɞɧɢɟ ɥɟɜɵɟ lnn. colici dextri, medii, sinistri ɪɚɫɩɨɥɨ ɠɟɧɧɵɟ ɜɞɨɥɶ ɚɪɬɟɪɢɣ ɩɢɬɚɸɳɢɯ ɨɛɨɞɨɱɧɭɸ ɤɢɲɤɭ ɜɟɪɯɧɢɟ ɩɪɹɦɨɤɢɲɟɱ ɧɵɟ lnn. rectales superiores ɫɨɩɪɨɜɨɠɞɚɸɳɢɟ ɜ ɜɢɞɟ ɰɟɩɨɱɤɢ ɜɟɪɯɧɢɸ ɩɪɹ ɦɨɤɢɲɟɱɧɭɸ ɚɪɬɟɪɢɸ

ȼɫɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɩɨɥɭɱɚɟɬ ɢɧɧɟɪɜɚɰɢɸ ɢɡ ɫɢɦɩɚɬɢɱɟɫɤɨɣ ɜɟɪɯɧɟɝɨ ɢ ɧɢɠɧɟɝɨ ɛɪɵɠɟɟɱɧɨɝɨ ɫɩɥɟɬɟɧɢɹ plexus mesentericus superior et inferior ɢ ɩɚɪɚɫɢɦɩɚɬɢɱɟɫɤɨɣ ɛɥɭɠɞɚɸɳɟɝɨ ɧɟɪɜɚ n. vagus ɢ ɬɚɡɨɜɵɯ ɧɟɪɜɨɜ nn. pelvici

± ɞɨ ɫɢɝɦɨɜɢɞɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɫɢɫɬɟɦ Ɉɪɝɚɧɵ ɜɟɪɯɧɟɝɨ ɷɬɚɠɚ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɠɟɥɭɞɨɤ ɩɟɱɟɧɶ ɠɟɥɱɧɵɣ

ɩɭɡɵɪɶ ɫɟɥɟɡɟɧɤɚ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɢ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɫɧɚɛɠɚɸɬɫɹ ɜɟɬɜɹɦɢ ɨɬɯɨɞɹɳɢɦɢ ɨɬ ɱɪɟɜɧɨɝɨ ɫɬɜɨɥɚ ɨɪɝɚɧɵ ɧɢɠɧɟɝɨ ɷɬɚɠɚ

± ɡɚ ɫɱɟɬ ɜɟɪɯɧɟɣ ɢ ɧɢɠɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ȼɟɬɜɢ ɜɟɪɯɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ɜɢɞɧɵ ɟɫɥɢ ɨɬɛɪɨɫɢɬɶ ɤɜɟɪɯɭ ɛɨɥɶɲɨɣ ɫɚɥɶɧɢɤ ɜɦɟɫɬɟ ɫ ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɨɣ ɚ ɬɨɧɤɢɣ ɤɢɲɟɱɧɢɤ ± ɜɥɟɜɨ ɢ ɤɧɢɡɭ Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɨɬ ɤɪɵɜɚɟɬɫɹ ɩɪɚɜɵɣ ɫɢɧɭɫ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɢ ɜɢɞɧɚ ɱɚɫɬɶ -ɩɟɪɫɬɧɨɣ ɤɢɲɤɢ ɥɟɠɚɳɟɣ ɜ ɧɢɠɧɟɦ ɨɬɞɟɥɟ ɜɟɫɶ ɬɨɧɤɢɣ ɤɢɲɟɱɧɢɤ ɦɟɫɬɨ ɜɩɚɞɟɧɢɹ ɬɨɧɤɨɣ ɤɢɲɤɢ ɜ ɬɨɥɫɬɭɸ ɜɨɫɯɨɞɹɳɚɹ ɨɛɨɞɨɱɧɚɹ ɤɢɲɤɚ ɢ ô ɩɨɩɟɪɟɱɧɨɣ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ȼɫɟ ɷɬɨ ɤɪɨɜɨɫɧɚɛɠɚɟɬɫɹ ɜɟɬɜɹɦɢ ɜɟɪɯɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ɧɢɠɧɢɦɢ ɩɚɧɤɪɟɚɬɨɞɭɨɞɟɧɚɥɶɧɵɦɢ ɬɨɧɤɨɤɢɲɟɱɧɵɦɢ ɩɨɞɜɡɞɨɲɧɨɨɛɨɞɨɱɧɨɣ ɩɪɚɜɨɣ ɨɛɨɞɨɱɧɨɣ ɢ ɫɪɟɞɧɟɣ ɨɛɨɞɨɱɧɨɣ ɚɪɬɟɪɢɹɦɢ ȿɫɥɢ ɬɨɧɤɭɸ ɤɢɲɤɭ ɨɬɛɪɨɫɢɬɶ ɤɜɟɪɯɭ ɢ ɜɩɪɚɜɨ ɬɨ ɨɛɧɚɠɢɬɫɹ ɥɟɜɵɣ ɫɢɧɭɫ ɢ ɫɬɚɧɭɬ ɜɢɞɧɵ ɧɢɫɯɨɞɹɳɚɹ ɱɚɫɬɶ ɨɛɨɞɨɱɧɨɣ ɤɢɲɤɢ ɫɢɝɦɨɜɢɞɧɚɹ ɢ ɧɚɱɚɥɶɧɵɣ ɨɬɞɟɥ ɩɪɹɦɨɣ ɤɢɲɤɢ ɩɨɥɭɱɚɸɳɢɟ ɤɪɨɜɨɫɧɚɛɠɟɧɢɟ ɨɬ ɧɢɠɧɟɣ ɛɪɵɠɟɟɱɧɨɣ ɚɪɬɟɪɢɢ ȿɟ ɜɟɬɜɢ ɥɟɜɚɹ ɨɛɨɞɨɱɧɚɹ ɫɢɝɦɨɜɢɞɧɚɹ ɜɟɪɯɧɹɹ ɩɪɹɦɨɤɢɲɟɱɧɚɹ ɚɪɬɟɪɢɢ

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