肾脏的局部解剖(英)

For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, since it is separated from the upper pole of the kidney only by the diaphragm.

Horseshoe kidney
Suprarenal Gland
•Endocrine gland
•T11 level
•Right is triangular •Left is semi-lunar
Relation
Left right liver diaphrag m
superior
anterior inferior
renal vein renal artery renal pelvis From above downwards the renal artery renal vein renal pelvis
Hydronephrosis
renal artery
T11
Renal artery
Vascular renal segment
Case D
An examination of a patient revealed that she had a horseshoe kidney. What anatomical structure prevents a horseshoe kidney from ascending to a level above the umbilicus?
Position
Retroperitoneal Upper
poles
T12 vertebra
Lower poles
L3 vertebra
Right
is lower than left
Cadaveric kidneys
Surface Projection of kidney
Renal Angle
Case E
An intravenous pyelogram revealed that the calyces and pelvis of a patient’s right kidney were grossly dilated (a condition known as hydronephrosis). What embryological anomaly may be responsible for this condition?
Left suprarenal vein, into the left renal vein Right suprarenal vein, into the

inferior vena cava
incision
Posterior retroperitoneal approach Anterior transperitoneal approach
Renal Capsule



Renal fascia Adipose capsule Fibrous capsule
Renal fascia
Fibrous capsule
Adipose capsule Perirenal fat
Pararenal fat
Fibrous Capsule
Case A
A 55-year-old woman was found rolling on her kitchen floor, crying out from agonizing pain in her abdomen. The pain came in waves and extended from the right loin to the groin and to the front of the right thigh. An anteroposterior radiograph of the abdomen revealed a calculus in the right ureter.
Ureter
Ureter is divided into 3 parts:
①abdominal
part part
②pelvis
part
③intramural
28 to 34 cm 3 narrowing sites • the pelviureteric junction • crossing the pelvic brim • traversing the bladder wall
Case B
An explorer in the Amazon jungle was found alive after having lost contact with the outside world for six months. On physical examination, he was found to be in an emaciated condition. On palpation of the abdomen, a rounded, smooth swelling appeared in the right loin at the end of inspiration. On expiration, the swelling moved upward and could no longer be felt. What anatomical structure could produce such a swelling?
Case F
Which congenital anomaly of the ureter is likely to present as a case of urinary incontinence?
operation procedure of kidney transplant
nephrectomy
Tenderness or percussing pain caused by kidney disease is localized here
Neighbor of Kidney
Anterior Surface of the kidney
Posterior Surface
Costodiaphragmatic recess of the pleural cavity
stomach tail of pancreas & spleen vessel
diaphragm abdominal aorta
posterior medial
Inferior vena cava
Artery of Adrenal Gland
Veins of adrenal gland

Renal hilum, Renal sinus and Renal pedicle
Renal pyramid
Renal sinus cortex Renal column
calyx
Renal hilumpa源自illaRenal pedicle
From anterior to posterior
Question
a.
b.
c.
d.
What causes the pain when a ureteral calculus is present? Why is the pain felt in such an extensive area? Where does one look for the course of the ureter in a radiograph? Where along the ureter is a calculus likely to be held up?
Aorta-renal artery-segmental arterylobar artery-interlobar artery-arcuate artery-interlobulor artery-afferent arteriole-glomerulus (capillaries)efferent arteriole-peritubular capillaries and vasa recta-interlobular vein-arcuate vein-interlobar vein-renal vein-interior vena cava
Case C
An intravenous pyelogram revealed that a patient’s left kidney was in its normal position, but the right kidney was situated in front of the right sacroiliac joint. Can you explain this on embryological grounds?
Superior (apical)