凌树才_Supracolic Compartment
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Transcript 凌树才_Supracolic Compartment
Regional anatomy
Supracolic Compartment
结肠上区
Ling Shucai
Relationships of abdominal viscera
• First layer-live, gallbladder, stomach(肝、胆囊、胃)
• Second layer-duodenum, pancreas, spleen
(十二指肠、胰、脾)
• Third layer-suprarenal gland, kidney, ureter, inferior
vena cava, abdominal aorta, nerves and lymphatics
(肾上腺、肾、输尿管、下腔静脉、腹主动脉等。)
Relationships of the stomach
• Anterior:
– Live (right part)
– Diaphragm (left upper
part)
– Anterior abdominal wall
(left lower part)
• Posterior-separated by
peritonum of lesser sac from
the following (“stumach-bed”)
– Pancreas
– Left suprarenal gland
– Left kidney
– Spleen
– Transverse colon and
transvers mesoclon
Arteries of stomach
• Left and right gastric
arteries arise from celiac
trunk and proper hepatic
artery, repectively. These
two vessels run in lesser
omentum along lesser
curvature , and
anastomose end-to-end.
• Right and left gastroepiploic
arteries arise from the
gastroduodenal and splenic
artery, repectively.
• Short gastric arteries,
branches of splenic artery,
course through the
gastrosplenic ligament and
supply the fundus of stomach.
• Posterior gastric artery (72%)
arise from the splenic artery,
course through the
gastrophrenic ligament and
supply the posterior wall of
fundus of stomach.
Venous drainage of stomach
• Right and left gastric veins empty directly into hepatic
portal vein.
• Left gastroepiploic and short gastric veins drain into
hepatic portal vein via the splenic vein.
• Right gastroepiploic vein join either superior mesenteric
vein.
Lymphatics of stomach
• Right and left gastric ln. lie
along the same vessels and
finally to the celiac ln.
• Right and left gastroomental
ln. lie along the same vessels,
the former drain into
subpyloric ln., the latter drain
into splinic ln.
• Supra- and subpyloric ln.
receive lymphatics from
pyloric part and finally to the
celiac ln.
• Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the
celiac ln.
Innervation of stomach
Parasympathetic innervation by
anterior (left) and posterior (right)
vagal trunks
• The anterior trunk divides into
anterior gastric and hepatic
branches
• The posterior trunk divides into
posterior gastric and celiac
branches
• “crow’s foot” to supply the pyloric
part
Sympathetic innervation
• Mainly from celiac ganglia
• Affent and effent fibers derives
from thoracic segments (T5 -L1)
Relationships of the the duodenum
Relationships of superior part
• Anteriorly
– Quadrate lobe of live
– Gallbladder
• Posteriorly
– Commom bile duct
– Gastroduodenal a.
– Hepatic portal v.
– Inferior vena cava
• Superioely
– Omental foramen
• Inferiorly
– Head of pancreas
Relationships of descending part
• Anteriorly
– Live
– Transverse colon and mesocolon
– Loops of small intestine
• Posteriorly
– Right renal hilum and ureter
– Right renal vessels
• Medially
– Head of pancreas
– Common bile duct and
pancreatic duct
• Laterally
– Right colic flexure
Relationships of horizontal part
• Superiorly
Head of pancreas
• Inferiorly
– Loops of small intestine
• Anteriorly
– Radix of mesentery
– Superior mesenteric a.
and v.
• Posteriorly
– Right ureter
– Inferior vena cava
– Abdominal aorta
Relationships of ascending part
• Right
– Head of pancreas and abdominal aorta
• Left
– Left kidney and ureter
Blood supply of duodenum
• Arteries
– Superior pancreaticoduodenal a.
– Inferior pancreaticoduodenal a.
• Veins
-follow arteries, draining directly
into superior mesenteric and
hepatic portal veins
Relationships of liver
• Diaphragmatic surface
-separated by diaphragm from
the following
– Right costodiaphramatic
recess and lung
– Cardiac base
• Visceral surface
– Left lobe is related to the
stomach and abdominal part
of esophagus
– Right lobe is related to the
right colic flexure anteriorly,
gallbladder and superior
duodenal flexure medially,
right kidney, superarenal
gland posteriorly
The internal structure of the liver
Glisson system
For knowledge :
Claude Couinaud
:
A French surgeon & anatomist
who made significant
contribution in the field of
hepatobiliary surgery ,he was
the first to describe
segmental anatomy of the
liver (1954)
Prof Henri Bismuth :
A French surgeon who
contributes much to the
segmentation of the liver …
His classification is popular in
the USA …while Couinauds’
classification is more popular in
Asia & Europe…
Segments of liver
左半肝:
• 尾叶(段Ⅰ)
• 左外叶
上段(段Ⅱ)
下段(段Ⅲ)
• 左内叶(段Ⅳ)
右半肝:
• 右前叶
下段(段Ⅴ)
上段(段Ⅷ)
• 右后叶
下段(段Ⅵ)
上段(段Ⅶ)
Liver segment
Comparison between classical anatomy & modern functional
segmentation of the liver…
Divisions and relations of common bile duct
1. Supraduodenal segment
• Descends along the right
margin of hepatoduodenal lig.
• To the right of proper
hepatic a.
• Anterior to hepatic portal v.
2. Retroduodenal segment
• Behind the superior part of
duodenum
• Anterior to the vena cava
• To the right of the hepatic
portal v.
3. Pancreatic segment
• Lies in a groove between
posterior surface of head
of pancreas and duodenum
4. Intraduodenal segment
• Enters the wall of
descending part of
duodenum obliquely where
jions the pancreatic duct
to form the
hepatopancreatic ampulla
• Opens at the major
duodenal papilla
Divisions and relations of pancreas
Head of pancreas
• Located in C-shapes
curvature of doudenum
• Anteriorly
– Transverse mesocolon
• Posteriorly
– Inferior vena cava
– Right renal vessels
– Common bile duct
Neck of pancreas
• Anteriorly-pylorus
• Posteriorly-commencement
of hepatic portal v. (formed
by union of splenic and
superior mesenteric veins)
Body of pancreas
• Anteriorly
– Separated from stomach
by omental bursa
• Posteriorly
– Abdominal aorta
– Left suprarenal gland
– Left kidney
– Left renal vessels
– Spleen vein
• Superiorly
– Celiac trunk
– Celiac plexus
– Splenic a.
Tail of pancreeas
– Runs in splenicorenal
ligament to reach hilum of
spleen
– Accompanies with splenic
vessels
Relationships of spleen
Diaphragmatic surface-
diaphragm
Visceral surface
• Anteriorly-fundus of
stomach
• Posteriorly-left
suprarenal gland and
kidney
• Inferiorly-tail of
pancreas and left colic
flexure
思考题
何谓“胃床”?由哪些结构构成。胃后壁穿孔时,胃内
含物可通过何结构到达何部位?
试述胃的毗邻、血供和淋巴回流。
试述十二指肠的分段及各段毗邻。
熟悉肝的分段
试述胆总管的分段及胆汁的产生与排除的途径。
胰分为哪些部?各部分别与哪些结构毗邻?
试述胰头的位置和毗邻,患胰头癌时可压迫哪些结构,
引起哪些症状?