Download 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？