Supracolic Compartment 结肠上区 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） 21

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？