Supracolic Supracolic

CompartmentCompartment

结肠上区结肠上区

Ling ShucaiLing Shucai

Regional anatomy Regional anatomy

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…

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 ）

Segments of liver

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？