SupracolicCompartment

結腸上區LingShucaiRegionalanatomy第1頁RelationshipsofabdominalvisceraFirstlayer－live,gallbladder,stomach（肝、膽囊、胃）

Secondlayer－duodenum,pancreas,spleen

（十二指腸、胰、脾）Thirdlayer－suprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphatics

（腎上腺、腎、輸尿管、下腔靜脈、腹積極脈等。）第2頁

RelationshipsofthestomachAnterior:Live(rightpart)Diaphragm(leftupperpart)Anteriorabdominalwall(leftlowerpart)Posterior－separatedbyperitonumoflessersacfromthefollowing(“stumach-bed”)

PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversmesoclon第3頁ArteriesofstomachLeftandrightgastricarteriesarisefromceliactrunkandproperhepaticartery,repectively.Thesetwovesselsruninlesseromentumalonglessercurvature,andanastomoseend-to-end.第4頁Rightandleftgastroepiploicarteriesarisefromthegastroduodenalandsplenicartery,repectively.Shortgastricarteries,branchesofsplenicartery,coursethroughthegastrosplenicligamentandsupplythefundusofstomach.Posteriorgastricartery(72%)arisefromthesplenicartery,coursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach.第5頁VenousdrainageofstomachRightandleftgastricveinsemptydirectlyintohepaticportalvein.Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein.Rightgastroepiploicveinjoineithersuperiormesentericvein.第6頁LymphaticsofstomachRightandleftgastricln.liealongthesamevesselsandfinallytotheceliacln.Rightandleftgastroomentalln.liealongthesamevessels,theformerdrainintosubpyloricln.,thelatterdrainintosplinicln.Supra-andsubpyloricln.receivelymphaticsfrompyloricpartandfinallytotheceliacln.Splenicln.receivelymphaticsfromfundusandleftthirdofstomach,andfinallytotheceliacln.第7頁InnervationofstomachParasympatheticinnervationbyanterior(left)andposterior(right)vagaltrunksTheanteriortrunkdividesintoanteriorgastricandhepaticbranchesTheposteriortrunkdividesintoposteriorgastricandceliacbranches“crow’sfoot”tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAffentandeffentfibersderivesfromthoracicsegments(T5－L1)第8頁RelationshipsofthetheduodenumRelationshipsofsuperiorpart

AnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommombileductGastroduodenala.Hepaticportalv.InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreas第9頁RelationshipsofdescendingpartAnteriorlyLiveTransversecolonandmesocolonLoopsofsmallintestinePosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexure第10頁RelationshipsofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica.andv.PosteriorlyRightureterInferiorvenacavaAbdominalaorta第11頁RelationshipsofascendingpartRightHeadofpancreasandabdominalaortaLeftLeftkidneyandureter第12頁BloodsupplyofduodenumArteriesSuperiorpancreaticoduodenala.Inferiorpancreaticoduodenala.Veins

－followarteries,drainingdirectlyintosuperiormesentericandhepaticportalveins第13頁RelationshipsofliverDiaphragmaticsurface

－separatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanteriorly,gallbladderandsuperiorduodenalflexuremedially,rightkidney,superarenalglandposteriorly第14頁

Theinternalstructureoftheliver第15頁第16頁第17頁Glissonsystem第18頁Forknowledge:ClaudeCouinaud:AFrenchsurgeon&anatomistwhomade

significantcontributioninthefieldofhepatobiliarysurgery,hewasthefirsttodescribesegmentalanatomyoftheliver(1954)第19頁ProfHenriBismuth:AFrenchsurgeonwhocontributesmuchtothesegmentationoftheliver…Hisclassificationispopular

intheUSA…whileCouinauds’classificationismorepopularinAsia&Europe…第20頁左半肝：尾葉（段Ⅰ）左外葉上段（段Ⅱ）下段（段Ⅲ）左內葉（段Ⅳ）右半肝：右前葉下段（段Ⅴ）上段（段Ⅷ）右后葉下段（段Ⅵ）上段（段Ⅶ）Segmentsofliver第21頁第22頁Liversegment第23頁第24頁Comparisonbetweenclassicalanatomy&modernfunctionalsegmentationoftheliver…第25頁Divisionsandrelationsofcommonbileduct1.Supraduodenalsegment

Descendsalongtherightmarginofhepatoduodenallig.Totherightofproperhepatica.Anteriortohepaticportalv.2.Retroduodenalsegment

BehindthesuperiorpartofduodenumAnteriortothevenacavaTotherightofthehepaticportalv.第26頁3.PancreaticsegmentLiesinagroovebetweenposteriorsurfaceofheadofpancreasandduodenum4.Intraduodenalsegment

Entersthewallofdescendingpartofduodenumobliquelywherejionsthepancreaticducttoformthehepatopancreaticampulla

Opensatthemajorduodenalpapilla第27頁DivisionsandrelationsofpancreasHeadofpancreasLocatedinC-shapescurvatureofdoudenumAnteriorlyTransversemesocolonPosteriorlyInferiorvenacavaRightrenalvesselsCommonbileductNeckofpancreas

Anteriorly－pylorusPosteriorly－commencementofhepaticportalv.(formedbyunionofsplenicandsuperiormesentericveins)第28頁BodyofpancreasAnteriorlySeparatedfromstomachbyomentalbursaP