山东大学医学院 解剖教研室.ppt

Regionalanatomyofabdomen 山东大学医学院解剖教研室李振华 Relationsofabdominalviscera Firstlayer live gallbladder stomachSecondlayer duodenum pancreas spleenThirdlayer suprarenalgland kidney ureter inferiorvenacava abdominalaorta nervesandlymphatics Relationsofthestomach Anteriorly Live rightpart Diaphragm leftupperpart Anteriorabdominalwall leftlowerpart Posteriorly separatedbyperitoneumoflessersacfromthefollowing stomach bed PancreasLeftsuprarenalglandLeftkidneySpleenTransversecolonandtransversemesocolon Arteriesofstomach LeftandrightgastricarteriesArisefromceliactrunkandproperhepaticartery respectively Thesetwovesselsruninlesseromentumalonglessercurvature andanastomoseend to end Arteriesofstomach RightandleftgastroepiploicarteriesArisefromthegastroduodenalandsplenicartery respectively Thesetwovesselspassintothegreateromentum runparalleltothegreatercurvature andanastomoseend to end Arteriesofstomach ShortgastricarteriesBranchesofsplenicarteryCoursethroughthegastrosplenicligamentSupplythefundusofstomach Posteriorgastricartery 72 ArisefromthesplenicarteryCoursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach Venousdrainageofstomach Rightandleftgastricveinsemptydirectlyintohepaticportalvein Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein Rightgastroepiploicveindrainintosuperiormesentericvein Lymphdrainageofstomach Rightandleftgastricln liealongthesamevesselsandfinallytotheceliacln Rightandleftgastroomentalln liealongthesamevessels theformerdrainintosubpyloricln thelatterdrainintosplenicln Suprapyloricandsubpyloricln receivelymphaticsfrompyloricpartandfinallytotheceliacln Splenicln receivelymphaticsfromfundusandleftthirdofstomach andfinallytotheceliacln Nervesupplyofstomach ParasympatheticinnervationTheanteriorvagaltrunkdividesintoanteriorgastricandhepaticbranchesTheposteriorvagaltrunkdividesintoposteriorgastricandceliacbranchesTheanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthepyloricantrumtofanoutintobranchescalled crow sfoot tosupplythepyloricpartSympatheticinnervationMainlyfromceliacgangliaAfferentandefferentfibersderivesfromthoracicsegments T5 L1 Relationsofduodenum RelationsofsuperiorpartAnteriorlyQuadratelobeofliveGallbladderPosteriorlyCommonbileductGastroduodenala Hepaticportalv InferiorvenacavaSuperioelyOmentalforamenInferiorlyHeadofpancreas Relationsofduodenum AnteriorlyLiveTransversecolonandtransversemesocolonLoopsofsmallintestinePosteriorlyRightrenalhilumandureterRightrenalvesselsMediallyHeadofpancreasCommonbileductandpancreaticductLaterallyRightcolicflexure Relationsofdescendingpart Relationsofduodenum RelationsofhorizontalpartSuperiorlyHeadofpancreasInferiorlyLoopsofsmallintestineAnteriorlyRadixofmesenterySuperiormesenterica andv PosteriorlyRightureterInferiorvenacavaAbdominalaorta Relationsofduodenum RelationsofascendingpartRight HeadofpancreasandabdominalaortaLeft leftkidneyandureter Bloodsupplyofduodenum ArteriesSuperiorpancreaticoduodenala Inferiorpancreaticoduodenala Veins followarteries drainingdirectlyintosuperiormesentericandhepaticportalveins Relationsofliver Diaphragmaticsurface separatedbydiaphragmfromthefollowingRightcostodiaphramaticrecessandlungCardiacbaseVisceralsurfaceLeftlobeisrelatedtothestomachandabdominalpartofesophagusRightlobeisrelatedtotherightcolicflexureanterioly gallbladderandsuperiorduodenalflexuremedially rightkidney superarenalglandposteriorly Divisionsandrelationsofcommonbileduct DivisionsSupraduodenalsegment十二指肠上段Retroduodenalsegment十二指肠后段Pancreaticsegment胰腺段Intraduodenalsegment十二指肠壁段 Relationsofcommonbileduct SupraduodenalsegmentDescendsalongtherightmarginofhepatoduodenallig Totherightofproperhepatica Anteriortohepaticportalv RetroduodenalsegmentBehindthesuperiorpartofduodenumAnteriortothevenacavaTotherightofthehepaticportalv Relationsofcommonbileduct PancreaticsegmentLiesinagroovebetweenposteriorsurfaceofheadofpancreasandduodenumIntraduodenalsegmentEntersthewallofdescendingpartofduodenumobliquelywherejionsthepancreaticducttoformthehepatopancreaticampullaOpensatthemajorduodenalpapilla Cystohepatictriangle Calot sTriangle 胆囊三角 BoundariesCommonhepaticductontheleftCysticductontherightLivesuperiorlyContent cysticartery ThePancreas胰 FourpartsHeadLieswithinthecancavityoftheC shapedcurvatuneofduodenumUncinateprocess aprojectiontotheleftfromthelowerpartoftheheadbehindthesuperiormesentericvessels Neck narrowpart overliesthesuperiormesentericvesselsandbeginningoftheportalveinBody triangularincrosssection passesupwardandtotheleftacrossthemidlineTail extendstothehilumofspleeninthesplenorenalligament Relationsofpancreas HeadofpancreasLocatedinC shapescurvatureofdoudenumAnteriorlyTransversemesocolonPosteriorlyInferiorvenacavaRightrenalvesselsCommonbileduct Relationsofpancreas NeckofpancreasAnteriorly pylorusPosteriorly beginningofhepaticportalv Relationsofpancreas BodyofpancreasAnteriorlySeparatedfromstomachbyomentalbursaPosteriorlyAbdominalaortaLeftsuprarenalglandLeftkidneyLeftrenalvesselsSpleenveinSuperiorlyCeliactrunkCeliacplexusSplenica Relationsofpancreas TailofpancreeasRunsinsplenorenalligamenttoreachhilumofspleenAccompanieswithsplenicvessels Relationsofspleen Diaphragmaticsurface diaphragmVisceralsurfaceAnteriorly fundusofstomachPosteriorly leftsuprarenalglandandkidneyInferiorly tailofpancreasandleftcolicflexure Retroperitonealspace腹膜后隙 Position itliesbetweentheparietalperitoneumandtransversfasciaoftheposteriorabdominalwall fromdiaphragmtopromontoryofsacrum continuationwithextraperitonealfascia ContentsKidneySuprarenalglandUreterAbdominalaortaInferiorvenacavaNervesandlymphaticsLooseconnectivetissue Suprarenalgland肾上腺 ShapeandpositionRightispyramidalinshape leftonesemilunarinshape consistingofoutcortexandinnermedullaLocatedretroperitoneally superomedialtosuperiorpolesofeachkidney enclosewiththekidneybytherenalfasciaBloodsupplyArteriesSuperiorsuprarenala Middlesuprarenala Inferiorsuprarenala VenousdrainRightsuprarenalv drainsintoinferiorvenacavaLeftsuprarenalv joinsleftrenalv AxialCTscanoftheupperabdomen Onsoft tissuewindows todemonstrateretroperitonealanatomy IVC inferiorvenacava Dissection Live Stomach Gallbladder Greateromentum Dissection Omentalforamen Dissection Radixofmesentery Rightmesentericsinus Ascendingcolon Vermiformappendix Transversecolon Dissection Descendingcolon Transversescolon Sigmoidcolon Leftmesentericsinus Radixofmesentery Celiactrunk Youmustidentifyfollowstructures StomachLessercurvatureGreatercurvatureangularincisurecardiacincisureCardiacpartFundusofstomachBodyofstomachPyloricpartDuodenumSuperiorpartDescendingpartMajorduodenalpapillaHorizontalpartAscendingpart LargeIntestineColicbandsHaustraofcolonEpiploicappendicesCecumileocecalvalveVermiformappendixAscendingcolonTransversecolonDescendingcolonSigmoidcolon Youmustidentifyfollowstructures LiverFalciformlig ofliverligamentumtereshepaticportahepaticNotchforligamentumtereshepatisNothchforgallbladderGallbladderFundusofgallbladderBodyofgallbladderNeckofgallbladderCysticductRightandlefthepaticductsCommonhepaticductCommonbileduct PancreasHeadUncinateprocessNeckBodyTailPeritoneumLessoromentumOmentalforamenGreateromentumMesenteryMesoappendixGastrosplenicligamentrectovesicalpouchRectouterinepouchVesicouterinepouch Youmustidentifyfollowstructures KidneyRenalhilumRenalsinusRenalcortexRenalpyramidRenalpapillaMinorrenalcalicesMajorrenalcalicle