肝病整合课程肝应用解剖.ppt

When eat The stone in the gallbladder is the common disease in clinic. The stone can be anywhere in the biliary duct CLINICAL CORRELATION Borders: Cystic duct Common hepatic duct Inferior surface of liver Content: Cystic artery The cystic artery arises from the right branch of the proper hepatic artery. It is usually found in the triangle of Calot (61.67%) 胆囊三角（Calot 三角) The gall-bladder triangle CLINICAL CORRELATION The cystic artery may pass posterior (75%) or anterior (24%) to the common hepatic duct. CLINICAL CORRELATION The cystic artery varies considerably in its origin and course. It may arise from the left branch of the heoatic artery, the proper hepatic artery, the gastroduodenal artery, the common hepatic artery, of may be double. During removal of the gallbladder, only the cystic artery should be ligated. If the right branch of the hepatic artery is ligated, half of the liver will probably necrosis. Features：　　①all capillaries at origin and insertion. So the blood of hepatic portal vein returns to inferior vena cava after 2 sets vessels substance exchange. ②lack of valves in vessels and tributaries. ③special blood. 四、肝门静脉 hepatic portal vein 肝门静脉由肠系膜上静脉和脾静脉在胰颈后方汇合。 肝门静脉属支 肠系膜上静脉 sup. mesenteric v. 脾静脉 splenic vein 肠系膜下静脉 inf. mesenteric v. 胃左静脉 left gastric vein 胃右静脉 right gastric vein 胆囊静脉 cystic vein 附脐静脉 paraumbilical vein 食管静脉丛 Esophageal venous plexus 奇静脉 上腔静脉 胃左静脉 肝门静脉 食管静脉 1、 肝门静脉高压---呕血 门腔静脉吻合Portal-systemic anastomoses 髂内静脉 下腔静脉 直肠静脉丛 Rectal venous plexus 肝门静脉 肠系膜下静脉 直肠上静脉 髂总静脉 直肠下静脉及肛静脉 2、 脾静脉 肝门静脉高压----便血 肝门静脉 附脐静脉 脐 周 静 脉 网 Paraumbilical venous vete 胸腹壁静脉 腋静脉 锁骨下静脉 头臂静脉 上腔静脉 腹壁浅静脉 大隐静脉 股静脉 髂外静脉 髂总静脉 下腔静脉 3、 肝门静脉高压---- 海蛇头 五、肝的淋巴引流和神经 Lymph drainage and nerves of the liver 肝的淋巴引流： 浅组-浆膜下成网，脏面：肝淋巴结----纵隔后淋巴结 膈面：纵隔后淋巴结；胃右、主动脉前淋巴结； 深组-升干随肝静脉出第2肝门后经膈入纵隔后淋巴结； 降支伴肝门静脉分支出肝门入肝淋巴结。 肝的神经： 迷走神经 腹腔神经丛 右膈神经（放射性痛） 围绕肝固有动脉和肝门静脉形成肝丛，经肝门入肝分布肝小叶间结缔组织及肝细胞之间。 肝血管只有交感神经分布，而肝管和胆囊则有交感和副交感双向分布。