2022年医学专题—肝管和胆总管.ppt

消化系统(xiohu xtng)Alimentary system,兰州大学(ln zhu d xu)基础医学院人体解剖学教研室,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第一页，共二十六页。,第七节 肝,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二页，共二十六页。,肝是人体中最大的腺体，也是体内最大的消化腺。长（左右径）宽（上下径）厚（前后径）约为258mm152mm58mm。肝的功能：参与蛋白质、脂类、糖类和维生素等物质(wzh)的 合成、转化与分解；参与激素、药物等物质的转化和解毒；具有分泌胆汁，吞噬、防御以及在胚胎时期 造血等功能。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第三页，共二十六页。,一、肝的形态(xngti)二、肝的位置及毗邻三、肝的分叶与分段四、肝外胆道系统,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第四页，共二十六页。,一、肝的形态(xngti),呈不规则的楔形，分为上、下两面，前、后、左、右四缘。肝的两面：肝上面，又称膈面。后部没有(mi yu)腹膜被覆的部分称裸区；肝下面，又叫脏面。将肝分为肝左叶、肝右叶、方叶和尾状叶。脏面中部有呈“H”形的三条沟。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第五页，共二十六页。,肝的四缘：前缘是肝的脏面与膈面的分界线，薄而锐利(rul),胆囊 底常在此处露出；后缘钝圆，朝向脊柱；右缘是肝右叶的右下缘，亦钝圆；左缘是肝左叶的左缘，薄而锐利。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第六页，共二十六页。,肝 的 形 态,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第七页，共二十六页。,肝 的 形 态,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第八页，共二十六页。,大部分：右季肋区 腹上区 小部分(b fen)；左季区,二、肝的位置(wi zhi)及毗邻,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第九页，共二十六页。,按照肝脏(gnzng)外形分为：肝左叶、肝右叶、方叶和尾状叶；肝内有四套管道，形成两个系统：Glisson系统和肝静脉系统。按照Glisson系统将肝分为：两个半肝，进一步分为五个叶、六个段。,三、肝的分叶与分段(fn dun),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十页，共二十六页。,肝,左半肝右半肝,左内叶左外叶右前叶右后叶尾状叶,上段下段,上段下段,上段下段,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十一页，共二十六页。,肝的分叶与分段(fn dun),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十二页，共二十六页。,肝的分叶与分段(fn dun),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十三页，共二十六页。,是指行出于肝门之外的胆道系统，包括胆囊、输胆管道（包括肝左管、肝右管、肝总管和胆总管）。与肝内胆道一起将肝分泌(fnm)的胆汁输送到十二指肠腔。,四、肝外胆道系统(xtng),January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十四页，共二十六页。,（一）胆 囊,胆囊(gall bladder)储存胆汁、浓缩胆汁。呈长梨形，长8-12cm,宽3-5cm,容量(rngling)40-60ml。分底、体、颈、管四部分。Calot三角：也称胆囊三角,指胆囊管、肝总管和肝的脏面围成的三角形区域。常有胆囊动脉通过。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十五页，共二十六页。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十六页，共二十六页。,（二）肝管和胆总管,肝总管长约3cm,下行于肝十二指肠韧带内，并在韧带内与胆囊管以锐角(rujio)汇合成胆总管。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十七页，共二十六页。,（三）胆总管,胆总管长约4-8cm，直径0.6-0.8cm，由肝总管(zn un)和胆囊管汇合而成。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十八页，共二十六页。,胆 总 管,肝胰壶腹十二指肠(sh rzhchng)乳头肝胰壶腹括约肌（Oddi括约肌）,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第十九页，共二十六页。,第八节 胰,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十页，共二十六页。,胰(pancreas)是人体的第二大腺，由外分泌部和内分泌部两部分组成。外分泌部分泌胰液，内含多种消化酶，分解消化蛋白质、脂类；内分泌部即胰岛，主要分泌胰岛素和胰高血糖(xutng)素，调节血糖(xutng)浓度。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十一页，共二十六页。,（一）胰的位置(wi zhi)与毗邻,胰位于(wiy)腹上区和左季肋区，平对第1、2腰椎体。上缘平脐上10cm,下缘约在脐上5cm。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十二页，共二十六页。,（二）胰的分部(fn b),胰可分为头、体、尾三部，各部间无明显(mngxin)界限。头部在腹中线右侧，体、尾部在腹中线左侧。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十三页，共二十六页。,胰管：位于胰实质内，偏背侧，其走形与胰的长轴一致，从胰尾经胰体走向胰头，沿途经过许多小叶间导管，最后(zuhu)于十二指肠降部的壁内与胆总管汇合成肝胰壶腹，开口于十二指肠大乳头。在胰头上部常可见一小管，行与胰管上方，称副胰管，开口于十二指肠小乳头。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十四页，共二十六页。,思 考 题,1.食物(shw)在消化管中是如何被消化吸收和排出的。2.肝、胃、胰和胆囊的位置及形态结构。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二十五页，共二十六页。,内容(nirng)总结,消化系统 Alimentary system。January,2007。长（左右径）宽（上下径）厚（前后径）约为258mm152mm58mm。肝内有四套管道，形成两个系统：Glisson系统和肝静脉系统。按照Glisson系统将肝分为：两个半肝，进一步分为五个叶、六个段。呈长梨形，长8-12cm,宽3-5cm,容量40-60ml。头部在腹中线右侧(yu c)，体、尾部在腹中线左侧,第二十六页，共二十六页。,