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1、Pancreas胰腺疾病DepartmentofSurgeryMaQingyong2006.11AnatomyThepancreaslieswithintheretroperitoneumintheupperabdomen,lyinginfrontofthesecondlumbervertebraandendinginthesplenichilum.Theglandcanbedividedintofourportions-head,neck,body,andtail.uncinateprocessAnatomyThemainpancreaticduct(theductofWi
2、rsung,2~3mmindiameter)coursesalongtheglandfromthetailtotheheadandjoinsthecommonbileductjustbeforeenteringtheduodenumattheampullaofVater(85%).Theaccessorypancreaticduct(theductofSantorini)enterstheduodenum2~2.5cmproximaltotheVater.theductofWirsungSantoriniampullaofVateruncinateprocessAnatomy
3、BloodsupplyThesuperiorpancreaticoduodenalarteryarisesfromthegastroduedenalartery,runsparalleltotheduodenum,andeventuallymeetstheinferiorpancreaticoduodenalartery,abranchofthesuperiormesentericartery,toformanarcade.Thesplenicarteryprovidestributariesthatsupplythebodyandtailofthepancreas.panc
4、reaticmagnaAsuperiormesentericarterysplenicarteryarcadesuperiorpancreaticoduodenalarteryinferiorpancreaticoduodenalarterydorsalpancreaticApancreaticmagnaAsuperiormesentericVPhysiologyExocrineFunctionTheexternalsecretionconsistsofaclear,alkaline(pH7.0~8.3)solutionof750~1000ml/dcontainingdige
5、stiveenzymes.Secretionisstimulatedbythehormonessecretinandcholecystokinin(CCK)andbyparasympatheticvagaldischarge.SecretinandCCKaresynthesized,store,andreleasedfromduodenalmucosalcellsinresponsetospecificstimuli.Acidinthelumenoftheduodenumcausesthereleaseofsecretin,andluminaldigestionproduct
6、soffatandproteincausethereleaseofCCK.PhysiologyExocrineFunctionenzymessynthesized,stored(aszymogengranules),andreleasedbytheacinarcellsofthegland,inresponsetoCCKandvagalstinulation.Pancreaticenzymesareproteolytic,lipolytic,andemylolytic.Lipaseandamylasearestoredandsecretedinactiveforms.Thep
7、rolyticenzymesaresecretedasinactiveprecursorsandactivatedbytheduodenalenzymeenterokinase.OtherenzymesincluderibonucleasesandphospholipaseA.PhysiologyEndocrineFunctionInsulin(51aminoacidresidues,formedinthebetacellsviatheprecursorproinsulin)glucagons(29am
