胆囊脈管系の解剖

Topographical Anatomy of the Gallbladder

要旨　胆囊の脈管・神経の局所解剖について解説した．動脈については，下面に分布する浅枝と肝に付着した上面に分布する深枝とに分けて解析する必要性を，静脈では，上面の静脈が1本にまとまらずに数本が短いまま肝に侵入していることなどを強調した．神経では迷走神経が肝十二指腸間膜に到達する経路として，前迷走神経幹から小網緻密部を通過する路と後迷走神経幹から腹腔神経叢を経て肝動脈に沿う路の2系が存在することを指摘した．リンパ系については，われわれの剖出所見を示説し，胆囊のリンパ管が総胆管に沿って膵後面に下行するのみならず，井上のLgl. coeliacae retropancreaticaeを経て，左腎静脈の上下の高さで，大動静脈間リンパ節に入る経路が存在することを明らかにした．

　A brief review of the vessels and nerves of the gallbladder is given from the standpoint of topographical anatomy, with special attention to their anatomical arrangement.

　The cystic artery usually divides into a superficial branch distributing to the lower free surface of the gallbladder, and a deep branch to the upper surface attached to the liver. However these two branches sometimes arise separately. Veins from the upper surface do not form a single trunk, but drain directly into the liver. There are two possible routes of the vagus nerve to the plexus around the hepatic pedicle: one is from the anterior vagal trunk through the pars condensa of the lesser omentum, and the other from the posterior vagal trunk through the celiac plexus and along the hepatic artery.

　In order to show the typical lymphatic arrangement, a series of illustrations demonstrating a step by step dissection of an adult cadaver is given (Figs. 5-9). The lymphatics around the hepatic pedicle are generally classified into two groups according to their routes: right and left.

　The lymphatics of the right group descend obliquely into the lymph node on the anterior border of the foramen of Winslow (Lgl. paracholedochus of Inoue), located on the lower right edge of the common bile duct. This node also receives most of the drainage from the gallbladder, duodenum and the posterosuperior surface of the head of the pancreas. After leaving the node, the lymphatics run posteriorly into a terminal visceral node (Lgl. coeliacae retropancreaticae of Inoue) which is situated on the posteroinferior surface of the hepatoduodenal ligament at the lower end of the portal vein. Its efferents cross the anterior surface of the right celiac plexus and run downward into the para-aortic nodes, and the uppermost of the interaorticocaval nodes, which are situated immediately around the end of the left renal vein.

　The lymphatics of the left group descend along the hepatic artery into the lymph node located at the origin of the hepatic artery proper. The efferents pass into the celiac nodes and descend on the superficial surface of the left celiac plexus, into those of the para-aortic nodes positioned at the level of the left renal pedicle.

　The efferents from the para-aortic nodes run around the abdominal aorta, to drain into the thoracic duct.