人体胆道系统：肝总管、胆总管与胰管汇合机制

人体胆道系统：肝总管、胆总管与胰管汇合机制

这里的“总管”，不是管事的，而是管道的汇合。“管”特指胆管，里面引流胆汁，包括肝脏内外，胆囊上下，上上下下的胆管通畅，是正常的状态，否则就是胆道梗阻，会引发黄疸。

一、肝总管

肝总管，common hepatic duct，CHD，common，公共的，字面意思是汇合的，由左、右肝管（hepatic duct，肝胆管）汇合而成，与胆囊管（cystic duct）汇合成胆总管（common bile duct），bile，胆汁；bile duct，胆管。CHD长4cm，内径4mm，是引流胆汁的通道。

The common hepatic duct (CHD)is formed by the right and left hepatic ducts junction. It joins the cystic duct to form the common bile duct (CBD). It is approximately 4 cm long and4 mm in diameter, typically.

二、卡洛特三角

卡洛特三角，是胆囊和肝之间的近似三角的区域，是外科肝胆操作时的解剖识别标志，这个区域由肝下缘，胆囊管，胆囊动脉，肝动脉，肝总管围成，具体由胆囊动脉和肝动脉的解剖变异而形状略有不同。

Calot's triangle is a small anatomical space in the abdomen where the hepatic artery (肝动脉), cystic artery (胆囊动脉，superiorly) and cystic duct (胆囊管，laterally) enter/exit the liver.

Calot’s triangle is orientated so that its apex is directed at the liver. The borders are as follows:

• Medial – common hepatic duct.

• Inferior – cystic duct.

• Superior – inferior surface of the liver.

The contents of Calot’s triangle include:

• Right hepatic artery – formed by the bifurcation of the proper hepatic artery into right and left branches.

• Cystic artery – typically arises from the right hepatic artery and traverses the triangle to supply the gall bladder.

• Lymph node of Lund – the first lymph node of the gallbladder.

• Lymphatics

三、胆囊管

胆囊管，cystic duct，连接胆囊与胆总管（common bile duct，胆囊管与肝总管的汇合），长约2.54cm，管径约0.20.3cm。胆囊管具有多种的解剖学变异。

四、胆总管

胆总管，common bile duct，CBD，胆囊管与肝总管汇接部至十二指肠乳头称胆总管，又分为十二指肠上段、十二指肠后段、胰腺段和十二指肠壁内段四段，十二指肠上段胆总管直径在10mm以内，超过12mm时，为胆总管扩张。70%~80%的人胆总管与主胰管末端结合，共同开口于主乳头。

胆总管，The common bile duct，可能常常简写为The bile duct容易与肝内胆管（Intrahepatic bile duct），甚至胆囊管（cystic duct）混淆，产生歧义。并且常规CT可能无法有效观察，如果没有胆管扩张。

The bile duct（其实是The common bile duct） is a small channel (tube) through which bile fromthe liver is delivered into the duodenum.

Thus, the oft-quoted normal value of < 6 mm (measured inner aspect of wall to inner aspect of the wall, typically by ultrasound) in adults actually refers to the CHD in most cases.The CHD is best measured when the patient is fasting,at the porta hepatis, typically parallel and anterior to the portal vein.In recent years, 7 mm has been proposed as a better cut-off.

胆总管长约48厘米，直径约68毫米，有一定舒缩功能，在肝固有动脉（proper hepatic artery，PHA）右侧、门静脉（portal vein，PV）前方，下行于肝十二指肠韧带中，向下经十二指肠上部后方，至胰头与十二指肠降部间，进入十二指肠降部的左后壁，在此处与胰管汇合，形成略膨大的总管，叫肝胰壶腹（hepatopancreatic ampulla,ampula of vater，ampullaof vater）。

胆总管初向后下行于小网膜右缘，在门静脉之前，肝固有动脉的右侧。

五、肝胰壶腹

肝胰壶腹，Vater壶腹，hepatopancreatic ampulla，ampulla of vater，是胆总管在十二指肠降部中份的后内侧壁内与胰管汇合，形成的略膨大的胆总管共同管道，有肝胰壶腹括约肌包绕，开口于十二指肠大乳头（major duodenal papilla）。肝胰壶腹常发生胆结石梗阻，也可能发生肿瘤，所谓壶腹癌（ampullary cancer），引起明显的梗阻。

六、磁共振胰胆管造影

肝、胆、胰管常规影像学显示不清晰，造影可以直接进行显示，但操作繁琐，费时费力，磁共振胰胆管造影，Magnetic Resonance Cholangiopancreatography，MRCP，是肝、胆、胰管道病变检查的无创影像检查，可显示主胰管、胆囊和胆管，普遍采用。

Magnetic resonance cholangiopancreatography or MRCPuses a powerful magnetic field, radio waves and a computer to evaluate the liver, gallbladder, bile ducts, pancreas and pancreatic duct for disease. It is noninvasive and does not use ionizing radiation.