腹腔镜胰十二指肠切除术中肠系膜上血管的应用解剖  

Applied anatomy of superior mesenteric vessels during laparoscopic pancreatoduodenectomy

作　　者：刘兴国[1] 冉凌[2] 吴涛[1] 丁自海[1] 钟世镇[1] 

机构地区：[1]南方医科大学微创外科解剖学研究所,广州510515 [2]兰州军区乌鲁木齐总医院肛肠科,乌鲁木齐830000

出　　处：《中国临床解剖学杂志》2007年第2期172-175,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的:为腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)中探查、显露、分离肠系膜上血管提供解剖学依据。方法:10例已固定成人尸体腹部标本,2例新鲜成人尸体。全组男7例,女5例。进行解剖观测,并行模拟腹腔镜操作。结果:⑴肠系膜上静脉(superior mesenteric vein,SMV)的十二指肠水平部段长(3.80±0.72)cm、胰头钩突部段长(1.76±0.25)cm、胰颈后段长(3.81±0.64)cm、胰颈上段长(4.73±1.31)cm,其中胰头钩突部段属支最多;⑵胃网膜右静脉汇入SMV有6种类型;⑶肠系膜上动脉(superior mesenteric artery,SMA)距腹腔干下方(1.12±0.15)cm起自腹主动脉前壁,主干长(3.97±0.54)cm,外径(0.69±0.03)cm,胰十二指肠下动脉和第1空肠动脉起源SMA的有5种类型。结论:(1)SMV的胰头钩突部段最短,属支最多,显露分离最难;(2)LPD中以胃网膜右静脉为标志来探查、显露SMV较好;(3)对肠系膜上动、静脉的显露分离应采用不同的主操作孔来进行;(4)充分利用腹腔镜的放大作用和超声刀的精确切割特性是可以探查、显露和分离好肠系膜上血管的。Objective： To provide anatomic data of superior mesenteric vessels for laparoscopic pancreatoduodenectomy （LPD）. Methods： Superior mesenteric vessels were studied in 10 cases of abdominal specimen fixed with 10% formalin and in 2 cases of fresh （ ≤24h）cadavers, and then LPD were simulated on those specimens. Re,tits： （1）The mean length of superior mesenteric vein （SMV）before the third part of duodenum, along with uncinate process of pancreas head, behind the cervix of pancreas and over pancreas were （3.80±0.72）cm, （ 1.76±0.25）cm, （3.81±0.64）cm and （ 4.73 ±1.31 ）cm, respectively. （2）There were six types of right gastroepiploic vein＇s flowing into SMV. （3） Superior mesenteric artery （SMA）originated from abdominal aorta at an average distance of （1.12±0.15）cm from coeliac trunk. The mean caliber and length of superior mesenteric artery were （0.69±0.03）cm and （3.97 ±0.54）cm, respectively. There were five types of inferior pancreaoduodenal artery and the first jejunal artery＇s originating from SMA. Conclusions： （1） Right gastroepiploic vein is a good landmark for seeking superior mesenteric vein during laparoscopic pancreatoduodenectomy. （2） To dissect superior mesenteric vein and artery should be undergone through left and right trocar respectively. （3） It is feasible to seek and dissect superior mesenteric vessels during laparoscopic pancreatoduodenectomy if making use of amplification effect of laparoscopy and spliting effect of ultrasonic dissector.

关 键 词：腹腔镜 胰十二指肠切除术 肠系膜上血管 解剖 

分 类 号：R323.3[医药卫生—人体解剖和组织胚胎学] R656[医药卫生—基础医学]