十二指肠乳头肿瘤局部切除术应用解剖  

Applied Anatomy of Local Resection of Duodenal Papillary Neoplasm

作　　者：刘云建[1] 张韧[2] 汪谦[3] 陈强谱[1] 周希环[1] 

机构地区：[1]滨州医学院附属医院肝胆外科,山东滨州256603 [2]中山大学中山医学院解剖学教研室 [3]中山大学附属第一医院肝胆外科

出　　处：《解剖与临床》2008年第5期319-321,共3页Anatomy and Clinics

摘　　要：目的:为十二指肠乳头部肿瘤局部切除术提供解剖学资料。方法:50例正常成人腹部标本,解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度,胆总管与胰管的夹角,肝胰壶腹区的血管分布,十二指肠大乳头位置、乳头小孔开口位置、胆胰管开口形式等。结果:肝胰壶腹和十二指肠乳头区的营养动脉平均为2.2支,均来源于胰十二指肠上动脉、下动脉,其中肝胰壶腹和十二指肠乳头区9-12点钟处的营养动脉出现率为45.9%(50支)。胆总管、胰管、壶腹末端的长度分别为(32.1±8.7)mm、(9.9±4.1)mm、(12.6±2.8)mm;宽度分别为(7.3±2.1)mm、(3.2±0.7mm)、(7.3±1.2)mm。胆总管和胰管之间的夹角平均为35.6°。十二指肠大乳头位于十二指肠降部上1/3段占8.45%±4.39%,中1/3段占72.33%±6.72%,下1/3段占19.22%±4.12%;乳头小孔开口于十二指肠纵襞占74.3%±6.68%。有十二指肠小乳头占41.43%±3.65%。胆胰管开口呈V型占37.1%±7.43%,Y型占62.9%±6.32%。结论:本实验结果为临床在十二指肠乳头部肿瘤切除过程中选择切开部位和切开深度等提供了解剖学依据,对防止术后并发症具有重要意义。Objective： To provide anatomic data for local resection of duodenal papillary neoplasm. Methods： The lengths and widths of eholedochus, pancreatic duct, ampulla hepatopancreatica and mamillary region, the angle between choledoehus and pancreatic duct, the distribution of blood vessels in ampulla hepatopanereatica region, the location of duodenal papilla, the opening of minor duodenal papilla, the opening of pancreatic duct, ere, were dissected and observed on 50 cadavers. Results ： There were average 2.2 arterial branches to the papillae of Santorini and Vater＇ s ampulla. They all originated from the superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery, and 45.9% of them appeared between nine and twelve points as in an o＇ clock. The lengths of eholedoch, pancreatic duct and Vater＇ s ampulla were （32.1±8.7） mm, （9.9±4.1 ）mm and （ 12.6±2.8 ） ram, respectively. The corresponding widths were （ 7.3±2. 1 ） ram, （ 3.2±0. 7 ） mm,and （7.3±1.2）mm, respectively. The mean angle between choledoch and pancreatic duct was 35.6° （ ranged from 20° to 45°）. The 8.45% ±4.39% of duodenal papilla located at upper 1/3 segment of descendant duodenum,72.33%±6.72% at medium 1/3 segment, and 19.22% ± 4.12% at lower 1/3 segment. The Nipple eyelet opening at longitudinal fold of duodenum accounted for 74.3%±6.68%. The cases possessing minor duodenal papilla accounted for 41.43%±3.65%. The cases whose openings of bile duct and pancreatic duct forming ＂V＂ shape occupied 37.1% ± 7.43% , and ＂Y＂ shape occupied 62.9% ± 6.32%. Conclusions： This study provides morphological bases for choosing site and depth of resection in the treatment of duodenal papillary neoplasm, and should benefit preventing from postoperative complications.

关 键 词：肝胰壶腹 胆总管 胰管 十二指肠乳头 肿瘤 

分 类 号：R735.31[医药卫生—肿瘤]