胰头与十二指肠的血供关系及其临床意义  

Blood supply to the head of the pancreas and the duodenum and its clinical application

作　　者：殷永芳[1] 许继凡[1] 郭涛[1] 戴珏[1] 罗诗樵[1] 孙善全[2] 

机构地区：[1]重庆医科大学附属第一医院肝胆外科 [2]重庆医科大学基础医学国家级示范中心大体解剖实验室,重庆400016

出　　处：《中国临床解剖学杂志》2013年第6期655-658,共4页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金(30972789)

摘　　要：目的了解胰头及十二指肠的血管走行,为在DPPHR术中如何保护十二指肠的血供及是否行Kocher操作提供更多的形态学资料。方法随机选取40具尸体,充分解剖暴露肠系膜上动脉、胃十二指肠动脉及胰十二指肠前后动脉弓,对供应十二指肠的动脉及伴行的静脉行径进行仔细观察和记录。结果在97.5%的标本中(n=39),胰十二指肠后动脉弓及伴行的静脉均位于胰后筋膜内;在90%的标本中(n=36),胰十二指肠下前动脉及伴行的静脉走行于胰十二指肠沟内,易于保留;在个别标本中(10%,n=4),没有完整的胰十二指肠前动脉弓;其中1例标本(2.5%,n=1),没有完整的胰十二指肠后动脉弓,但供应十二指肠的动脉及其伴行静脉仍位于胰后筋膜内。结论 DPPHR手术的关键在于保留胰十二指肠后动脉弓,同时尽可能地保留部分胰十二指肠前动脉弓,而Kocher操作有利于保护胰十二指肠后动脉弓;在个别标本中,没有完整的胰十二指肠前动脉弓,此时施行DPPHR可能伤及十二指肠血供,导致手术失败。Objective To study blood supply to the head of the pancreas and the duodenum, and provide anatomical basis for Kocher maneuver and protecting vessels of the duodenum during duodenum preserving pancreatic head resection （DPPHR）. Methods A total of 40 cadavers were collected for the study. The superior mesenteric artery, the gastroduodenal artery, the anterior pancreaticoduodenal arterial arcade, the posterior pancreaticoduodenal arterial arcade,their branches and accompanying veins were completely exposed. The arterial branches between the head of the pancreas and the duodenum were observed. Results For 97.5% cases （n=39）, the posterior pancreaticoduodenal arterial arcade and accompanying veins were found in pancreatic fascia. For 90% cases （n=36）, it was easy to preserve the anterior inferior pancreaticoduodenal artery and accompanying veins lied in the pancreaticoduodenal groove. For 10% cases （n=4）, the anterior pancreaticoduodenal arterial arcade was absent, and 2.5% （n=1） was absent for the posterior pancreaticoduodenal arterial arcade, but the arteries to the duodenum and their accompanying veins were found in pancreatic fascia. Conclusions Protecting the posterior pancreaticoduodenal arterial arcade and the part of the anterior pancreaticoduodenal arterial arcade are the key process for successful DPPHR. Kocher maneuver helps to expose and identify the posterior pancreaticoduodenal arterial arcade and drainage veins. The failure of DPPHR maybe caused by the absence of the anterior pancreaticoduodenal arterial arcade.

关 键 词：保留十二指肠的胰头切除术 胰十二指肠前动脉弓 胰十二指肠后动脉弓 Kocher操作 

分 类 号：R323.3[医药卫生—人体解剖和组织胚胎学]