腹腔镜胰十二指肠切除术钩突部位动脉解剖研究  

Applied anatomy of the blood supply of the uncinate process in laparoscopic pancreatoduodenectomy

作　　者：王巍[1] 姜翀弋[1] 陈寅涛[1] 戴正寿[2] 袁祖荣[1] 

机构地区：[1]复旦大学附属华东医院普外科胰腺肝胆疾病诊疗中心微创外科中心,上海200040 [2]复旦大学上海医学院解剖教研室,上海200032

出　　处：《中国实用外科杂志》2016年第2期206-209,213,共5页Chinese Journal of Practical Surgery

基　　金：上海市科委资助课题(No.14411966300)

摘　　要：目的探讨胰腺钩突部血供来源与走行,为腹腔镜胰十二指肠切除术(LPD)钩突部位动脉处理提供解剖学依据。方法选择13具无腹部器官病变的成人尸体,在复旦大学上海医学院解剖教研室进行胰腺血管的解剖学研究。其中甲醛溶液防腐处理的12具尸体行大体解剖,另1具新鲜尸体行动静脉管道铸型研究。另选择复旦大学附属华东医院胆胰外科中心2014年1-12月收治的12例行LPD病人,术中观察钩突部动脉分布情况。结果 (1)胰背动脉分为左右两支,左支向左延续为胰横动脉,右支供应胰腺钩突部位。(2)从腹侧观察,胰背动脉右支在胰腺钩突部约4点钟方向分为上下两支,于8点钟处上下两条分支又汇合形成完整动脉闭合环路。该动脉环分别与肝总动脉及胰十二指肠动脉弓形成丰富吻合支。(3)12例LPD中,6例术中发现胰背动脉及其分支走行。4例(66.7%)来源于脾动脉,2例(33.3%)来源于肠系膜上动脉。结论胰头钩突由胰十二指肠动脉弓与胰背动脉右支来源的钩突动脉环同时供血,并形成丰富的交通支;LPD术中处理钩突时,应注意胰背动脉右支及钩突动脉环发出的交通支以降低大出血风险。Objective To investigate the origin and distribution of arteries in the uncinate process, and provide precious anatomy structure of the blood supply of the uncinate process for laparoseopic pancreatoduodenectomy （LPD）. Methods Twelve cases of cadaver specimen fixed with formaldehyde and 1 cases of fresh casting mold specimen of pancreatic vessels allied with pancreatic duct were studied for the blood supply of the uncinate process of pancreas in Department of Anatomy, Shanghai Medical College of Fudan University. The distribution of dorsal pancreatic artery （DPA） of 12 cases of LPD performed between January 2014 and December 2014 in Pancreato-Biliary Clinical Center, Huadong Hospital, Fudan University were also observed in operations. Results （ 1 ）The right branch of DPA distributes to the uneinate process. （2） From ventral aspect, the right branch of the DPA was divided into two smaller branches at four o＇ clock. And those two branches anastomosed with each other at eight o＇ clock, which formed a closed arterial loop in the uneinate process. The arterial loop communicated with the common hepatic artery and the pancreaticoduodenal arterial arcade by hub-and-spoke arterial anastomosis. （3） In 12 eases of LPD, 4 cases （66.7%） of DPA originated from the splenic artery and 2 eases （33.3%） from superior mesenteric artery. Conclusion The uneinate process is supplied by the pancreaticoduodenal arterial arcade and the right branch of DPA, and they communicate with each other by hub-and-spoke arterial anastomosis in the uncinate process. In order to decrease the risk of bleeding in LPD procedure, the surgeons should pay attention to the right branch of DPA and the anastomosed branches from the uncinate process arterial circle.

关 键 词：胰腺动脉 钩突 临床解剖学 胰十二指肠切除术 

分 类 号：R6[医药卫生—外科学]