十二指肠空肠曲解剖学观察及临床意义

Anatomical observation and its clinical significance of duodenum-jejunum bend

目的:观察与研究十二指肠空肠曲和Trietz韧带解剖变异的临床意义。方法: 吸取前瞻性总结通过再次手术治愈2例BillrothⅡ式胃大部分切除术后十二指肠高度扩张的经验与教训,指导在以后的151例同类手术中对十二指肠空肠曲及Trietz韧带的解剖学观察。结果:151例中,147例十二指肠空肠曲位于脊柱前正中位置,相当于11、12胸椎平面,不论输入襻空肠对吻胃大弯还是胃小弯,术后均无十二指肠扩张。4例十二指肠空肠曲解剖变异中,借鉴本文报告2例的临床经验与教训,慎重选择输入襻空肠是对吻胃大弯还是胃小弯,术后亦无并发症。结论:在BillrothⅡ式胃大部分切除术中,认真观察每一例十二指肠空肠曲和Trietz韧带有无解剖位置变异和其它异常情况(异位胰腺、空肠憩室)等,对胃大部分切除术中胃空肠吻合方式选择有一定的临床意义。

Objective: To study anatomical variance and the clinical significance of duodenum-jejunum bend and Treitz ligament. Methods: To summarize the experience that severe dilatation occurred on duodenum in 2 cases after subtotal gastrectomy(Billroth II Method), and observe the anatomical characteristics of duodenum-jejunum bend and Treitz ligament in 151 cases at the same operation. Results: Regardless of importing jejunum anastomosized with the big or small bend of the stomach, there was no duodenum dilatation in 147 cases in which duodenum-jejunum bend located in the ante-centric position of spine and corresponded with the plane of 11, 12 vertebra thoracalis. There were no sequelae in 4 patients having anatomical variance after selecting operation style cautiously according to our clinical experience. Conclusions: For selecting stomach-jejunum inosculate manner correctly, it is essential to observe the anatomic variance of duodenum-jejunum bend, Treitz ligament and other viscera.