胰十二指肠区火棉胶包埋薄型化断层解剖的研究

Study on collodion-embedded thin sectional anatomy of the pancreaticoduodenal region

目的:应用火棉胶包埋胰十二指肠区,行薄型化水平断层切片,为影像学检查和临床各科诊疗提供形态学依据。方法:选取腹部脏器无明显病变的成人尸体12例,进行胰十二指肠区标本取材,采用火棉胶包埋法做连续水平断层切片,片厚0.5mm。另选健康志愿者10名做上腹部CT薄层扫描,对照研究该区域的结构及毗邻关系。结果:在层厚0.5mm的连续水平断层切片上,每例平均约有110个有效的观察层面。胰头位于十二指肠降部的左前方,其最大前后径为(29.23±1.02)mm,最大左右径为(36.60±5.48)mm,钩突最大前后径(14.76±2.12)mm,最大左右径为(37.89±2.47)mm;胰管在肠系膜上静脉右缘突然转向后,走行在胰头靠后部,主胰管在胰头部管径为(4±2.1)mm;胆总管下段走行在胰十二指肠沟中,后边可有胰腺组织覆盖;十二指肠乳头在十二指肠降部中1/3处占67%。多层螺旋CT水平断层图片可以清楚显示该区域组织器官的毗邻关系,胰头与钩突结构清晰可见,但是胰管和胆管在不扩张的情况下显示欠佳。结论:在水平断面上,十二指肠乳头形态及胰胆管汇合处清晰可见;肠系膜上静脉是区分胰头和胰颈的标志,肠系膜上动脉可作为判断胰头钩突是否增大的标志。该实验可为组织分辨率更高的影像学检查和临床各科诊疗提供实用的解剖学依据。

Objective： To make thin cross-sectional anatomy of the pancreaticoduodenal region by using collodion-embedded method and provide anatomy data for the imaging and clinical diagnosis and treatment of the diseases of the pancreaticoduodenal region. Methods： The conformation, adjacency, and size of the region on the sectional planes were investigated using 12 sets of serial cross section of uper abdomen of Chinese adult cadavers without significant lesion, and CT cross-sectional images of the abdomen were observed in 10 Chinese adult healthy volunteers. Results： At 0.5mm thickness of continuous cross sectional planes, pancreas appeared on average 110 levels.The pancreatic head was located on the left and anterior of the descending part of the duodenum, its maximal superoinferior, and maximal left and right diameters was （29.23±1.02） mm and （36.60±5.48） mm respectively. The uncinate process＇ maximal superoinferior, and maximal left and right diameters was （14.76±2.12） mm and （37.89±2.47） mm respectively. The pancreatic duct went to the back of the pancreatic head suddenly at the right side of the superior mesenteric vein, its diamiter was about （4±2.1） mm; The lower segment of the choledochal went through the pancreaticoduodenal groove and sometimes was covered by pancreatic tissue. The duodenal papilla was situated the medium 1/3 of the descending part of the duodenum for about 67%. The multiple spiral CT could show the adjacency of this area, the pancreatic head and the uncinate process clearly, but the pancreatic duct and common bile duct were hardly to see without dilatation. Conclusion： On the cross-section anatomy, the shape of the duodenum and the convergence of the cholangiopancreatography are easily to distinguish; The superior mesenteric vein is a landmark to identify the pancreatic head and neck; The superior mesenteric artery is a sign to evaluate the uncinate process augmentated or not. This study may provide anatomy data for the imaging examination and clinical diagnoses and treatment.