内窥镜十二指肠大乳头取结石术的动脉应用解剖

Applied arterial anatomy of duodenal region under endoscopic operation of endo-removing calculus through major duodenal papilla

目的：为内窥镜十二指肠大乳头取结石术提供形态学基础。方法：25具尸体标本采用大体解剖方法，以十二指肠大乳头为中心，观察血管分布特点、测量管径及与十二指肠大乳头的最短距离，与肝胰壶腹人肠壁处的最短距离，与肝胰壶腹的最短距离；采用128排螺旋CT对5例新鲜胰十二指肠区标本进行扫描，并进行三维重建，记录十二指肠乳头区血管的空间位置关系。结果：胰十二指肠上前动脉在十二指肠大乳头（13．70±1．09）mm转向胰下方，与胰十二指肠下前动脉吻合成前动脉弓。胰十二指肠上后动脉在于距离十二指肠大乳头（1．12±0．09）mm处，再一次跨过胆总管移行为胰十二指肠下后动脉。胰十二指肠上后动脉距离十二指肠乳头为（14．8±6．45）mm；胰头前动脉弓最凸处位于十二指肠乳头处，距十二指肠大乳头（13．08±2．35）mm。胰头后动脉弓最凸处也位于十二指肠乳头处，距十二指肠大乳头（16．10±3．21）InlTl；十二指肠乳头动脉在胆总管右侧与之伴行进入十二指肠乳头部，起始处距离Vater壶腹（12．50±1．30）mm，直径为（O．42±0．05）mm；重建的三维图像可以直观形象地体现胰十二指肠区血管的空间位置关系，并可向各种方向任意旋转演示。结论：了解胰十二指肠区的血管分布和毗邻关系，对于内窥镜十二指肠大乳头取结石术的安全性具有重要临床意义。

Objective： To provide the morphological data for the operation of obtaining calculus through duodenal papilla. Methods： Anatomic observation on 25 duodenum and pancreas specimens were performed, and the blood vessel of carunculae major region was observed. CT was used to examine the anatomic relationship between carunculae major region and its blood vessel in 5 pancteatic specimens. Results： In the anterior superior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery, the head of the pancreas of the anterior artery arches was anastomosed; posterior superior pancreaticoduodenal antery stepped over bile commen duct in the distance to carunculae major being （16.10_--4-3. 21） mm and the distance from it to the major duodenal papilla was （14. 8_--＋- 6. 45） mn~ The most protruding of the head of the pancreas of the anterior and posterior artery arches were located in the carunculae major; their distance to major duodenal papilla were about （13. 08＋_2.35） mm and （16.10--＋-_3.21） mm. Carunculae major artery enter the carunculae major in right of board common bile duct; The initiation from the carunculae major artery to Vater bulb was about （12. 50＋_1.30） rnm and diameter was about （0. 42~0. 05） m~ 3D reconstructed models could perfectly display the relationship of the blood vessel of carunculae major region and rotate in every direction. Conclusions： The results Supply anatomical data of blood vessel of earunculae major region for the security in the anatomical surgery.