远端胰腺联合腹腔干切除术解剖的影像学分析

An imaging analysis on anatomy of distal pancreatectomy with resection of celiac axis

目的分析腹腔干各分支动脉血管成像(CTA)的形态学特征。方法收集88例肝脏或胰腺疾病患者腹部CTA的影像学资料,分析腹腔干各分支的起源、行径、变异和侧支血管吻合情况。结果 88例CTA影像资料中均能看到胰十二指肠动脉吻合弓的存在。其中,肝动脉发生变异23例,变异率26.14%。结论胰十二指肠动脉弓是人体内固有的解剖结构,切除腹腔干后,经该动脉弓可通过肠系膜上动脉提供肝脏动脉血供,这为施行远端胰腺联合腹腔干切除术(Appleby术)提供了解剖学依据。但在本研究中的Ⅱ型、Ⅳ型、Ⅴ型、Ⅵ型腹腔干,由于发出替代性肝左动脉的胃左动脉、肝总动脉或腹腔干均被手术切除,可能对术后左肝的血供造成影响。

Objective To analyze the mophological characteristics of computed tomography angiography（CTA）of the artery branches of the coeliac trunk.Methods Imaging data of 88 cases with diseases of liver or pancreas underwent CTA were collected and the origin,travel path,variation and collateral vessels anastomosis of celiac artery branches were analyzed.Results The pancreatoduodenal arterial arcades were identified on CTA in all cases.The variation of the hepatic artery was seen in 23 cases with a variation rate of 26.14%.Conclusion The pancreatoduodenal arcades are the inherent structures of human being.The blood supply of the liver after the resection of the celiac axis during Appleby surgery can be compensated by the superior mesenteric artery via pancreatoduodenal arcades,which provides an anatomical basis for Appleby surgery.But the blood supply of the left liver after operation may be affected in the artery branches of the coeliac trunk identified as the types ofⅡ,Ⅳ,Ⅴ and Ⅵ following the resection of the left gastric artery,common hepatic artery or celiac axis,which forming the alternative left hepatic artery.