腹腔镜胰十二指肠切除术相关肠系膜上血管应用解剖学研究

Applied anatomy of superior mesenteric vessels associated with laparoscopic pancreaticoduodenectomy via uncinate process approach

目的:探讨肠系膜上血管的解剖特点,为钩突入路腹腔镜胰十二指肠切除术的实施提出可供参考的解剖学标志。方法:对4具成人尸体标本作解剖学观察,并分析96例上腹部64排螺旋CT血管成像资料与13例钩突入路腹腔镜胰十二指肠切除术的视频资料。结果:门静脉-肠系膜上静脉可分为3个部分,包括胰腺上段,左侧可有胃冠状静脉汇入(22.1%);胰腺段,有较多的属支汇入,主要有胃结肠干、胰十二指肠上后静脉、胰十二指肠下静脉等,并可有肠系膜下静脉汇入该段左侧(7.5%);十二指肠水平段,未见血管分支,且左侧与肠系膜上动脉紧密相邻。肠系膜上动脉在胰头十二指肠区域内走行于肠系膜上静脉的左后侧,胰十二指肠下动脉为其主要分支,另见有与第一空肠动脉共干起源者(33.0%)。肠系膜上动脉起源的替代肝右动脉2例(1.8%)。结论:充分认识肠系膜上血管及其相关血管的分布及走行对腹腔镜胰十二指肠切除术有重要的临床意义,肠系膜上静脉的十二指肠段可作为钩突入路的重要解剖标志。

Objective： To investigate the anatomical characteristics of the superiormesenteric vessels, so as to provide anatomical landmarks for reference during the performance oflaparoscopic pancreaticoduodenectomy （PD） with uncinate process approach. Methods： Anatomical dissection in 4 adult human cadaveric specimens was performed, and the image data of computed tomography angiography （CTA） for upper abdomen using CT from 96 cases and video data oflaparoscopic PD with uncinate process approach of 13 patients were analyzed. Results： Portal-superior mesenteric veins could be described as three portions that comprised the superior pancreatic portion, where the gastric coronary vein drained into its right side in some cases （22.1%）, the pancreatic portion, presenting as a confluence of several vein tributaries such as gastrocolic trunk, posterior inferior pancreaticoduodenal vein and posterior pancreaticoduodenal vein, and the inferior mesenteric vein was also seen draining into its left side （7.5%）, and the horizontal duodenal portion, where no vein branch was observed and the superior mesenteric artery was closely adjoined to the left side. The superior mesenteric artery was seen running alongside the superior mesenteric vein within the region of the head of the pancreas and the duodenum, with the inferior pancreaticoduodenal artery as its main branch, which was also found forming a common trunk with the first jejunal artery （33.0%）. Replaced right hepatic artery arising from the superior mesenteric artery was found in two cases （1.8%）. Conclusion： Adequate knowledge of the distribution and flowing courses of the superior mesenteric vessels and their associated vessels is of great clinical importance in laparoscopic PD, and the duodenal portion of superior mesenteric vein can be used as a main anatomical landmark for the uncinate process approach.