胰头部胰腺系膜的局部解剖及病理学研究

Local anatomical and pathologic study of the structure of mesopancreas

目的探讨胰腺系膜的解剖结构及病理学特征。方法解剖12例非腹部疾病死亡的尸体胰腺及其周围组织,整块获取标本,蜡块包埋并制作大切片,行相应解剖学、组织学及病理学研究;解剖2例死于不可切除的胰头癌尸体标本,进行病理学检查,并结合生前影像学综合评价胰腺系膜的病理学特点。结果胰腺系膜区域由胰腺头颈部背侧及钩突左侧缘开始,包绕腹腔动脉干及肠系膜上动脉,向左延伸为十二指肠及部分空肠系膜,向右延伸至主动脉-腔静脉平面,并与后腹膜相延续。该区域富含神经、血管、淋巴及脂肪等组织,无确切境界及纤维组织鞘包裹;胰头癌易致腹腔动脉干及肠系膜上动脉周围神经、血管、纤维组织浸润,导致肿瘤不可切除或切缘阳性。结论胰腺系膜不同于结直肠系膜,无独立的纤维组织鞘包绕;胰腺系膜更宜作为外科理念而非解剖学结构来指导临床实践。

Objective To investigate the anatomical and pathologic characteristics of mesopancreas.Methods A regional anatomical and pathological study was performed on 14 cadavers with large slices and paraffin sections with 12 normal samples and 2 samples from unresectable pancreatic cancer.Anatomical and pathological analysis were performed.Results Mesopancreas is a region that begins from the back of pancreatic head and neck and the left margin of uncinate process,then continues with mesentery of duodenum on the left and Gerota fascia via mesopancreatic root ontheright.The mesopancreatic root surrounded celiac trunk and superior mesentericartery containing vessels,nerves and other connective tissue.But no independent fiber sheath was found enveloping the sestructures.The tumor usually invaded inside the mesopancreas via nerves,vessels and fibers in the mesopancreatic root towards the retroperitoneum.Conclusion Mesopancreasis different from mesocolon and has no independent fascial envelop covered.Mesopancreas should be considered as a clinical concept rather than an anatomic structure to guide clinical practice.