四种方法系统研究胰头的动脉分布及其临床意义.DOCVIP

胰头动脉分布解剖学研究及其临床意义 姜文浩1 ，赵玲辉2 （1北京市回民医院肿瘤科，北京100021；2哈尔滨医科大学解剖教研室，哈尔滨150086） 摘要 目的：观察胰头动脉的分布及血液供应，并对胰头的血管分布规律及临床意义进行阐述。方法：24例成人尸体标本和4例儿童尸体标本采用甲醛固定、动脉乳胶灌注、ABS动脉铸型3种方法、22例临床血管造影检查者采用数字减影血管造影(DSA)系统地对胰头动脉分布和血液供应进行解剖学观察。结果：胰十二指肠上前动脉出现率为100%，起源于胃十二指肠动脉，发出分支到十二指肠和胰头供应血液；胰十二指肠上后动脉出现率为98%，起源于胃十二指肠动脉者占96%。供血范围与胰十二指肠上前动脉基本一致。在走行过程中与胆总管之间有着螺旋盘绕关系；胰十二指肠下前动脉和胰十二指肠下后动脉出现率均为100%，起源于肠系膜上动脉、空肠动脉，起点变异较大。血液供应至胰头下1/3部分和邻近的十二指肠。结论：胰十二指肠上后动脉血供丰富，且与胆总管螺旋盘绕，临床手术中应加以注意；胰十二指肠下前、后动脉单独或共干起源于空肠动脉应在其进入胰头前，于钩突的左缘处结扎，避免误扎空肠动脉。 关键词： 胰头；动脉分布；应用解剖；动脉灌注；动脉铸型；数字减影中图法分类号：R322.491 文献标识码：A Study of the arterial supply of head of pancreas and its clinical significance Abstract Objective: The aim of this study was to clarify arterial supply and anatomic characteristics of arteries of the head of pancreas, and provide a series of definitive data of those arteries for the operation on pancreas and duodenum, as well as for arterial intubation and infusion therapy. Method: 24 adult specimen and 4 children specimen were dissected and observed by three methods, including formalin fixation, arterial emulsion perfusion and artery cast form, 22 patients were photographed by digital signature algorithm (DSA). These data were analyzed to recognize the arterial distribution of the head of pancreas and blood supply. Results: The results obtained from 4 methods showed as follow. The incidence of anterior superior pancreaticoduodenal artery was 100%. They are from the gastroduodenal artery and provide blood supply to the duodenum and head of pancreas by branches. The incidence of posterior superior pancreaticoduodenal artery was 98%. The arteries which are derived from gastroduodenal artery occupied 96%. The region of blood supply is similar to anterior superior pancreaticoduodenal artery. The main characteristic is that they coiled coil with common bile duct during the locomotion. The incidence of both anterior inferior pancreaticoduodenal artery and posterior inferior pancreaticoduodenal were 100% derived from a