中国普通外科杂志 ›› 2021, Vol. 30 ›› Issue (3): 313-320.doi: 10.7659/j.issn.1005-6947.2021.03.009

• 临床研究 • 上一篇    下一篇

国人胰背动脉、胰十二指肠下动脉的CT解剖观察

杨英,刘戬,王旭,徐同江,刘建新,尹晓明   

  1. (应急总医院 影像科,北京 100028)
  • 收稿日期:2020-12-11 修回日期:2021-02-12 出版日期:2021-03-25 发布日期:2021-04-06
  • 通讯作者: 尹晓明, Email: yinxiaoming_1971@aliyun.com
  • 作者简介:杨英,应急总医院主治医师,主要从事体部CT、MRI影像诊断方面的研究。

CT-based anatomical features of dorsal pancreatic artery and inferior pancreaticoduodenal artery in Chinese

YANG Ying, LIU Jian, WANG Xu, XU Tongjiang, LIU Jianxin, YIN Xiaoming   

  1. (Department of Medical Imaging, Emergency General Hospital, Beijing 100028, China)
  • Received:2020-12-11 Revised:2021-02-12 Online:2021-03-25 Published:2021-04-06

摘要: 背景与目的:胰腺切除手术复杂,术中意外出血风险较大。术前精准评估胰腺周围血管起源、走行有助于降低术中出血风险。目前,尚缺乏对国人胰周血管解剖的系统性研究。本研究目的在于探明国人胰背动脉(DPA)及胰十二指肠下动脉(IPDA)的解剖学特点,并探索最佳CT图像后处理方式。
方法:收集2016年12月—2017年6月行腹部增强CT检查的患者影像学资料,进行多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)等技术处理,得到动脉期胰腺直接供血动脉的图像,由两名有经验并熟悉胰腺血管解剖的放射科医师观察DPA及IPDA,内容包括DPA及IPDA支数、发出部位、与上级血管根部的距离,并比较不同的CT后处理技术对相应血管的检出率。
结果:期间共有762例患者行腹部增强CT检查,结合入组与排除标准,211例患者纳入研究,其中男性98例,女性113例;年龄16~92岁;BMI 17.5~35.2 kg/m2。全组患者,DPA及IPDA检出率分别为95.3%及96.2%。58.7%的DPA来源于腹腔干(CA),其中,发自脾动脉者占49.1%(58/118),发出部位距离根部平均距离为4.6(2~10)mm;发自肝动脉者占39.8%(47/118),发出部位距离根部平均距离为6.4(2~10)mm;发自CA分叉部者及本身者分别占6.8%(8/118)及4.2%(5/118)。41.3%的DPA来自肠系膜上动脉(SMA),发出部位通常在SMA的9~12点位(94.0%,78/83),距离SMA根部平均距离为26(18~45)mm。各有171例(84.2%)、29例(14.3%)及3例(1.5%)分别存在1支、2支或3支IPDA。根据IPDA与第一空肠动脉(FJA)的关系,可将其分为共干发出、分别发出2种类型。IPDA与FJA共干发出者约占60.1%(122/203),发出部位通常位于SMA的4~7点位(75.4%,92/122),距离SMA根部的平均距离为42(18~54)mm。约39.9%的IPDA自接发自SMA,发出部位通常位于SMA的6~9点位,距离SMA根部平均距离为40(18~52)mm。共有10.4%(22/211)可见IPDA与DPA共干。1 mm重建、MIP及VR技术对DPA的显示率分别为93.8%(198/211)、95.3%(201/211)、94.3%(199/211),明显优于3 mm(81.5%,172/211)或5 mm(68.7%,145/211)重建(均P<0.01);对IPDA的显示率分别为94.8%(200/211)、96.2%(203/211)、94.8%(200/211),明显优于3 mm(78.2%,165/211)或5 mm(67.3%,142/211)重建(均P<0.01)。
结论:DPA与IPDA起源、走行复杂,术前1 mm CT重建可明确其解剖学特征,有助于术中对相关血管的解剖,减少意外损伤风险。

关键词: 胰腺, 血管, 解剖变异, 体层摄影术

Abstract: Background and Aims: Pancreatectomy is a complex procedure with a high risk of accidental intraoperative bleeding. Accurate preoperative assessment of the origin and running course of the peripancreatic vessels is helpful to reduce the risk of intraoperative bleeding. There is still lacking systematic study of the anatomy of peripancreatic vessels in Chinese population. The purpose of this study is to ascertain the anatomical characteristics of the dorsal pancreatic artery (DPA) and the inferior pancreaticoduodenal artery (IPDA) in Chinese, and further to explore the best post-processing method of CT images.  
Methods: The imaging data of patients who underwent abdominal enhanced CT examination from December 2016 to June 2017 were collected for multiplanar reconstruction (MPR), maximum intensity projection (MIP),  volume rendering (VR) and so on. The data of the DPA and IPDA were observed by two experienced radiologists who are familiar with the anatomy of pancreatic vessels, and the observed variables included the number of branches of the DPA and IPDA, the location of the origin, and the distance from the root of superior vessels. The detection rates of different CT post-processing techniques for corresponding vessels were also compared. 
Results: During the period, a total of 762 patients underwent abdominal enhanced CT examination. According to the inclusion and exclusion criteria, 211 patients were enrolled, including 98 males and 113 females, with age from 16 to 92 years, and BMI from 17.5 to 35.2 kg/m2. In the whole group of patients, the detection rates of the DPA and IPDA were 95.3% and 96.2%, respectively. The DPA arising from the celiac trunk (CA) accounted for 58.7%. Among them, 49.1% (58/118) originated from the splenic artery, and the average distance from the origin to the root was 4.6 (2–10) mm; 39.8% (47/118) were derived from the hepatic artery, and the average distance from the origin to the root was 6.4 (2–10) mm; in addition, 6.8% (8/118) and 4.2% (5/118) of the DPA came from the bifurcation of the CA and CA itself, respectively. The DPA arising from the superior mesenteric artery (SMA) accounted for 41.3%, and their origin sites were mostly located at the 9–12 points of the SMA (94.0%, 78/83), and the average distance from the root of SMA was 26 (18–45) mm. There were 171 cases (84.2%), 29 cases (14.3%) and 3 cases (1.5%) had one, two or three IPDA, respectively. According to the relationship between IPDA and the first jejunal artery (FJA), they were classified as common trunk or separate independent origins with the FJA. About 60.1% (122/203) of IPDA and the FJA originated from the same trunk. The root of IPDA usually located at 4–7 points of the SMA (75.4%, 92/122). The average distance from the root of SMA was 42 (18–54) mm. About 39.9% of the IPDA originated from the SMA directly, which was usually located at 6–9 points of the SMA, with an average distance of 40 (18–52) mm from the root of the SMA. A total of 10.4% of the IPDA (22/211) had the common trunk with the DPA. The display rates of 1-mm reconstruction, MIP and VR for DPA were 93.8% (198/211), 95.3% (201/211) and 94.3% (199/211) respectively, which were significantly better than those of 3 mm (81.5%, 172 / 211) or 5 mm (68.7%, 145/211) reconstruction (all P<0.01), and for IPDA were 94.8% (200/211), 96.2% (203/211) and 94.8% (200/211) respectively, which were also significantly better than those of 3 mm (78.2%, 165/211) or 5 mm (67.3%, 142 / 211) reconstruction (all P<0.01).
Conclusion: The origins and running courses of the DPA and IPDA are complex. Preoperative 1 mm CT reconstruction can clarify the anatomical characteristics of the DPA and IPDA, which is helpful for the dissection of related vessels and reducing the risk of accidental injury. 

Key words: Pancreas, Blood Vessels, Anatomic Variation, Tomography

中图分类号: 

  • R657.5
[1] 韩仕锋, 金春风, 朱磊. 预后指数在可切除胰腺导管腺癌患者术后评估中临床价值[J]. 中国普通外科杂志, 2021, 30(3): 247-253.
[2] 秦雯, 陈泰文, 郑海平, 杨建宇, 朱小东. 血清ANGPTL2与胰腺癌临床病理特征的关系及其在胰腺癌诊断中的价值[J]. 中国普通外科杂志, 2021, 30(3): 254-260.
[3] 刘向梅, 许达峰, 王春玲, 符于正, 王丹, 武金才. NIMA相关激酶2在胰腺癌中的表达及其临床意义[J]. 中国普通外科杂志, 2021, 30(3): 269-275.
[4] 李铭旭, 仲成成, 张功铭, 胡伟, , 王仲, . DEP结构域蛋白质1B在胰腺癌中的表达及其临床意义[J]. 中国普通外科杂志, 2021, 30(3): 261-268.
[5] 张波, 徐涛, 徐浩, 夏雨, 周文策, . 基于生物信息学胰腺腺癌关键基因的筛选及支持向量机诊断模型的构建[J]. 中国普通外科杂志, 2021, 30(3): 276-285..
[6] 秦亚飞, 霍星光, 李秋霞, 徐玉生. 骨髓间充质干细胞对急性重症胰腺炎大鼠的炎症抑制作用及对TLR4/NF-κBp65通路的关系[J]. 中国普通外科杂志, 2021, 30(3): 294-304.
[7] 李臻, 张晓英, 杨国栋. p38MAPK抑制剂对高脂血症性急性胰腺炎大鼠肠道微生物区系的影响[J]. 中国普通外科杂志, 2021, 30(3): 286-293.
[8] 杨熊, , 刘若鸿, 谢川, , 董鸿斐, 吴俊, 孙红玉, 汤礼军. 早期腹腔穿刺引流对重症急性胰腺炎肾损伤的保护作用[J]. 中国普通外科杂志, 2021, 30(3): 321-329.
[9] 李威威, 刘金龙. 循环肿瘤DNA在胰腺癌中的临床应用进展[J]. 中国普通外科杂志, 2021, 30(3): 337-342.
[10] 谢学文, 费书珂. 中性粒细胞胞外诱捕网与胰腺疾病的研究进展[J]. 中国普通外科杂志, 2021, 30(3): 343-348.
[11] 王蒲雄志, 于新哲, 史向军, 袁周 . 胰腺导管腺癌的免疫治疗研究进展 [J]. 中国普通外科杂志, 2021, 30(3): 330-336.
[12] 李文斌, 朱朝庚, 向兴华, 陈少丰, 成伟, 陈梅福, 李国光. 胰源性门静脉高压症的诊断和外科治疗:附20例报告[J]. 中国普通外科杂志, 2021, 30(3): 365-368.
[13] 张帆, 李泽东, 彭禹, 陈胜, 周钧. 基于血清miRNA表达数据的胰腺癌诊断决策树构建[J]. 中国普通外科杂志, 2021, 30(2): 211-218.
[14] 肖鸣, 李灿, 陈英茂, 邵明哲, 项灿宏, 王良, 黄鑫, 孙爱军, 王开宇. 原发性肝癌机械性压迫对邻近肝组织功能的影响[J]. 中国普通外科杂志, 2021, 30(1): 16-23.
[15] 蔡翊, 李国光, 成伟, 陈梅福, 朱朝庚, 谢阳云, 姚佳水. 小切口联合肾镜治疗重症急性胰腺炎合并胰周感染坏死:附30例报告[J]. 中国普通外科杂志, 2021, 30(1): 111-116.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 李宇,郝杰,孙昊,王林,仵正,王铮,陶杰,杨雪. 一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较[J]. 中国普通外科杂志, 2016, 25(2): 202 -208 .
[2] 肖卫星,周君,顾梦佳,肖广远. 精准肝切除在肝内胆管结石手术治疗中的应用[J]. 中国普通外科杂志, 2016, 25(2): 191 -196 .
[3] 徐安书1|傅朝春1|韦萍1|王峻峰2|刘煜1|付彪1|张世博1|邓大波1|杨晓宾1|陈会彬1. 3D打印技术在精准切除治疗肝脏肿瘤中的应用[J]. , 2018, 27(1): 29 -34 .
[4] 白宁1, 2|王栋2|欧阳锡武2|周乐杜2|王志明2. 苦参碱对大鼠肝缺血再灌注损伤的抑制作用及机制[J]. , 2018, 27(1): 81 -86 .
[5] 王烁, 陈波, 苗雄鹰. 谷胱甘肽过氧化物酶1在肝癌组织中的表达及其意义的生物信息学分析[J]. 中国普通外科杂志, 2019, 28(2): 179 -187 .
[6] 黄隽, 胡元萍, 陈创, 齐晓伟. 新型冠状病毒肺炎疫情特殊时期对乳腺癌治疗临床问题的若干思考[J]. 中国普通外科杂志, 2020, 29(2): 153 -160 .
[7] 廖信芳1,李正荣2,杨清水1,张乡城2, 李柱1,揭志刚2. microRNA-139-5p及其靶基因Notch1在结直肠癌中的作用[J]. 中国普通外科杂志, 0, (): 1373 -1378 .
[8] 项灿宏|童翾 . 肝门部胆管癌外科治疗的进展与争议[J]. , 2018, 27(2): 137 -142 .
[9] 黄耿文|申鼎成|何文|杨柳|周书毅|阳建怡|纪连栋|魏伟. 快速康复模式下的腹腔镜腹股沟疝修补术[J]. , 2016, 25(10): 1470 -1474 .
[10] 王桂立1|韩思林2|王利新1. 经腹腔干-胃十二指肠弓逆向介入治疗肠系膜上动脉开口处完全闭塞无残端病变1例[J]. , 2017, 26(6): 699 -705 .