Vascular Anatomy of Mesopancreas in Pancreatoduodenectomy Using an Intestinal Derotation Procedure
Vascular Anatomy of Mesopancreas in Pancreatoduodenectomy Using an Intestinal Derotation Procedure
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DOI：
10.1007/s00268-020-05605-z
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发表时间：
2020-05-30
影响因子：
2.6
通讯作者：
Abe, Nobutsugu
中科院分区：
文献类型：
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作者：
Sugiyama, Masanori;Suzuki, Yutaka;Abe, Nobutsugu
背景胰腺切除术中的胰腺系膜切除技术复杂，因为胰腺系膜与下胰周血管的解剖结构复杂，这是由于胎儿期肠道旋转引起的。我们已经开发了一种新的动脉优先的方法（肠去旋转程序），以促进胰腺切除。本研究的目的是阐明去旋转后中胰腺的血管解剖。方法从腹膜后游离右半结肠和小肠，然后去旋肠袢。本文对136例去旋转法胰腺切除术中的中胰血管解剖进行了分析。结果去旋转后，解剖结构简化。中胰腺从上级肠系膜动脉（SMA）的右侧延伸，形成一个水平面。第一空肠干（FJT）与第二空肠动脉平行，位于SMA前方（91%）或后方（9%）。胰十二指肠下静脉（IPDV）进入FJT右侧（83%）或肠系膜上静脉（17%）。除IPDV外，89%的病例中有1 - 4条支流进入FJT的右壁。胰十二指肠下动脉起源于SMA的右壁，与第一空肠动脉共干（70%）或直接从SMA分支（29%）。结论在胰头切除术中，小肠去旋转简化了胰腺的解剖结构，显示了胰周下血管的解剖细节。
Background Mesopancreas excision in pancreatoduodenectomy is technically complicated because of the anatomical complexity of the mesopancreas with the inferior peripancreatic blood vessels which is caused by intestinal rotation in fetal life. We have developed a novel artery-first approach (the intestinal derotation procedure) for facilitating mesopancreas excision. The aim of this study was to clarify the vascular anatomy of the mesopancreas after derotation. Methods The right-sided colon and small intestine are mobilized from the retroperitoneum, and the intestinal loop is then derotated. In 136 cases of pancreatoduodenectomy employing the derotation procedure, we analyzed the vascular anatomy of the mesopancreas. Results After derotation, the anatomy was simplified. The mesopancreas extended from the right aspect of the superior mesenteric artery (SMA), forming a horizontal plane. The first jejunal trunk (FJT) was situated in parallel with the second jejunal artery and was anterior (91%) or posterior (9%) to the SMA. The inferior pancreaticoduodenal vein (IPDV) entered the right side of the FJT (83%) or the superior mesenteric vein (17%). Besides the IPDV, 1-4 tributaries entered the right wall of the FJT, in 89% of cases. The inferior pancreaticoduodenal artery was observed to originate from the right wall of the SMA, sharing a common stem with the first jejunal artery (70%) or branching directly from the SMA (29%). Conclusions Intestinal derotation simplifies the mesopancreas anatomy and reveals the anatomical details of the inferior peripancreatic blood vessels in pancreatoduodenectomy.