Kim S W, Kim K H, Jang J Y, Park S, Park Y H
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Hepatogastroenterology. 2001 Jan-Feb;48(37):264-9.
BACKGROUND/AIMS: The purpose of this study was to create a practical guideline for vascular preservation during duodenum-preserving resection of the head of the pancreas.
We examined the anatomy of pancreaticoduodenal arteries by specimen angiography and dissection using 12 pancreaticoduodenectomy specimens. We also reviewed our experiences with duodenum-preserving resection of the head of the pancreas.
In the specimens, the posterior pancreaticoduodenal artery and its duodenal branches were easily separated from the posterior surface of the pancreas, and its papillary branch was identified in two-thirds of the cases. It was difficult to dissect the anterior superior pancreaticoduodenal arteries from the pancreas because they were partially buried in the pancreatic parenchyma. The anterior inferior pancreaticoduodenal artery located in the posterior and inferior surface of the pancreas could be safely dissected in two-thirds of the cases. Duodenum-preserving resection of the head of the pancreas was performed in 7 patients. In every case, the anterior superior pancreaticoduodenal artery was sacrificed and the anterior inferior pancreaticoduodenal artery was preserved. In 3 cases, the entire posterior pancreaticoduodenal artery was preserved and in 4 cases a short segment of the posterior pancreaticoduodenal artery was removed accidentally. The pancreatic head was totally removed and the intrapancreatic common bile duct was preserved. There were 3 postoperative complications, pancreatic leakage, intraabdominal fluid collection and bile duct stricture. They improved with conservative management.
To safely perform duodenum-preserving resection of the head of the pancreas, preservation of the whole posterior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery is recommended because they can be safely dissected from the pancreas, and the posterior pancreaticoduodenal artery provides the major blood supply to the papilla and distal bile duct. However, removal of a short segment of posterior pancreaticoduodenal artery does not preclude a good blood supply to the duodenum because of bidirectional blood flow.
背景/目的：本研究旨在制定一份在保留十二指肠的胰头切除术中进行血管保留的实用指南。
我们通过标本血管造影和解剖，使用12个胰十二指肠切除术标本研究了胰十二指肠动脉的解剖结构。我们还回顾了我们在保留十二指肠的胰头切除术中的经验。
在标本中，胰十二指肠后动脉及其十二指肠分支很容易从胰腺后表面分离，其三分之二的病例中可识别出其乳头分支。由于胰十二指肠上前动脉部分埋于胰腺实质内，因此很难从胰腺上分离。位于胰腺后下表面的胰十二指肠下前动脉在三分之二的病例中可安全分离。对7例患者进行了保留十二指肠的胰头切除术。在每例手术中，均牺牲了胰十二指肠上前动脉并保留了胰十二指肠下前动脉。3例患者保留了完整的胰十二指肠后动脉，4例患者意外切除了一小段胰十二指肠后动脉。胰头被完全切除，胰内胆总管得以保留。术后有3例并发症，即胰瘘、腹腔积液和胆管狭窄。经保守治疗后病情好转。
为安全地进行保留十二指肠的胰头切除术，建议保留整个胰十二指肠后动脉和胰十二指肠下前动脉，因为它们可安全地从胰腺上分离，且胰十二指肠后动脉为乳头和远端胆管提供主要血供。然而，由于存在双向血流，切除一小段胰十二指肠后动脉并不排除十二指肠有良好的血供。
