Hagai Hideo
Department of Surgery, Jichi Medical School, Minami-Kawachi, Tochigi 329-0498, Japan.
J Hepatobiliary Pancreat Surg. 2003;10(1):48-56.
The structure of the adult human pancreas retains develop-mental traits in ontogenesis and comparative anatomy, under-standing of which greatly contributes to pancreatic surgical anatomy. The pyramidal process called the "auricle" or "ear"at the inferior margin of the neck suggests the vestige of the ontogenetic twist at the neck, resulting from bursal bulging with rotation of the pancreatic body and tail. This anatomical consideration serves to avoid inadvertent bleeding or pancreatic fistula during dissection of the right gastroepiploic arteryand vein at their roots. Recognition of embryonic rotation of the gastrointestinal tract eases detachment of the pancreati-coduodenal and jejunal vessels at their origins, enabling "reversed Kocherization" and complete resection of the mesoduodenum and upper mesojejunum. Embryological knowledge of vascular arcades of the pancreatic head serves as a guide for limited resection of the pancreas. The anterior inferior pancreaticoduodenal artery often runs behind, not in front of, the lower portion ("mentum" or "chin") of the pancreatic head, but still on the anterior leaflet of the embryonic mesoduodenum. The attachment of the adult pancreatic head to the duodenum occurs only at the major papilla of Vater and at the region around the minor papilla, which seems to be rational from ontogenetical and comparative-anatomical aspects. Knowledge of the pancreatic attachment helps when performing duodenum-preserving pancreatectomy and pancreas-sparing duodenectomy. The "lingula" or "small tongue", a pancreatic portion overlapping the common bile duct on the posterior aspect of the pancreas, is a key structure in resection of the extrahepatic bile duct.
成人胰腺的结构在个体发生和比较解剖学中保留了发育特征，对这些特征的理解极大地有助于胰腺外科解剖学。胰腺颈部下缘的锥形突起称为“耳廓”或“耳”，提示颈部个体发生扭转的遗迹，这是由于胰体和胰尾旋转时囊袋膨出所致。这种解剖学上的考虑有助于在解剖胃网膜右动静脉根部时避免意外出血或胰瘘。认识到胃肠道的胚胎旋转有助于在其起源处分离胰十二指肠和空肠血管，从而实现“反向 Kocher 法”并完整切除十二指肠系膜和空肠上段系膜。胰腺头部血管弓的胚胎学知识可作为胰腺有限切除的指导。胰十二指肠下前动脉通常走行于胰头下部（“颏”或“下巴”）的后方而非前方，但仍位于胚胎十二指肠系膜的前叶上。成人胰头与十二指肠的附着仅发生在 Vater 主乳头和副乳头周围区域，从个体发生学和比较解剖学角度来看这似乎是合理的。了解胰腺的附着情况在进行保留十二指肠的胰切除术和保留胰腺的十二指肠切除术时很有帮助。胰腺后部与胆总管重叠的胰腺部分“舌状部”或“小舌”，是肝外胆管切除术中的关键结构。
