Ueki Toshiharu, Yao Tsuneyoshi, Beppu Takahiro, Otani Keisuke, Yorioka Makoto, Sakaguchi Seigo, Matsui Toshiyuki, Ono Hiroyuki, Nakamura Hironori
Department of Gastroenterology, Chikushi Hospital, Fukuoka University, Chikushino-shi, Fukuoka, Japan.
Pancreas. 2006 May;32(4):426-9. doi: 10.1097/01.mpa.0000220870.10529.dd.
Several hypotheses have been proposed to explain the embryogenesis of an annular pancreas. Three-dimensional (3D) imaging of the annular pancreas may be useful to elucidate the embryogenesis. The aim of this case report is to clarify the pancreatic ducts in the annular pancreas by 3D computed tomography pancreatography (3D-CTP), stereographically.
Three-dimensional CTP under endoscopic retrograde pancreatography using a balloon catheter was performed with a helical CT scanner. Three-dimensional images of the pancreatic duct were obtained with simple threshold, shaped surface display.
Wirsung duct that surrounds the ventral side of the descending portion of the duodenum and Santorini duct that surrounds the dorsal side of the descending portion of the duodenum were reconstructed by 3D-CTP, stereographically, and the presence of an annular pancreas was confirmed. These findings suggest that the formation of the annular pancreas in the current case may be attributable not only to abnormal development of the right lobe of the ventral pancreatic bud, but also to overgrowth of the dorsal pancreatic bud toward the ventral aspect of the duodenum or excessive rotation of the duodenum following fusion of the ventral bud to the dorsal bud.
Three-dimensional CTP is expected to contribute usefully toward clarifying the embryogenesis of an annular pancreas.
已提出多种假说以解释环状胰腺的胚胎发生过程。环状胰腺的三维（3D）成像可能有助于阐明其胚胎发生情况。本病例报告的目的是通过三维计算机断层扫描胰管造影（3D-CTP）立体地明确环状胰腺中的胰管情况。
使用螺旋CT扫描仪，在经内镜逆行胰管造影时通过球囊导管进行三维CTP检查。通过简单阈值和塑形表面显示获得胰管的三维图像。
通过3D-CTP立体重建了环绕十二指肠降部腹侧的主胰管（Wirsung管）和环绕十二指肠降部背侧的副胰管（Santorini管），并证实了环状胰腺的存在。这些发现表明，本例中环状胰腺的形成可能不仅归因于腹侧胰芽右叶的异常发育，还归因于背侧胰芽向十二指肠腹侧的过度生长或腹侧芽与背侧芽融合后十二指肠的过度旋转。
三维CTP有望对阐明环状胰腺的胚胎发生起到有益作用。
