Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
Endoscopy. 2011 Apr;43(4):307-11. doi: 10.1055/s-0030-1256229. Epub 2011 Mar 31.
Arterial bleeding from the major duodenal papilla is an uncommon but potentially life-threatening complication of endoscopic sphincterotomy. We investigated the arterial blood supply of the papilla to determine whether there might be a safer region for sphincterotomy.
Arteries supplying the major duodenal papilla were studied in 19 cadaver pancreaticoduodenal specimens (nine male, mean age 81 years, range 64 - 97 years) using a combination of microdissection and histology. The number, origin, caliber, and distribution of arteries within 5 mm of the major duodenal papilla were recorded.
A total of 98 papillary arteries were identified by microdissection giving a mean of 5.2 arteries (range 3 - 9) per specimen. Papillary arteries originated from three sources: communicating arteries and the posterior and anterior pancreaticoduodenal arcade arteries. The majority of arteries were related to the antero-superior and postero-inferior quadrants of the major duodenal papilla, both at their point of entry into the duodenal wall or bile/pancreatic ducts (microdissection) and in their distribution 5 mm from the tip of the papilla (histology). The combined 10 and 11 o'clock segments of the papilla (as viewed endoscopically) contained only 10 % and 11 % of all papillary arteries on microdissection and histology, respectively, with seven of 19 specimens having no arteries in this region.
This study documents for the first time the distribution of papillary arteries around the circumference of the major duodenal papilla. Arterial bleeding complicating endoscopic sphincterotomy might be reduced by incising the papilla in the 10 - 11 o'clock region rather than the currently recommended 11 - 1 o'clock position.
来自十二指肠大乳头的动脉出血是内镜下括约肌切开术的一种罕见但潜在危及生命的并发症。我们研究了乳头的动脉血液供应，以确定是否存在更安全的括约肌切开术区域。
在 19 个尸检胰十二指肠标本（9 名男性，平均年龄 81 岁，范围 64-97 岁）中，使用微血管解剖和组织学相结合的方法研究了供应主要十二指肠乳头的动脉。记录了距主要十二指肠乳头 5mm 内动脉的数量、起源、口径和分布。
通过微血管解剖共发现 98 支乳头动脉，平均每个标本 5.2 支（范围 3-9 支）。乳头动脉起源于三个来源：交通动脉和胰十二指肠前后动脉弓。大多数动脉与主要十二指肠乳头的前上和后下象限有关，无论是在进入十二指肠壁或胆管/胰管的部位（微血管解剖）还是在距乳头尖端 5mm 的分布部位（组织学）。从内镜上观察，乳头的 10 点和 11 点区段（组织学）仅占微血管解剖和组织学上所有乳头动脉的 10%和 11%，19 个标本中有 7 个在该区域没有动脉。
本研究首次记录了围绕主要十二指肠乳头周围的乳头动脉分布。通过在 10-11 点区域而不是目前推荐的 11-1 点位置切开乳头，可以减少内镜下括约肌切开术引起的动脉出血。
