Terakawa Hirofumi, Kitagawa Hirohisa, Makino Isamu, Hayashi Hironori, Oyama Katsunobu, Nakagawara Hisatoshi, Miyashita Tomoharu, Tajima Hidehiro, Takamura Hiroyuki, Fushida Sachio, Ozaki Noriyuki, Ohta Tetsuo
Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan.
Department of Functional Anatomy, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan.
Oncol Lett. 2017 Jul;14(1):397-403. doi: 10.3892/ol.2017.6138. Epub 2017 May 9.
The meso-pancreatoduodenum is the primary site of tumor infiltration in patients with pancreatic head cancer, with numerous patients exhibiting lymph node metastases. Effective dissection of the regional lymphatic basin requires knowledge of the patterns of the arterial branches. The present study examined the patterns of the arteries feeding the pancreatic head and the distribution of the meso-pancreatoduodenum. The present study included 123 patients with pancreatic cancer who underwent contrast-enhanced preoperative 64-multidetector-computed tomography to determine the routes of the inferior pancreaticoduodenal and first jejunal arteries. Surgical specimens and cadavers were also evaluated histologically to clarify the distribution of the meso-pancreatoduodenum. The feeding arteries were divided into three types, with 64.2% of patients having type A, 28.4% having type B and 7.3% having type C branches. The branches emerged from the back or left side of the superior mesenteric artery and ran to the far side of the pancreatic head in an arc. Consequently, the meso-pancreatoduodenum had a roll-shaped appearance, surrounding the trunk arteries and extending to the left side of the superior mesenteric artery. Dissecting the right and left sides of the superior mesenteric artery during lymphadenectomy could improve the effectiveness of resection.
胰十二指肠系膜是胰头癌患者肿瘤浸润的主要部位，众多患者存在淋巴结转移。有效清扫区域淋巴结需要了解动脉分支的走行模式。本研究检查了供应胰头的动脉走行模式及胰十二指肠系膜的分布。本研究纳入了123例胰腺癌患者，术前行64排增强计算机断层扫描以确定胰十二指肠下动脉和空肠第一动脉的走行。还对手术标本和尸体进行了组织学评估，以明确胰十二指肠系膜的分布。供血动脉分为三种类型，64.2%的患者为A型，28.4%为B型，7.3%为C型分支。这些分支发自肠系膜上动脉的后方或左侧，呈弧形走向胰头的远侧。因此，胰十二指肠系膜呈卷状，围绕主干动脉并延伸至肠系膜上动脉左侧。在淋巴结清扫术中解剖肠系膜上动脉的右侧和左侧可提高切除的有效性。
