Jiang Chong-Yi, Liang Yun, Chen Yin-Tao, Dai Zheng-Shou, Wang Wei
Department of General Surgery, Huadong Hospital, Fudan University, No. 221, Yanan West Road, Shanghai, 20040, People's Republic of China.
Minimally Invasive Center, Huadong Hospital, Fudan University, Shanghai, 20040, People's Republic of China.
Surg Endosc. 2021 Feb;35(2):569-575. doi: 10.1007/s00464-020-07417-7. Epub 2020 Feb 18.
Bleeding control as one of the major challenges in laparoscopic pancreaticoduodenectomy (LPD) necessitates a considerable anatomical knowledge of the blood supply to the pancreatic head so as to improve the safety of this surgery. This study aimed towards a better understanding of the anatomical features of the dorsal pancreatic artery (DPA), as well as its clinical significance in LPD.
Thirteen Chinese cadaveric specimens were used to study the blood supply of the pancreatic head. Twelve of them were perfused with latex, and the other fresh one was used to build the intraorganic structure model of the pancreas by mold casting. Between July 2018 and June 2019, a total of thirty-five consecutive patients without vascular encasement, who underwent LPD in our institute, were performed with computed tomography as a preoperative detection of the DPA. The DPA was ligated prior to uncinate process dissection in seventeen patients ("early DPA ligation" group), as the others were assigned into the control group.
In the thirteen cadaveric specimens, the DPA originates, respectively, from the splenic artery (46.1%), superior mesenteric artery (38.5%), common hepatic artery (7.7%) and right gastroepiploic artery (7.7%). The right branch of the DPA gives off terminal arteries to form an "inner ring" in the pancreatic head, which communicates with the pancreaticoduodenal arterial arches by plenty of collateral arteries. As compared to the control group, the "early DPA ligation" group showed a significantly lower mean blood loss (218 ± 111 vs 320 ± 162, P = 0.038), as well as shorter mean resection time (121 ± 23 vs 136 ± 22, P = 0.049).
The DPA is one of the major blood supplies to the pancreatic head. A ligation of DPA prior to dissection of the uncinate process can help to completely block the blood supply to the pancreatic head, and therefore improve surgical outcome and safety in LPD.
出血控制是腹腔镜胰十二指肠切除术（LPD）的主要挑战之一，这需要对胰头血供有相当的解剖学知识，以提高该手术的安全性。本研究旨在更好地了解胰背动脉（DPA）的解剖特征及其在LPD中的临床意义。
使用13例中国尸体标本研究胰头血供。其中12例用乳胶灌注，另一例新鲜标本用于通过铸型构建胰腺的器官内结构模型。2018年7月至2019年6月，共有35例在我院接受LPD且无血管包绕的连续患者，术前行计算机断层扫描作为DPA的术前检测。17例患者在钩突部解剖前结扎DPA（“早期DPA结扎”组），其余患者作为对照组。
在13例尸体标本中，DPA分别起源于脾动脉（46.1%）、肠系膜上动脉（38.5%）、肝总动脉（7.7%）和胃网膜右动脉（7.7%）。DPA的右支发出终末动脉在胰头形成一个“内环”，通过大量侧支动脉与胰十二指肠动脉弓相通。与对照组相比，“早期DPA结扎”组的平均失血量显著降低（218±111 vs 320±162，P = 0.038），平均切除时间也较短（121±23 vs 136±22，P = 0.049）。
DPA是胰头的主要血供之一。在钩突部解剖前结扎DPA有助于完全阻断胰头血供，从而改善LPD的手术效果和安全性。
