Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Surg Radiol Anat. 2020 Dec;42(12):1501-1508. doi: 10.1007/s00276-020-02547-y. Epub 2020 Aug 14.
Total mesopancreas excision has been found to be helpful for increasing no residual tumor resection rate and improving the prognosis of pancreatic cancer. This study analyzed the relationships among the mesopancreas and pancreatic head plexus from the morphological, developmental, and clinical perspectives.
Twenty-four cadavers were employed. The upper abdominal viscera were resected en-bloc with the hepatoduodenal ligament, abdominal aorta, and nerve plexuses, and the innervation of the pancreas was dissected. Ten additional cadavers were used for histological examination of the pancreatic head and neck, part of the duodenum, the superior mesenteric artery (SMA) and its surrounding tissues, and the related arteries and veins.
As results, cross-sections of the SMA revealed 6-9 layers of membranous structures resembling the layers of an onion, and the nerve fibers of the superior mesenteric plexus ran between the layers. Loose areolar tissue, adipose tissue, and lymphatics existed between the SMA and the pancreatic head/uncinate process, along with abundant thin blood vessels and capillaries, but very few nerves were found approaching the pancreas. Several parallel layers of collagen fibers (so-called Treitz's fusion fascia) existed between the dorsal aspect of the pancreatic head and the aortocaval plane.
The mesopancreas was continuous and connected with the para-aortic area. It may be better termed the mesopancreatoduodenum than the mesopancreas, as the duodenum-pancreas-SMA forms a complex morphological, developmental, functional, and pathological structure.
全胰系膜切除术有助于提高无残瘤切除率，改善胰腺癌预后。本研究从形态学、发育和临床角度分析了胰系膜与胰头丛之间的关系。
共使用 24 具尸体。肝十二指肠韧带、腹主动脉和神经丛整块切除上腹部内脏，解剖胰腺的神经支配。另外 10 具尸体用于胰头和颈部、部分十二指肠、肠系膜上动脉（SMA）及其周围组织以及相关动静脉的组织学检查。
SMA 的横切面显示 6-9 层膜状结构，类似于洋葱的层状结构，肠系膜上丛的神经纤维在层间穿行。SMA 和胰头/钩突之间存在疏松的纤维结缔组织、脂肪组织和淋巴管，以及丰富的细血管和毛细血管，但接近胰腺的神经很少。胰头背侧与腹主动脉-腔静脉平面之间存在数层平行的胶原纤维（所谓的 Treitz 融合筋膜）。
胰系膜是连续的，并与腹主动脉旁区相连。它可能被更好地称为胰肠系膜十二指肠，因为十二指肠-胰腺-SMA 形成了一个复杂的形态学、发育、功能和病理学结构。
