Reyes G A, Fowler C L, Pokorny W J
Section of Pediatric Surgery, Baylor College of Medicine, Houston, TX.
J Pediatr Surg. 1993 May;28(5):712-5. doi: 10.1016/0022-3468(93)90039-n.
The literature is riddled with misconceptions concerning the landmarks and the actual amount of pancreatic tissue resected in "subtotal" 60% to 90% pancreatectomies. In order to clarify the surgical anatomy of the pancreas, 13 autopsy specimens from children aged 2 days to 15 years were carefully examined. Pancreata were serially removed from the in situ position in four sections and weighed. Section 1 included pancreatic tissue from the tail to the left of the superior mesenteric vessels (SMV); section 2 included all tissue from the tail to the right of the SMV; section 3 contained tissue up to the left of the pancreaticoduodenal vessels in the head of the pancreas; and section 4 included the remainder of the pancreatic head within the duodenal sweep and the uncinate process. Results showed that section 1 weighed 47.5% +/- 9.7% (mean +/- SD) of the total pancreatic weight with a wide range of 32.3% to 67.3%; section 2 weighed 53.5% +/- 9.0% (range, 38.7% to 72.2%); section 3 weighed 69.1% +/- 15.6% (range, 43.5% to 95.8%); and section 4 weighed 31.6% +/- 14.6% (range, 4.2% to 56.5%). As noted, pancreatic anatomy was extremely variable in relation to the percent of tissue to either side of the SMV and the proportion of tissue contained within the uncinate process. Resections historically reported to result in a "75%" pancreatectomy (section 2) were demonstrated to contain a mean of only 53.5% +/- 9.0% of the pancreas. Less tissue than expected would be resected by using the SMV as landmarks for a 75% resection. The wide variation in anatomy also has important clinical implications in performing "subtotal" pancreatectomies in infants with nesidioblastosis in whom the amount of tissue resected is critical to the patient's postoperative clinical course. This study demonstrates that a subtotal pancreatectomy should not be based upon the presumed relation of the pancreatic substance to the SMV. The entire gland including the uncinate process should be visualized at operation in order that a proper pancreatectomy is performed.
关于“次全”60%至90%胰腺切除术中胰腺标志及实际切除胰腺组织量，文献中存在诸多误解。为阐明胰腺的手术解剖结构，对13例年龄在2天至15岁儿童的尸检标本进行了仔细检查。将胰腺从原位分四部分连续取出并称重。第1部分包括从胰尾至肠系膜上静脉（SMV）左侧的胰腺组织；第2部分包括从胰尾至SMV右侧的所有组织；第3部分包含胰腺头部至胰十二指肠血管左侧的组织；第4部分包括十二指肠包绕内胰头部的其余部分及钩突。结果显示，第1部分重量占胰腺总重量的47.5%±9.7%（均值±标准差），范围为32.3%至67.3%；第2部分重量占53.5%±9.0%（范围为38.7%至72.2%）；第3部分重量占69.1%±15.6%（范围为43.5%至95.8%）；第4部分重量占31.6%±14.6%（范围为4.2%至56.5%）。如前所述，胰腺解剖结构在与SMV两侧组织百分比及钩突内组织比例的关系上差异极大。历史上报道导致“75%”胰腺切除术（第2部分）的切除范围，实际平均仅包含胰腺的53.5%±9.0%。以SMV为标志进行75%切除时，切除的组织比预期少。解剖结构的广泛差异在对患有成神经细胞瘤的婴儿进行“次全”胰腺切除术中也具有重要临床意义，因为切除组织的量对患者术后临床病程至关重要。本研究表明，次全胰腺切除术不应基于胰腺实质与SMV的假定关系。手术中应完整观察包括钩突在内的整个腺体，以便进行恰当的胰腺切除术。
