Three-dimensional Reconstruction And Applied Anatomy Of The Blood Supply Of The Uncinate Process Of Pancreas

OBJECTIVE:To study the arterial blood supply of uncinate process of pancreas,so as to provide more theoretical basis for surgeons to optimize pancreatic surgery program and reduce intraoperative bleeding.METHODS:①71 adult cadavers and 11 fresh adult cadavers with red latex artery perfusion were used to observe the morphology of pancreas and the distribution of peripancreatic artery,with emphasis on the direction of the branches of inferior pancreaticoduodenal artery to the uncinate process of pancreas,the right branch of dorsal pancreatic artery and its relationship with superior mesenteric vein.②131 cases of upper abdominal thin-wall enhanced CT data were selected,and the three-dimensional reconstruction of the pancreatic artery was performed with Mimics 14.The distribution of peripancreatic artery was observed.The starting point,branch,running and variation of the pancreaticoduodenal artery and the dorsal pancreatic artery were recorded.③One case of fresh adult abdominal viscera specimens was taken and perchloroethylene solution with red pigments was injected through abdominal aorta intubation.After perchloroethylene coagulation,the specimens were corroded by 38%concentrated hydrochloric acid for one week.Afterwards the blood supply of the pancreatic artery was cast following by cleaning.The spatial structure of the peripancreatic artery and the anastomosis of the arterial arch of the pancreatic head were observed and recorded.RESULTS:(1)Among 82 adult cadavers,type Ⅰ was 63.41%(52/82),type II A was 18.29%(15/82),type Ⅱ B was 8.53%(7/82),type Ⅱ C was 9.76%(8/82).The dorsal pancreatic artery might originate from the origin of splenic artery,common hepatic artery,celiac trunk or be compensated by inferior pancreatic artery.When the dorsal pancreatic artery was absent,the blood supply of the body of the pancreas was compensated by the inferior pancreatic artery.(2)In 131 cases of CT data,there were 71 cases(54.55%,71/131)of type I,12 cases(9.09%,12/131)of type Ⅱ A,12 cases(9.09%,12/131)of type Ⅱ B and 36 cases(27.48%,36/131)of type II C.(3)In this study,the blood supply of uncinate process of pancreas in cast specimens was type II A.The spatial structure of the peripancreatic artery was well demonstrated.CONCLUTION:The blood supply of uncinate process of pancreas mainly came from the branch of uncinate process from inferior pancreaticoduodenal artery and the right branch of dorsal pancreatic artery running behind superior mesenteric vein.Therefore,during the operation of freeing pancreatic uncinate process,attention should be paid to the separation and ligation of the branches of the superior mesenteric artery on the right side and the branches of the upper margin of the uncinate process of the pancreas.