| Objiective:To make thin cross-sectional anatomy of the pancreaticoduodenal region by using collodion-embedded method, and provide anatomy data for the imaging diagnosis and clinical treatment of the diseases of the pancreaticoduodenal region.Methods:①The materials were obtained from 14 (8 men,6 women) formalin fixed adult cadavers without significant lesion of the abdominal organs. Made cross cut on the abdominal region, and then cut the greater omentum along the greater curvature of stomach, upward tilted the stomach, exposed the pancreaticoduodenal region after cutting the retroperitoneal, the conformation and adjacency of the region were observed. Specimens were cut from the twelfth thoracic vertebrae to the third lumbar vertebrae after the observation generally. According to the demand of research, the specimens were cut to 18cm×12cm×10cm; we rejected some tissue which had nothing to do with our study, embedded the remained tissue and organ with collodion, and then made series cross sectional planes about 0.5mm thickness by cerebrosection. Put the planes in order and took pictures, measured them by using the 3D-DOCTOR software. The interest views were magnified for about 8 to 10 times. The other two cases of samples selected from major duodenal papilla, then stain the pancreaticoduodenal region with Haematoxylin-eosin.②We choose 15 (9men,6weman)patients'CT imagings which took during the period from January to March in the Second Hospital of Tianjin Medical and First Hospital of Lanzhou University, to compared with the planes made by collodion-embedded method. All the 15 patients without the disease of abdominal, we also choose one case who had choledochectasia.Results:①The pancreatic head is the right intumescentia of the pancreas, its anteroposterior is flat, its location ranges from the twelfth thoracic vertebra to second lumber vertebra on the specimens we observed. There are hepatic artery and its branches above the pancreatic head. The horizontal part of duodenum locates under the pancreatic head. The anteroinferior side of the head is next to the jejunum, at the middle of the anterior of the head adjoins the right of the root of the transverse mesocolon. The inferior vena cava, right renal vein, the end of left renal vein and common bile duct locate posterior to the pancreatic head. The beginning of the portal vein situates posteriosuperior to pancreatic head, on the right upper of the pancreatic head, it is next to the pyloric antrum and the superior part of the duodenum, the gastroduodenal artery and vein go through the intergroove between them. To the right side of the pancreatic head is the descending part of the duodenum, their connection is too close to be separated.②At 0.5mm thickness of continuous cross sectional planes, we can get 128 to 135 planes on each specimen, pancreas appeared on average 110 levels, taking the max plane of duodenal papilla as a standard, the pancreatic head appears 70 layers above and 40 layers below。③On the planes made by collodion-embedded method, the pancreatic head was located on the left and anterior of the descending part of the duodenum, its maximal anteroposterior diameters, and maximal left and right diameters were (20.17±3.19) mm and (28.14±3.12) mm respectively. The uncinate processes' maximal anteroposterior diameters and maximal left and right diameters were (9.40±1.58) mm and (12.30±3.04) mm respectively. The pancreatic duct went to the back of the pancreatic head suddenly at the right side of the superior mesenteric vein; its diameters were about (1.04±0.34) mm. The lower segment of the choledoch went through the pancreaticoduodenal groove and sometimes was covered by pancreatic tissue. The duodenal papilla was situated the medium 1/3 of the descending part of the duodenum about 64.29%. We observed from the duodenal papilla with pancreatic duct and choledoch was magnified 8 times by somatotype anatomical lens that, the muscle of the left of the duodenum adjacent and right of the pancreatic is discontinued, but connected with pancreatic lobule of the head of pancreas. We can see the pancreatic duct and the choledoch clearly, the mucosal fold is denticulated on the duodenal ampulla.④The CT image slice thickness 3mm equivalent to six levels of collodion sections image thickness 0.5mm, if so, some of the fine structures can not display in CT images. On the planes of CT, the pancreatic head situated the left of the descending part of the duodenum, the splenic vein and the superior mesenteric vein went together to the upward and backward of it, the uncinate process located behind of the superior mesenteric vein and the right of the superior mesenteric artery, pancreatic duct and bile duct can not be seen without dilatation.Conclusion:①The collodion-embedded method is pragmatic and easy to handle. After embedding, the fixed organs had no significant deformation and in situ fixed. Biopsy tissues and organs during the process without any loss, so the results are reliable and credible, which could provide best morphological basis for the research platform of clinic and radiology.②The CT image slice equivalent to six levels of collodion sections image, so some of the fine structures can not display in each CT image, this might affect the diagnosis of small lesions. On the CT imaging, the pancreatic head, the duodenum, the superior mesenteric vein and artery can be seen, we can distinguish the uncinate process by finding the mesenteric artery, and view the shape of it. The duodenal papilla can not be seen, we can not observe the pancreatic duct and bile duct without dilatation.③On the planes embedded by Collodion, the shape of the duodenum and the convergence of the cholangiopancreatography were easily to distinguish; the superior mesenteric vein is a landmark to identify the pancreatic head and neck; the superior mesenteric artery is a sign to evaluate the uncinate process augmentated or not. This study may provide anatomy data for the imaging examination and clinical diagnoses and treatment. |
PDF Full Text Request