Study On The Characteristics Of The Pancreatic Hook And The Distal End Of The Duodenum And The Way Of LPD Operation

Objective:The autopsy and 64 slice CT revealed the uncinate process of pancreas duodenum level and CT angiography reconstruction technology display uncinate process at the end of the anatomical characteristics to choose different LPD operation approach,reduce intraoperative hemorrhage and improve pancreatic tumor resection rate and provide anatomic basis.Methods: 1?In this study,21 cases of adult cadavers were observed,and the adjacent structures of the duodenum,the hook and the adjacent vessels and nerves were observed.Use vernier caliper to measure the relevant data?2?The use of 35 healthy adult abdomen CT continuous scanning imaging,to observe the relationship between the uncinate process and the spinal plane,5 uncinate process plane to observe the anatomical structure of the duodenum,the diameter of value?3?We collected 30 cases of 64 slice spiral CT angiography in the abdomen,the use of imaging technology for peripancreatic vascular reconstruction,observe the distribution and uncinate process of regional vascular origin,length?4?retrospective analysis of ** Medical College Affiliated ** hospital of hepatobiliary surgery 2013-07-2014-07 on 19 cases of laparoscopic pancreatic duodenal resection,focuses on the analysis of the uncinate process and on the horizontal part of duodenum and mesenteric vein around the local anatomy,the surgical approach and operative procedure,endoscopic resection of uncinate process experience.Results:.1?(1)22cases of adult cadavers were observed except for 1 cases,there was no obvious hook process and the other 21 had obvious hook.There was no overlap between the upper part and the lower part of the pancreatic body,and the lower part of the hook process was partially overlapped with the posterior wall of the horizontal part of the duodenum,and 38%(7/21).The author takes the superior mesenteric vein as a sign to measure the pancreatic diameter,the maximum and the minimum,the mean value of the hook process are: 35.41 mm,11.82 mm,17.37 mm.Thickness: 25.71 mm,8.55 mm,14.90.Length: 45.21 mm,27.68 mm,37.65 mm.(2)The superior mesenteric vein was superior to 85.7%(18/21)in the superior mesenteric vein,and the superior mesenteric vein was not more than 11.1%(2/21)in the left margin of the vein,and only 4.7%(1/21)of the mesenteric vein was achieved.The superior mesenteric artery was 28.5%(6/21).(3)The maximum distance,the minimum distance and the average distance between the SMA and the left edge of the duodenal descending part were: 45.55 mm,39.98 mm,41.11 mm.(4)pancreatic between the upper edge of the edge and the horizontal part of duodenum of SMA length maximum diameter,minimum path,average diameter: 60.50 mm,23.56 mm,40.02 mm.2?Uncinate process of pancreas region arteriovenous vascular density:(1)the uncinate process and duodenal and ascending portion of duodenum,the main direct blood supply three arteries supply: inferior pancreaticoduodenal artery,inferior pancreaticoduodenal artery,anterior and dorsal pancreatic artery anastomosis branch,the first jejunal artery.Among them,the variation rate of the dorsal pancreatic artery: 38.20%.Inferior pancreaticoduodenal artery before and after artery total stem begins with a SMA or the first jejunal artery,or they originated from SMA,duodenum liters of blood supply mainly from the first jejunal artery,both at the start of the diameter were:(1.67 + 0.52mm),(1.21 + 0.02mm)hook process of the distal duodenum of venous reflux are mainly: first jejunal stem,gastric and colonic stem(Henle trunk).The occurrence rate of the first jejunum was 22.72%(5/22).There are 5 main types of variation in Henle dry.3?Pancreatic head and duodenum fascia and the anterior renal fascia flap coverage in the vena cava,abdominal aorta,right renal dynamic vein,and there is a potential space between the two layers of fascia,LPD surgery if you can smoothly into the gap to avoid peritoneal injury of the vascular injury.4?(1)Through 35 cases of adult abdominal CT imaging shows: the hook process is located in the CT level L3.-L1 where the rate of L1 25.71%(9/35).L3 level disappearance rate of 82.28%(29/35).Appear at the L2 level 100%.(2)Three dimensional measurement tools were used to measure the three-dimensional vascular reconstruction of pancreatic CT: the diameter of the posterior inferior pancreatic artery and the length of the dorsal pancreatic artery were(1.12 + 0.03)mm,(6.61 + 0.50)mm.By comparing the measured diameter and the autopsy data,the P value was more than 0.05,and the difference was not statistically significant.Conclusion:(1)There are no definite anatomic landmarks in the pancreatic duct and pancreatic head in the pancreatic parenchyma.If the hook procedure is defined,it is easy to damage the main pancreatic duct and the pancreatic duct.This study found that a small number of hooks up to the superior mesenteric artery in gross anatomical observation,the protection of the superior mesenteric artery in operation.(2)The common trunk of the anterior and posterior inferior pancreatic and duodenal arteries originated from the superior mesenteric artery.Or the origin of the superior mesenteric artery and the first jejunum artery,and the origin of the artery was noted in the surgical procedure.(3)The variation of venous reflux in the horizontal part of the hook process and the ascending part of the duodenum was more and more important,and the variation of the Henle was the most important.(4)There is a potential loose gap between the pancreas and the anterior fascia of the pancreas.There is a large vessel area in the gap.The gap between the operation time delay and the surgical delay is clear.In short,the removal of the hook and the duodenum is the key and difficult point in the operation of pancreas and duodenum.To fully understand the regional anatomy,surgery can improve the success rate of the operation.