The Three-dimensional Anatomic Study Of The Duodenum And Its Surrounding Viscera

The duodenal area has a complex anatomical structure and is adjacent to a variety of organs.Once duodenal injury occurs,its complexity and severity is far higher than that of biliary tract injury and other intestinal injuries.Intestinal fistula is very easy to occur,which often leads to severe peritonitis and septic shock,and even endangers the life of the patient.latrogenic duodenal injuries are mostly caused by careless operation during abdominal surgery,with the incidence ranging from 0.04%to 2.1%.However,the incidence of complications can be as high as 65%and the fatality rate can be as high as 15%to 20%,which must be paid great attention to by surgical medical staff.This research group will explore the anatomical relationship between duodenum and its surrounding organs.Based on the superiority of the digital 3D model in displaying the anatomical relationship of the abdomen and pelvis,1000 CTA in vivo data were collected and analyzed on the basis of the team research.The study is divided into two parts:The first part is to build a digital three-dimensional model of the duodenum and study its anatomical characteristics;The second part is to construct a three-dimensional digital model of the abdominal arteriovenous network and ureter,and to study the anatomical relationship between the duodenum and the surrounding organs.Part one Three-dimensional reconstruction of the duodenum and its anatomical features[Objective)Based on the 3D digital model of duodenum in vivo,the anatomical characteristics of duodenum were studied.[Method]1.Consecutive 1000 patients undergoing pelvic computer tomography angiography(CTA)scan with thin layer(less than 1 mm)for all sorts of gynecologic diseases in the department of gynaecology to Nanfang Hospital of Southern Medical University from October 2014 to December 2019 were recruited.2.The original CTA data set was imported into the medical 3D reconstruction software Mimics 21.0,and the digital 3D models of the pelvis and duodenum were built with the plain scanning data and the venous data respectively.The digital three-dimensional models were exported in STL format for storage.3.The pelvis was registered in the data of the venous phase.In the 3D view window of medical 3d reconstruction software,the anatomical characteristics of duodenum were observed,and the length of duodenum was measured by measuring tools.[Results]There are four main types of duodenal morphology:"C","U","V" and "O",most of which are "C"(53.6%,536/1000).The average length of duodenum was 221.71mm.And most of the duodenal level was at the level of vertebrae L3,accounting for 51.20%(512/1000),and a small part was at L2(9.00%,90/1000)and L4(10.60%,106/1000).[Conclusion]Duodenal morphology is variable,mainly in the shape of "C",the average length is 221.71mm,most of its horizontal part is located at the level of vertebrae L3.The successful construction of the duodenal model confirmed the feasibility of the three-dimensional reconstruction technology for the reconstruction and measurement of the duodenum,and also provided three-dimensional and intuitive technical support for the anatomical teaching research of the duodenum.Part two Three-dimensional anatomical relationship between duodenum and surrounding viscera[Objective]Based on the constructed three-dimensional digital model of the duodenum,abdominal arteriovenous network and ureter in vivo,the anatomical characteristics of the organs around the duodenum were studied.[Method]1.Consecutive 1000 patients undergoing pelvic computer tomography angiography(CTA)scan with thin layer(less than 1 mm)for all sorts of gynecologic diseases in the department of gynaecology to Nanfang Hospital of Southern Medical University from October 2014 to December 2019 were recruited.2.The original CTA data set was imported into the medical 3D reconstruction software Mimics software 21.0,and the digital 3d model of the abdominal artery network was established with the arterial data,and the digital 3D model of the abdominal vein network was established with the venous data.And the ureteral three-dimensional digital model was established based on the urinary data.The digital three-dimensional models were exported in STL format for storage.3.The digital 3D model of the celiac artery network and ureteral was successively introduced into the venous data for registration.In the 3D view window of medical 3D reconstruction software,the duodenum was used as the anatomical marker to study the anatomical characteristics of great vessels around the duodenum.[Results]1.There are three kinds of vascular structures distributed in front of the duodenum:superior mesenteric artery and superior mesenteric vein,superior mesenteric vein and non-vascular tissue.There are two kinds of vascular structures distributed in the posterior part of the duodenum:inferior vena cava,abdominal aorta and inferior vena cava.The vascular structures distributed behind the lower margin of the duodenum have five types:inferior vena cava,abdominal aorta,inferior vena cava and abdominal aorta,right ovarian vein,right renal artery.The horizontal anterior configuration of duodenum was mainly superior mesenteric artery and superior mesenteric vein,accounting for 78.20%(782/1000).The inferior vena cava and abdominal aorta were the majority of the posterior part of the duodenum,with a proportion of 85.80%(858/1000).The vessels distributed in the posterior part of the lower margin of the duodenum were mainly inferior vena cava,accounting for 78.60%(786/1000).2.The mean distance dl between the lower margin of the duodenum and the left renal vein was 53.74mm.The mean d2 distance between the lower margin of the duodenum and the inferior mesenteric artery was 1.92mm.The mean d3 distance between the lower margin of the duodenum and the junction of the inferior vena cava was 59.35mm.The mean distance d4 between the lower margin of the duodenum and the bifurcation of the abdominal aorta was 37.14mm.3.Duodenum and the right kidney space position relations had four types:the right side of the renal hilum corresponding duodenal door corresponding duodenal descending of the upper part and the right kidney,duodenal level by door of the right kidney and kidney on the right side door did not correspond to the duodenum,the proportion of door corresponding duodenal descending of the right kidney is highest,80.32%(800/996);The mean distance s1 between the duodenum and the right hilum of the kidney was 19.20mm.The mean distance s2 between the lower margin of the duodenum and the right hilum was 39.45mm.4.The mean distance M1 between the lower margin of the duodenum and the right ureter was 18.80mm.The mean m2 distance between the lower margin of the duodenum and the left ureter was 47.15mm.[Conclusion]1.Most of the anterior horizontal part of the duodenum is close to the superior mesenteric artery and vein,while most of the posterior part is close to the inferior vena cava and the abdominal aorta.Therefore,the relationship between the duodenum and blood vessels should be observed when dissected para-aortic lymph nodes in general surgery and gynecology.2.The lower margin of the duodenum is basically located at the midpoint of the connecting line between the left renal vein and the inferior vena cava.The origin of the inferior mesenteric artery lies mostly below the duodenum and occasionally above the duodenum.3.The descending part of the duodenum is closely related to the right hilum,which is only 19.20mm away,so there is a high possibility of damage to the descending part during the operation of the right hilum,and it should be close to the renal margin when separating the hilum.4.The distance between the right ureter and the lower edge of the duodenum is only 18.17mm closer than that between the left ureter,so the right ureter is more likely to be damaged during ureteral surgery,and the right ureter should be placed when the ureter is separated.