【摘要】 目的研究胰头动脉的变异情况及其在临床胰腺移植中的应用价值。方法回顾性研究连续300例观测对象的数字减影血管造影的影像学资料,其中经腹腔干动脉造影192例,经肠系膜上动脉造影102例,二者联合造影6例。观察胰头血管的分布及变异特征。根据胰腺血管的影像学研究依据,对3例供胰进行了胃十二指肠动脉重建,并应用于临床胰腺移植。结果192例腹腔干动脉造影者中,典型的胃十二指肠动脉且胰十二指肠上动脉分支显影的有73例,显影率为38%;胰十二指肠上后动脉未与胰十二指肠下后动脉吻合3例,胰十二指肠动脉后弓中断1例,胰十二指肠上动脉前、后支和胰背动脉分别分布于胰头上半部,相互间无交通1例;胰十二指肠动脉弓的变异率为5/73(6.8%)。102例肠系膜上动脉造影者中,胰十二指肠下动脉显影42例,占41%。未见1例胰十二指肠动脉弓及胰十二指肠上动脉显影。在联合造影者中。6例胰十二指肠上动脉均显影,胰头前后动脉弓同时显影且完整者4例,占66.7%。3例进行了胃十二指肠动脉重建的供胰应用于胰腺移植后.受者血糖水平均正常,未出现外科并发症。结论胰十二指肠上动脉对胰头的血液供应可能优于胰十二指肠下动脉;胰头前、后动脉弓存在变异的可能。在胰腺移植中,有必要在供胰修整时重建胃十二指肠动脉,以保证胰头血液供应,使移植胰的存活及功能恢复都得到改善。更多还原

【Abstract】 Objective To study the variation of the pancreatic head arteries and its value in pan- creas transplantation.Methods The DSA data of 300 cases were studied retrospectively:192 cases of celiac trunk angiography,102 cases of superior mesenteric artery angiography,and 6 cases of the com- bined.The distribution and variation of the arteries on the pancreatic head were observed.Results In the celiac angiography cases,typical gastroduodenal artery,superior pancreaticoduodenal artery and its branches were visualized in 73 cases(38%).The posterior superior panereaticoduodenal artery was not anastomosed with the posterior inferior pancraticoduodenal artery in 3 cases.The posterior pancre- aticoduodenal arcade was discontinued in 1 case.The anterior superior pancreaticoduodenal artery, posterior superior pancreaticodoodenal artery,and dorsal pancreatic artery were only distributed across the upper head of the pancreas separately but were not anastomosed each other in 1 case.The variation rate of pancreaticoduodenal arterial arcades was 6.8%(5/73).In 102 cases of the superior mesenteric artery angiography,the inferior pancreaticoduodenal artery was visualized in 42 cases(41%)while its branches were not visualized.In 6 cases of the combined angiography,superior panereaticoduodenal artery was visualized in all of the cases,of which anterior and posterior arcades were visualized in 4 cases(66.7%).The gastroduodenal artery reconstruction was performed in 3 cases of clinical pancre- as transplantation,all of the receivers maintained a normal blood glucose level after transplantation and no surgical complications were found.Conclusions The superior pancreaticoduodenal artery might of- fer more blood supply than inferior pancreaticoduodenal artery in the pancreatic head.The arterial re- construction of the transplanted pancreas should include the gastroduodenal artery because of the pos- sibility of arterial variation on the pancreatic head.更多还原