胰头部胰腺系膜的局部解剖及病理学研究

发布时间：2019-03-17 09:54

【摘要】：目的探讨胰腺系膜的解剖结构及病理学特征。方法解剖12例非腹部疾病死亡的尸体胰腺及其周围组织,整块获取标本,蜡块包埋并制作大切片,行相应解剖学、组织学及病理学研究;解剖2例死于不可切除的胰头癌尸体标本,进行病理学检查,并结合生前影像学综合评价胰腺系膜的病理学特点。结果胰腺系膜区域由胰腺头颈部背侧及钩突左侧缘开始,包绕腹腔动脉干及肠系膜上动脉,向左延伸为十二指肠及部分空肠系膜,向右延伸至主动脉-腔静脉平面,并与后腹膜相延续。该区域富含神经、血管、淋巴及脂肪等组织,无确切境界及纤维组织鞘包裹;胰头癌易致腹腔动脉干及肠系膜上动脉周围神经、血管、纤维组织浸润,导致肿瘤不可切除或切缘阳性。结论胰腺系膜不同于结直肠系膜,无独立的纤维组织鞘包绕;胰腺系膜更宜作为外科理念而非解剖学结构来指导临床实践。
[Abstract]:Objective to investigate the anatomic structure and pathological features of pancreatic mesentery. Methods the pancreas and surrounding tissues of 12 dead cadavers with non-abdominal diseases were dissected, the whole specimen was obtained, the wax was embedded and the large sections were made, and the corresponding anatomy, histology and pathology were studied. To dissect 2 cases of unresectable pancreatic head cancer cadaveric specimens for pathological examination and to evaluate the pathological characteristics of pancreatic mesentery in combination with pre-mortem imaging. Results the mesenteric area of pancreas began from the dorsal side of the head and neck of pancreas and the left margin of the uncinate process, surrounding the celiac artery trunk and superior mesenteric artery, extending left to duodenum and part of the mesojejunum, and extending right to the level of aorta-vena cava. And continue with retroperitoneal phase. The region is rich in nerves, blood vessels, lymph nodes and fat, and there is no definite boundary and sheath of fibrous tissue. Pancreatic head cancer is prone to infiltration of peripheral nerves, vessels and fibers of the celiac artery trunk and superior mesenteric artery, leading to unresectable or positive margin of the tumor. Conclusion the pancreatic mesentery is different from the mesorectum and does not have an independent sheath around the fibrous tissue, and the pancreatic mesentery is better used as a surgical concept than an anatomical structure to guide clinical practice.
【作者单位】：北京大学第一医院普通外科;北京医院国家老年医学中心普通外科;北京大学医学部人体解剖学教研室;
【基金】：首都临床特色应用研究项目(Z131107002213043)~~
【分类号】：R735.9

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