十二指肠返(升)动脉的解剖学

目的：调查国人十二指肠返(升)动脉的起源、分支、分布规律，为胃、胰、十二指肠手术提供解剖学资料。方法：动脉乳胶灌注的尸体标本在直视和手术显微镜下行解剖学观察和测量。结果：十二指肠返(升)动脉恒定出现。主要呈二支型(58％)。多数起源于胃十二指肠动脉末端或胃网膜右动脉、胰十二指肠上前动脉近端。根据其分支、分布情况，有3类：幽门十二指肠支(87％)、十二指肠胰支(79％)及单独起源的幽门下动脉(50％)。结论：十二指肠返(升)动脉是幽门及十二指肠上部血供重要来源，建议在PPPD术中尽量保护胃十二指肠动脉主干、胃网膜右动脉及胰十二指肠上前动脉起始部，以保障被保留的幽门及十二指肠残端的血供。     

幽门下动脉的解剖观测及临床意义

目的：为幽门毗邻部位病变的诊治或手术提供解剖学资料。方法：采用红色乳胶液经动脉灌注和防腐处理的尸体标本，解剖观测幽门下动脉的起始类型及分支分布情况。结果：（1）幽门下动脉主要起源于胃十二指肠动脉（51．6％）或胃网膜右动脉（29．0％）；（2）幽门下动脉双干起始占55．0％，单干起始占45．0％；（3）幽门下动脉与胃网膜右动脉在幽门下端构成浆膜下吻合。结论：在胃手术处理胃网膜右动脉时，应在幽门下动脉起点的远端结扎胃网膜右动脉，以防止幽门附近残胃血供匮乏。     

保留幽门胰十二指肠切除术在胰腺癌手术中的应用

目的探讨保留幽门胰十二指肠切除术(PPPD)在胰腺癌手术中的临床应用价值。方法回顾性分析98例胰腺癌手术患者的临床资料,将行胰十二指肠切除术(PD)的患者40例设为对照组,行保留幽门胰十二指肠切除术(PPPD)的58例患者为观察组,观察2组患者的临床疗效。结果 PPPD组患者手术时间明显短于PD组,胃排空延迟的发生率明显高于PD组(P0.05),但是2组患者术中输血、术后住院时间、淋巴结清扫总数和5、6组淋巴结数、术后并发症的发生率及1年生存率均无明显差异(P0.05)。结论 PPPD与PD疗效相似,不影响手术根治性,但PPPD保留了胃的贮存和消化功能,能提高患者远期生活质量。     

胰头的动脉分布及其临床意义

目的：为胰头和十二指肠的分部切除提供应用解剖学依据.方法：选取9例动脉灌注乳胶的胰头标本和3例胰头铸型标本对胰头的动脉分布进行解剖学观测.结果：胰头的动脉主要来源于前后动脉弓;其内部动脉可分为浅深两层和钩突部动脉.浅层动脉4条,以第1支最粗大;深层动脉主要由后动脉弓最上的3条分支营养,其中第3分支是最主要营养支;乳头动脉为后上动脉第3分支上发出的二级分支;钩突部的内部血供主要来自胰下动脉的下降支;在胰头内部浅深层及钩突部营养动脉间有着丰富的交通支,形成广泛的吻合.结论：胰十二指肠后上动脉在胰头与十二指肠血供中占据十分重要的位置,在术中保护好该动脉是手术成功与否的重要一环.     

胰头与十二指肠的血供关系及其临床意义

目的　了解胰头及十二指肠的血管走行,为在DPPHR术中如何保护十二指肠的血供及是否行Kocher操作提供更多的形态学资料。 方法　随机选取40具尸体,充分解剖暴露肠系膜上动脉、胃十二指肠动脉及胰十二指肠前后动脉弓,对供应十二指肠的动脉及伴行的静脉行径进行仔细观察和记录。 结果　在97.5%的标本中（n=39）, 胰十二指肠后动脉弓及伴行的静脉均位于胰后筋膜内;在90%的标本中（n=36）, 胰十二指肠下前动脉及伴行的静脉走行于胰十二指肠沟内,易于保留;在个别标本中（10%, n=4）, 没有完整的胰十二指肠前动脉弓;其中1例标本（2.5%,n=1）,没有完整的胰十二指肠后动脉弓,但供应十二指肠的动脉及其伴行静脉仍位于胰后筋膜内。 结论　DPPHR手术的关键在于保留胰十二指肠后动脉弓,同时尽可能地保留部分胰十二指肠前动脉弓,而Kocher操作有利于保护胰十二指肠后动脉弓;在个别标本中,没有完整的胰十二指肠前动脉弓,此时施行DPPHR可能伤及十二指肠血供,导致手术失败。     

肝外胆管的动脉血供及其临床意义

目的 :观察肝外胆管主要供血动脉 ,探讨预防术后胆管缺血的手术措施。方法 :对 15例乳胶灌注的尸体标本进行显微解剖 ,对其主要的供血动脉即胆囊动脉、胰十二指肠上后动脉及肝右动脉的分支进行观测。结果 :胰十二指肠上后动脉发出部位距胃十二指肠动脉起始部距离为 (0 .89± 0 .2 3)cm(0 .4 9～ 1.88cm) ,直径为 (0 .17± 0 .0 2 )cm(0 .12～ 0 .2 1cm) ,发出的分支为 3～ 5支。结论 :行肝移植手术时 ,保留胰十二指肠上后动脉可减少术后胆管缺血并发症的发生     

胰十二指肠下动脉来源变异1例

笔者在局部解剖学解剖1具成年男性尸体标本时,发现其胰十二指肠下动脉起点高,行程复杂,现报道如下. 该例标本的胰十二指肠下动脉起于腹腔干,垂直向下走行1.7 cm,在胰颈背面分出2个分支,经左肾静脉前方,于胰颈下缘穿出,其中右支向右下行,经肠系膜上动、静脉后方分布于胰头及十二指肠降部;左支偏左下行,分出下级分支分布于十二指肠水平部.     

十二指肠乳头肿瘤局部切除术应用解剖

目的：为十二指肠乳头部肿瘤局部切除术提供解剖学资料。方法：50例正常成人腹部标本，解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度，胆总管与胰管的夹角，肝胰壶腹区的血管分布，十二指肠大乳头位置、乳头小孔开口位置、胆胰管开口形式等。结果：肝胰壶腹和十二指肠乳头区的营养动脉平均为2．2支，均来源于胰十二指肠上动脉、下动脉，其中肝胰壶腹和十二指肠乳头区9—12点钟处的营养动脉出现率为45．9％（50支）。胆总管、胰管、壶腹末端的长度分别为（32．1±8．7）mm、（9．9±4．1）mm、（12．6±2．8）mm；宽度分别为（7．3±2．1）mm、（3．2±0．7mm）、（7．3±1．2）mm。胆总管和胰管之间的夹角平均为35．6°。十二指肠大乳头位于十二指肠降部上1／3段占8．45％±4．39％，中1／3段占72．33％±6．72％，下1／3段占19．22％±4．12％；乳头小孔开口于十二指肠纵襞占74．3％±6．68％。有十二指肠小乳头占41．43％±3．65％。胆胰管开口呈V型占37．1％±7．43％，Y型占62．9％±6．32％。结论：本实验结果为临床在十二指肠乳头部肿瘤切除过程中选择切开部位和切开深度等提供了解剖学依据，对防止术后并发症具有重要意义。     

保留幽门胰十二指肠切除术10例分析

目的：探讨保留幽门的胰十二指肠切除术的疗效及该技术并发症的发生率.方法：本组共10例,均行保留幽门的胰十二指肠切除术,术后病理报告均为腺癌.结果：全组病人术后无胃排空延迟,无胆漏、胰漏、肠漏,无消化道出血发生.全组病例痊愈出院.结论：保留幽门不影响胰头癌及壶腹周围癌根治的彻底性.本组病例术后胃肠功能恢复早、进食早,并发症少,死亡率低,是一种有广泛应用前景的术式.     

胃十二指肠动脉变异1例

<正>胃十二指肠动脉作为胰头上部滋养动脉~([1～4]),其变异率约为3.43%~([5])。作者在胰岛素瘤定位检查选择性动脉内钙离子刺激肝静脉采血术中意外发现1例胃十二指肠动脉经过幽门后方发出分支胰十二指肠上动脉,在胰头部与肠系膜上动脉发出的分支胰十二指肠下动脉交通,变异后部分血流到达胰颈部,同时滋养胰头部和部分胰颈部。现报道如下:患者,男,27岁,因"反复心悸,出汗,饥饿感"就诊。入院后行OGTT试验提示:空腹血糖1.20 mmol/L,餐后1 h血糖     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.     

Influence of the level of the transmembrane potential on the dynamics of the extinction of the amplitude of the synaptic reactions of the snail under voltage clamping conditions

The influence of the level of the transmembrane potential on the dynamics of the extinction of the amplitudes of summary excitatory postsynaptic currents arising in identified giant parietal neurons in response to rhythmic stimulation of the intestinal nerve was investigated in a preparation of the isolated CNS of the common snail in order to identify the possibility of the participation of the postsynaptic element in synaptic plasticity. It was demonstrated that, at a greater value of the transmembrane potential, the decrease in the amplitudes of the postsynaptic currents which have been induced by rhythmic stimulation takes place more rapidly. It was also demonstrated that at a higher frequency of stimulation of the nerve, the effect of the influence of the membrane potential level on the dynamics of the synaptic reactions is more prominent. The data obtained may be regarded as an argument in favor of the possibility of the participation of the post-synapse in plasticity. This study was partially supported by the Russian Basic Research Fund (project No. 94-04-12209). Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow. Translated from Zhurnal Vysshei Nervnoi Deyatel'nosti imeni I. P. Pavlova, Vol. 45, No. 1, pp. 171–179, January–February, 1995.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

Effect of the conditions of adaptation of the optic analyzer to the function of the thermoreceptors of the human skin

Summary A discussion is presented of the effect produced by light stimulation applied to the optic analyzer alone on the function of the temperature analyzer. The cutaneous-temperature analyzer was kept on constant illumination and temperature. The light effects from the retinal photoreceptors on the cutaneous thermoceptor system led to reflex changes of the functional rate of the latter. Conditions of the optic analyzer of light adaptation caused reflex adjustment of cold receptors as to heating. Dark adaptation of the eyes changed the functional state of the cold receptors, corresponding to their adjustment to low temperatures.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 57, No. 3, pp. 3–6, March, 1964