十二指肠和胰胆管汇合的应用解剖

作者在12具成尸、13具童尸标本上对十二指肠和胰胆管汇合进行了解剖观测。25例十二指肠上曲为83.4°±11.5°;十二指肠降部长:成人为68.2±12.6mm,2～10岁为41.8±9.1mm;24例胰胆共同管长为5.6±1.5mm。胆总管和胰管壁汇合后,被公共管壁分隔伴行,在十二指肠大乳头内两管开口汇合处有“锯齿状瓣膜”。文中探讨了公共管壁和锯齿状瓣膜的功能及临床意义。     

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。     

十二指肠大乳头异位一例

成年女尸,其十二指肠的形态、位置均属正常。解剖发现胰管在胰头部走行与胰头长轴并非平行,而是距胰头右缘30毫米处以135度角走向右下,达十二指肠水平部后上方,在距肠壁5毫米处与沿胰头后方垂直下降的胆总管又以25度夹角合成肝胰壶腹,穿十二指肠水平部后上壁,开口于十二指肠大乳头。大乳头的位置,距十二指肠降部与水平部所形成的夹角处12毫米,在肠系膜上血管右侧9毫米。未发现副胰管及十二指肠小乳头。其中胰头部的胰管直径6毫米,胆总管未端直径5毫米,长9厘米,肝胰壶腹直径7毫     

双源CT对十二指肠憩室的诊断及临床价值

目的探讨双源CT对十二指肠憩室的诊断及临床价值。方法选择我院经钡餐造影及ERCP证实并接受诊疗的十二指肠憩室患者共46例的临床资料进行回顾性分析,行双源CT平扫及增强扫描,分析其影像学特征和表现。结果双源CT检查出53个十二指肠憩室,其中7例患者为多发性憩室。憩室分布位置包括十二指肠降段内侧41个,水平段12个。其中,憩室直径的7例,10~20mm的32例,20mm的14例。40处囊袋中为气-液平面,8处囊袋为混杂密度影像,5处囊袋为气体。并发症情况为:胆总管扩大6例(13.04%),胆囊炎2例(4.35%),胆总管结石4例(8.70%),胆囊结石4例(8.70%),急性胰腺炎1例(2.17%)。结论采用双源CT可无创、安全、多方位显示十二指肠憩室,并且可以明确评价其并发症及与胆囊、胰腺疾病之间关系。     

42例国人胆总管的解剖学调查

本文从临床实际出发，对４２例成人尸体的胆总管及各段进行了解剖调查。调查结果：胆总管长度及各段长度变异均较大，胆总管平均长度为７５．３±１３．３ｍｍ，壁内段平均长度为１６．５±４．０ｍｍ。胆总管在十二指肠降部的后内侧进入十二指肠，并开口于十二指肠大乳头。本文发现胰管与胆总管完全分开行走者仅４例，占９．５％，而胰管汇入胆总管者３８例，占９０．５％，３８例中，胰管大多在左侧与胆总管汇合。在其前后壁汇入者各２例，未见从右侧汇入者。本文通过对ｏｄｄｉ括约肌的观察，提出作Ｏｄｄｉ括约肌切开成形术时，应根据术前检查所见，决定具体切开之长度一般以不超过２５ｍｍ为宜。     

胰管畸形伴胆胰管汇流异常一例

1 胆胰管汇合最常见的异常为共同通路>1.5cm,称合流异常,是先天性胆管扩张的常见原因之一.胆胰管汇合时又常见两种变异:一为胰胆管合流异常型(p-c型),即胰管注入胆总管;另一种为胆胰管合流异常型(c-p型),即胆总管注入胰管.正常或上述异常时均为一条胰管与胆总管合流.本例有三条胰管注入胆总管并伴胆胰管合流异常非常罕见,现将我们的尸体解剖所见报道如下.男尸,48岁,发育正常,生前曾诊断为胆总管扩张、胆囊炎.检查胰、胆管所见:胰管起自胰尾,横行贯穿胰的全长,中途先后汇集许多胰小管,在距十二指肠后内壁 4.5cm处胰管分出两支,一支横行呈直角穿入十二指肠内侧壁,开口于十二指肠小乳头.此支胰管直径 0.2～0.25cm.另一支向下向后迂曲走行,收纳胰颈、胰头部的小分支,此支自分出后在5.5cm处又分出呈“Y”型的两分支,且分别呈直角注入胆总管左后侧壁,在胆总管内二分支开口间距为 0.7cm,呈上下分布.此外见胰头及胰钩突部胰液汇流一独立     

胆肠结合部的应用解剖

一、胆肠结合部的胚胎起源 胆肠结合部均起源于人胚前肠。人胚发育到第4周时,从前肠的背腹两侧各伸出一个芽突,称之为背胰和腹胰。在发育过程中,腹胰随十二指肠转位至背侧;胚胎第7周时,腹胰及背胰合二为一,腹胰形成胰头的大部分,而背胰形成胰头细小部分及胰体尾部,腹胰管和背胰管汇合形成主胰管,并与胆管开口于十二指肠主乳头;有时背胰管残留,成为副胰管,开口于十二指肠副乳头。同样,在人胚发育至第四周时,前肠末端腹侧壁可向外长出一囊状突起,形成肝憩室,后者随胚胎发育继续增厚。此时,肝憩室分为头部和尾部。头部较大,且生长迅速,     

十二指肠的某些资料

对50例成年尸体的十二指肠进行了观测。十二指肠平均长209mm,外径在29.2—34.7mm之间。十二指肠乳头、副乳头和十二指肠纵襞的出现率分别为100％,48％和96％。十二指肠乳头与幽门的平均距85.5mm,副乳头与乳头的垂直间距平均16.5mm。十二指肠乳头与纵襞的关系,除已有的记载外,乳头还可位于纵襞的左侧或右侧。十二指肠乳头上方纵行隆起的基质有26％是胆总管,而在更多的标本中无胆管样结构。     

2.99 十二指肠乳头切开术后乳头功能的临床研究

目的探讨十二指肠乳头术后(EPT)乳头内气体和钡剂向胆管内的反流,判断乳头功能.方法采用X线稀钡钡餐方法,检测了54例EPT术后患者在术后1周、6月和1年时,比较手术切口的大小、原发疾病和乳头周围疾病的关系,判断术后乳头的功能.结果 54例EPT患者,手术切口的大小为(0.96±0.51)cm,胆总管结石33例 ,胆囊术后12例,慢性胰腺炎合并胰管结石3例,胆总管下段炎性狭窄2例,胆管炎3例,胆道蛔虫1例.合并十二指肠乳头旁憩室23例,大小约(3.24±0.78)cm.在前瞻性研究中, 随访1周33例,随访6月13例,随访1年8例.1年内胆管再发结石14.81%(8/54),其中7例有十二指肠乳头旁憩室,占87.50%(7/8),行鼻-胆管引流6例.X线稀钡钡餐检查中,出现术后1周、6月和1年的气体反流者15.15%(5/33)、15.38%(2/13)和12.50%(1/8);钡剂向胆管内反流12.12%(4/33)、7.69%(1/13)和12.50(1/8),行鼻-胆管引流者出现气体和钡剂反流者83.33%(5/6).结论 EPT术后患者乳头内气体和钡剂向胆管内的反流的发生率,与手术切口的大小、十二指肠乳头旁憩室大小和行鼻-胆管引流的时间密切相关.该研究还在继续之中 .     

十二指肠憩室一例

在制作十二指肠标本时,于一具成年男尸十二指肠上发现一十二指肠憩室,现报道如下:剖腹后见十二指肠位置及外形无异常,但在将十二指肠后面翻转向前时,见十二指肠后面向右方突出一囊袋,形如中国之茄子(附图),该憩室连于十二指肠后壁之左侧部,其根部位于胆总管汇入十二指肠壁处之上方,十二指肠憩室长为4.5cm,中部横径为3.0cm,连于十二指     

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