内窥镜十二指肠乳头切开术的应用解剖

目的：为临床经内窥镜十二指肠乳头括约肌切开术（Ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｎｃｔｅｒｏｔｏｍｙ,ＥＳＴ）提供形态学的依据。方法：３０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。结果：肝胰壶腹及十二指肠乳头区的营养动脉平均为２．１支,均来源于胰十二指肠上动脉、胰十二指肠下动脉,其中肝胰壶腹区及十二指肠乳头区９～１２点钟处营养动脉的出现率为４６．１％（２９支）。测量胆总管、胰管、壶腹末端的长度分别为３２．１±８．９ｍｍ、９．９±３．９ｍｍ、１２．８±２．９ｍｍ;宽度分别为７．２±２．２ｍｍ、３．１±０．６ｍｍ、７．１±１．４ｍｍ。胆总管和胰管间的夹角７０％为２０°至４５°,平均３５．４°。结论：本实验的结果为临床在ＥＳＴ中选择切开部位和切开的深度等提供了理论依据,对防止术后并发症具有重要的临床意义。     

与EST有关的胰胆管及十二指肠大乳头应用解剖

在１０具成尸，１３具童尸（２－１０岁）标本上对胰胆管及十二指肠大乳头与ＥＳＴ有关的应用解剖进行了研究。十二指肠纵襞长：成人为２４．０±６．８８ｍｍ，２－１０岁１６．８±４．２ｍｍ；大乳开口上缘至纵襞上端长；成人为１１．１±２．２ｍｍ，２－１０岁７．７±１．７ｍｍ；胆总管第四段长：成人为１６．６±１．６ｍｍ，６－１０岁１３．０±２．２ｍｍ；十二指肠纵襞长轴与胆总管（左上）夹角为４０．１°±１１．８°     

十二指肠小乳头的应用解剖

目的：为内镜下副胰管插管、十二指肠小乳头切开等提供解剖学基础。方法：在30例成人尸体上对十二指肠小乳头的形态、位置、开口以及与大乳头之间的关系进行解剖观察。结果：十二指肠小乳头的出现率为70%。可见明显开口的占55%。小乳头形态有半球形、圆锥形、半颗粒形、扁平形和不规则形。小乳头距离幽门、十二指肠第一环、大乳头的距离分别为(58．69±15．74)mm,(23．21±8．82)mm和(22．75±6．81)mm;大、小乳头开口连线与十二指肠纵襞纵轴线的夹角为(20．80±9．40)°。结论：十二指肠小乳头的出现率与副胰管的发育程度相关,本文结果为内镜下行十二指肠小乳头插管和小乳头切开术提供了参考。     

对十二指肠乳头旁憩室形成原因的探讨

目的:探讨十二指肠乳头旁憩室形成的原因.方法:随机选择100例十二指肠-胰标本,发现有乳头旁憩室的标本26例,无乳头旁憩室的标本74例,将26例有乳头旁憩室标本和随机选择的26例无乳头旁憩室标本作为观测对象,对其十二指肠降部、胆总管-胰管汇合部及汇合部穿肠处左侧的胰腺组织进行观测.结果:有乳头旁憩窜标本与无乳头旁憩室标本,在十二指肠大乳头处的肠管周经分别是(110±13.4)、(88.4±8.61)mm,在下曲处的肠管周经分别是(73.3±5.52)、(83.2±6.01)mm;在胆总管-胰管汇合部穿肠处胆总管-胰管汇合部的周经分别是(22.4+1.72)、(16.8±1.32)mm;在胆总管-胰管汇合部的前面,胰腺组织的厚度分别是(4.33±0.82)、(9.13±2.24)mm.结论:十二指肠乳头旁憩室形成的主要原因是十二指肠下曲较细、胆总管-胰管汇合部较粗大及在憩室发生处的左侧胰腺组织较少.     

胰,胆总管插管的应用解剖

在30例成人的标本上,对十二指肠第1环状襞、十二指肠纵襞、十二指肠大乳头、肝胰壶腹及其间隔等进行解剖观测.十二指肠第1环状襞高4.86±0.36mm,厚2.85±0.17 mm,距幽门45.80±2.93mm;十二指肠纵襞出现率为76.7%;十二指肠大乳头距幽门、第1环状襞的距离分别为81.14±2.71和41.76±2.11mm,其开口处上下径和横径分别为2.88±0.17mm和2.31±0.19mm.在20例肝胰壶腹切开的标本上见肝胰壶腹间隔部分分隔(16例)和完全分隔(4例)胰胆管,间隔长度 9.30±0.46mm,共同管长度5.53±0.29mm.结果为临床内镜下顺利进行胰、胆总管造影术寻找十二指肠大乳头和插管提供了形态学依据.     

十二指肠乳头肿瘤局部切除2例

1病例介绍例1,男性,82岁。厌食、尿黄、明显消瘦,伴右上腹不适、间歇低热2月余。体检:T37.4℃,巩膜轻度黄染,右上腹轻度深压痛,右肋缘下扪及肿大胆囊。血WBC10.6×109/L,N0.73,L0.27。肝功能:Tbil43.3μmol/L,Dbil27μmol/L,ALB35.1g/L,GLB30.2g/L,ALT101IU/L,AST73IU/L,GGT1058IU/L,ALP1061IU/L。B超:肝内外胆管扩张,Vater壶腹部见22mm×25mm低回声占位。CT:肝形态正常,肝内外胆管扩张,十二指肠乳头部见一类园形软组织肿块、直径约2cm,向十二指肠腔内生长,胆总管远端(十二指肠壁段)堵塞、狭窄;上腹部未见肿大淋巴结。胃…     

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。     

图解胰头十二指肠结合部解剖

胰头十二指肠结合部为胆、胰、肠三者交汇的部位,此处解剖复杂,生理功能重要,涉及许多类型的手术,搞清其解剖无疑具有重要的科学价值与临床价值。本文通过对胰头十二指肠切除标本实体解剖的介绍,可了解胰头、十二指肠是如何连接的,胆总管、主胰管是怎样穿入十二指肠壁的,两者穿入十二指肠壁之后又是如何汇合等问题,从而获得对这些问题具体...     

腹腔镜与开腹胰十二指肠切除术临床疗效单中心回顾性研究

目的 比较腹腔镜胰十二指肠切除术（LPD）与开腹胰十二指肠切除术（OPD）临床疗效。方法 回顾性分析承德医学院附属医院2015年1月~2018年8月收治的21例行腹腔镜胰十二指肠切除术（LPD）与20例开腹胰十二指肠切除术（OPD）患者围手术期相关资料,比较两组患者手术过程、术后恢复及其他相关围手术期情况。结果 两组患者均顺利完成胰十二指肠切除术。两组患者手术时间和手术出血量比较,差异无统计学意义（P＞0.05）。LPD组与OPD组重症监护时间[（9.32±2.11）d vs（7.34±3.51）d     

单纯降部切除治疗十二指肠乳头部肿瘤

目的 探讨早期十二指肠乳头部肿瘤的微创手术治疗方法。方法 选择十二指肠乳头部早期恶性肿瘤及良性肿瘤且年龄偏大、体质较差或合并内科疾病,手术耐受性较差的病人,行保留胃幽门及胰头、单纯切除乳头部十二指肠的手术方式进行治疗,共治疗该类患者14例。结果 14例病人手术操作顺利,术后黄疸消退迅速。4例术后1周内有明显胰肠吻合口渗漏,2例术后1周内并发胆肠吻合口渗漏,均在术后7～10d缓解;1例手术切口继发感染,经换药治愈;2例术后并发肺部炎症,保守治疗痊愈。住院期间,无死亡病例。出院后9例获得随访,随访时间1～4年,未出现局部复发病例。结论 乳头部良性肿瘤及早期恶性肿瘤患者,行保留胃幽门及胰头的单纯十二指肠降部切除可获得良好的治疗效果。该术式创伤小,尤其适合年龄偏大、体质较差或有内科合并症、手术耐受力欠佳的患者。     

Case Review of Impacted Bile Duct Stone at Duodenal Papilla: Detection and Endoscopic Treatment

Purpose

A bile duct stone impacted at the duodenal papilla is an urgent condition that can rapidly lead to either suppurative cholangitis or acute pancreatitis due to almost complete obstruction of the bilio-pancreatic outflow. This study evaluated the clinical characteristics and results of endoscopic treatment for a bile duct stone impacted at the duodenal papilla.

Materials and Methods

Forty-six patients who had been diagnosed with an impacted papillary stone were retrospectively reviewed.

Results

The typical features of acute cholangitis (Charcot''s triad) and pancreatitis were only observed only in 10 patients (21.7%) and 17 patients (37.0%), respectively. After the endoscopic retrograde cholangiopancreatography, 30 patients (65.2%) were found to have a solitary stone impacting the duodenal papilla and 16 patients had one or more stones in the bile duct. On the radiological studies, the former patients were associated more commonly with no visible stone or no bile duct dilatation (p < 0.05). All impacted papillary stones were successfully removed by endoscopic sphincterotomy: 23 by a needle knife and 23 by a pull type papillotome. The procedure-related complications (n = 7, 4 bleeding, 3 pancreatitis) were not serious and did not differ, based on endoscopic findings and the procedure used.

Conclusion

A bile duct stone impacted at the duodenal papilla requires both clinical and radiographic evidence to support the diagnosis. Endoscopic sphincterotomy, either with a needle knife or a pull type papillotome, was safe and effective for removing the impacted papillary stone.     

肝方叶舌状切除胆肠吻合术的应用解剖学

观测了40例成人肝脏标本,按临床肝方叶舌状切除术和胆肠吻合术的实际出发,分析了第一肝门部位的左右肝管、门静脉左右干、肝左右动脉的排列关系:肝方叶内的 Glisson's 系统的分支、分布及肝中静脉的属支范围和它们的规律等。为临床该术式的实施提出了解剖学依据,且讨论了应用要点及术中注意的问题。     

胡桃夹综合征的相关解剖学研究

目的:研究左肾静脉及其毗邻的局部解剖关系,为临床应用提供解剖学资料.方法:对21例成人尸体标本进行解剖,观测左肾静脉与下腔静脉、腹主动脉、肠系膜上动脉的毗邻关系.结果:左肾静脉长度,男(5.89±1.15)cm、女(4.84±0.47)cm;起始处外径,男(0.81±0.21)cm、女(0.88±0.15)cm;近下腔静脉处外径,男(0.93±0.19)cm、女(1.11±0.23)cm;左肾静脉与下腔静脉之间的夹角,男(69.02±8.03)°、女(69.63±12.12)°;左肾静脉汇入下腔静脉处的上缘距肠系膜上动脉根部的距离,男(0.10±0.14)cm,女(0.12±0.17)cm.结论:左肾静脉的相关解剖数据为胡桃夹综合征的病因、发病及临床治疗提供了解剖学基础.     

Signals from pancreatic mesoderm influence the expression of a pancreatic phenotype in hepatic stem-like cell line PHeSC-A2 in vitro: A preliminary study

The ex vivo generation of pancreatic cells from adult hepatic stem cells for subsequent transplantation has been proposed as a novel treatment for Diabetes mellitus. The pancreas and liver, closely related developmentally, may retain a shared (hepatopancreatic) stem cell whose plasticity could be exploited to differentiate into either lineage, dependent on environmental signals. This novel study investigated whether signals from pancreatic mesoderm could induce the differentiation of adult hepatic stem cell-like cells into pancreatic endocrine cells in vitro. A porcine hepatic stem-like cell line, designated PHeSC-A2, was co-cultured with quail pancreatic mesoderm in a Growth Factor Reduced Matrigel-Ham’s F12.ITS culture system. Immunocytochemical studies revealed insulin- and glucagon-producing cells. Assessment of nuclear morphology indicated that these endocrine cells were PHeSC-A2-derived. It is thus proposed that the PHeSC-A2 cell line has a higher level of plasticity than previously indicated. These preliminary results and assessment of published data have led to the following postulations: (a) permissive signaling from pancreatic mesoderm suffices to induce hepatic stem cells to assume a pancreatic lineage, (b) the pancreatic phenotype assumed by hepatic stem cells is a default state, (c) the differentiation capacity embodied by these cells indicates the existence of a hepatopancreatic stem cell lineage.     

甲状腺上动脉应用解剖

27具成人尸体股动脉红色乳胶灌注 ,10 %福尔马林固定。在手术显微镜下解剖甲状腺上动脉 ,观察该动脉的起源、分支、毗邻等形态特点 ,测量脉管、神经的外径、长度 ,讨论了这些结构临床意义     

闭孔神经切断术的应用解剖

为提高闭孔神经切断术治疗髋关节疼痛性疾患的治愈率,从局部解剖学方面提供必要的资料,本文对72侧成人闭孔神经盆内、外段及髋关节支的应用解剖进行了研究,同时结合临床的实际应用进行了有关的讨论。     

面神经隐窝进路的相关解剖研究

目的：对面神经隐窝进路涉及解剖区域的相关显微解剖和影像学解剖的研究进展进行综述。方法：选用近几年关键词为“面神经”、“颞骨”及“后鼓室”的文章进行分析和总结。结果：其解剖结构复杂精细,涉及面神经乳突段、鼓索神经、砧骨窝之间的解剖区域。一些重要解剖结构的位置相对恒定,如锥隆起、圆窗龛、圆窗、前庭窗、镫骨、砧骨短脚、匙突、面神经鼓室段、水平半规管凸、后半规管凸等,可以作为手术的参考标记。结论：面神经隐窝进路在现代耳显微外科中有重要地位,熟悉其解剖关系,可以指导临床手术,避免损伤。