肝右动脉和胆囊动脉的起源行程及分布的应用解剖学

在62具成人体尸体上,对肝右动脉和胆囊动脉的起源,行程及分支分布进行了观察,有58例胯右动脉起源于肝固有动脉（93．5％）,多经胆囊三角（Calot三角）分出胆囊动脉入胆囊,终支入肝右叶,胆囊动脉起于肝右动脉占76．2％,起于肝固有动脉占9．5％,胆囊动脉以单支型为主,多经Calot三角入胆囊。     

Division of the right posterior attachments of the head of the pancreas with a linear stapler during pancreaticoduodenectomy: vascular and oncological considerations based on an anatomical cadaver-based study

Background  Section of the right posterior attachment (RPA) of the pancreatic head from the adventicia of the superior mesenteric artery (SMA) is the last step of pancreaticoduodenectomy. This procedure might be technically demanding, time consuming and potentially dangerous. A method using a stapler has been proposed to simplify this step of the pancreaticoduodenectomy. Methods  To evaluate the potential consequences of RPA section using this new method, we used an experimental model of pancreaticoduodenectomy in 20 cadavers. After RPA stapling, the residual areolar tissue located between the staple line and SMA was removed (by sub adventicial dissection) and weighed. This allowed an evaluation of: (1) the theoretical risk of SMA injury and (2) the potential carcinological consequences of using stapling division, in comparison with the lymphadenectomy obtained with the conventional sub-adventicial dissection. Results  A right hepatic artery was accidentaly injured in 10% of cases because of the lack of arterial dissection and arterial anatomy recognition. Forty-three percent of the RPA containing nerves and lymphatics remains in place. Using the stapling technique for RPA division theoretically increases the risk of micro or macroscopically positive margin after surgical resection. Conclusion  The result of this human cadaver-based dissection suggests that the use of the mechanical stapling device for final division of the RPA might increase the risk of SMA injury. The risk of vascular injury has been reported in surgical literature and is confirmed by this study. Such results (10% of accidentaly injury) may not be representative in leaving human patients, thanks to the use of a detectable palpable pulse of the SMA. The latter is important in avoiding vascular injury during RPA division. This study also shows that this new technique may increase the risk of incomplete tumor resection.     

An anomalous right gastroepiploic artery arising from the superior mesenteric artery

During a routine dissection, the right gastroepiploic artery was found to arise from the superior mesenteric artery. The gastroduodenal artery ran in front of the common bile duct and descended along the posterior surface of the head of the pancreas (posterior superior pancreaticoduodenal artery). The enlarged pancreatic branch arising from the superior mesenteric artery mainly supplied the anterior surface of the head of the pancreas and then continued to become the right gastroepiploic artery. This route seemed to be formed due to the lack of a connection between the posterior superior pancreaticoduodenal artery and the common trunk of the anterior superior pancreaticoduodenal and right gastroepiploic arteries.     

胆囊炎病人胆囊动脉血流动力学的彩色多普勒血流图研究

本研究用彩色多普勒血流图检测了60例正常人和68例胆囊炎病人的胆囊动脉血流分布。结果表明正常胆囊的血液供应是低阻力型的血管床,急性及亚急性胆囊炎为胆囊壁血流分布显著增多,而血流动力学无明显改变。1例厚壁型胆囊癌不仅血流分布增多,且血流动力学呈高流速及高阻力型,可否作为与胆囊炎的鉴别指标尚待进一步研究。     

Measurement of the distance and angle between the aorta and superior mesenteric artery: normal values in different BMI categories

Aim The purpose of the study was to reveal the values of the distance and angle between the superior mesenteric artery (SMA) and aorta according to body mass index in normal population. Material and methods The study was performed on 524 routine abdominal CT examinations. On axial and reformatted sagittal–oblique sagittal images, the distance and the angle between superior mesenteric artery (SMA) and aorta were measured at the location where the duodenum crosses. Body mass index (BMI, Kg/m2) was calculated. The cases were divided into four groups according to the BMI categories (Group 1: BMI<18.5, Group 2: BMI 18.5–24.9, Group 3: BMI 25–29.9, Group 4: BMI>30) in both genders. For each gender group, mean values of distance and angle measurements were calculated with standard deviations and 95% confidence intervals. For each gender group, Pearson correlation coefficients were calculated between the distance and BMI, as well as between the angle and BMI. Spearman correlation coefficients were calculated between the distance and BMI category, as well as between the angle and BMI category. Results For both genders, there was a moderate and significant positive correlation between the distance and BMI. The correlation between the angle and BMI was low, but significant and positive (P < 0.001). The correlations between the BMI category and aortomesenteric distance or angle were moderate and significantly positive, as well (P < 0.001). Conclusion The aortomesenteric angle and distance significantly correlate with BMI in normal population. The mean values, we report, may be used as normal values to help reach the diagnosis of superior mesenteric artery syndrome.     

Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk: a case report

Anatomical variations in the origins and branching patterns of the hepatobiliary arterial system may be encountered during both conventional surgical and laparoscopic cholecystectomy. We report a rare case of double cystic arteries arising from both the right hepatic artery and the proximal part of the posterior superior pancreaticoduodenal artery. Additional variations consisting of an accessory left hepatic artery arising from a left gastric which in turn arose from the descending aorta superior to the origin of the celiac trunk and a small left hepatic artery arising from the hepatic proper artery were also noted. The celiac trunk bifurcated into the splenic artery and the common hepatic artery forming a hepatosplenic or lienohepatic trunk. The possible clinical implications are discussed.     

Evaluation of the effect of visceral fat area on the distance and angle between the superior mesenteric artery and the aorta

Purpose  To investigate the effect of visceral fat area on the distance and angle between the superior mesenteric artery (SMA) and the aorta. Methods  On axial and sagittal images from abdomen CT scan, the distance and the angle between the SMA and the aorta were measured at the location where the third part of the duodenum crosses. The visceral fat area was calculated at the level of the umbilicus on the abdominal CT section. Body mass index was calculated. Results  For both genders, the correlation between the distance and visceral fat area was substantial (p < 0.001). For males, there was no statistically significant relationship between the angle and the visceral fat area. For females, the correlation between the angle and the visceral fat area was low but significant and positive (r = 0.25, p < 0.048). In addition, it was found that males have a greater proportion of visceral fat than females. In both females and males, the subcutaneous fat area correlated with BMI (r = 0.65, r = 0.69, respectively, p < 0.001), more strongly than the visceral fat area did (r = 0.51, r = 0.63, respectively, p < 0.001). Conclusions  The distance between the aorta and the SMA significantly correlates with visceral fat area than with BMI. The size of visceral fat area of females and males vary; therefore, the amount of visceral fat area should be considered in the establishing diagnosis of SMA syndrome.     

Variation of Origin of Obturator Artery in Eastern Indian Population - A Study

Obturator artery is a medium-calibre parietal branch of internal iliac artery having wide variations in its origin. Since there was no previous investigation of variations of origin of obturator artery in a large series of eastern Indian subjects, it was decided to undertake this study. 56 pelvic halves from formaldehyde preserved cadavers were dissected in Calcutta National Medical College, Kolkata and B.S. Medical College, Bankura over a period of 3 years. Obturator artery originated in maximum number (44.6%) of cases from the anterior division of the internal iliac artery, the next common site (23.2%) being the inferior epigastric artery. Relatively late appearance of the obturator artery amongst the branches of internal iliac artery is most likely to be the cause of such a wide variation.     

Calot三角的应用解剖学

本对50例成年尸体Calot三角的形状，内容和位置关系作了调查，并进行了讨论，尤其是对于胆囊动脉在Calot三角内的有关情况作了探讨。     

Variability in the Origin of the Obturator Artery

INTRODUCTION

General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper’s ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported.

MATERIALS AND METHODS

The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted.

RESULTS

In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity.

CONCLUSION

The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.     

肠系膜上动脉压迫综合征多层螺旋 CT 的诊断价值

目的：探讨多层螺旋CT对肠系膜上动脉压迫综合征（SMACS）的诊断价值。方法：回顾性分析2009年1月至2012年7月我院临床确诊为SMACS,并已行上腹部CT增强扫描的13例患者的影像资料,并选取同期因肝脏或肾脏疾病行CT增强扫描的20例患者的影像资料作为对照组,将动脉期图像进行矢状位MPR重组并测量肠系膜上动脉（ SMA）与腹主动脉（ AA）的夹角及十二指肠水平段通过层面SMA和AA间距。结果：13例SMACS患者SMA与AA的夹角是14．7°～31．6°,平均19．1°±3．4°;十二指肠水平段通过层面SMA与AA的间距为3．1～10．2 mm,平均（7．1±2．0） mm。20例对照组患者SMA与AA的夹角分别为19．5°～60．4°,平均41．5°±9．3°;十二指肠水平段通过层面SMA与AA的间距为7．7～27．1 mm,平均（16．4±4．8）mm。两组间比较,SMA与AA夹角及间距的差异均有统计学意义（ P＜0．001）。结论：多层螺旋CT上腹部增强扫描的动脉期图像及MPR重组能够清楚显示SMA和AA的关系,并能够辅助诊断SMACS。     

Rapidly aggravated dissecting flap by angiography during percutaneous stent placement for acute isolated superior mesenteric artery dissection

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.     

肝动脉的应用解剖

在 6 3例成尸上观察了肝动脉的起源和行程 ,腹腔干及主要分支外径和腹腔干至肠系膜上动脉间的距离。结果肝右、左动脉 ,肝固有动脉 ,肝总动脉和腹腔干外径分别为 3.1± 0 .5 ,2 .8± 0 .3,4.0± 0 .12 ,5 .3± 0 .2 2和 7.4± 0 .4mm ;正常型肝动脉占 5 0 .79% (32例 ) ;Hiatt 、 型分别占 19.0 5 % (12例 )和 6 .34% (4例 ) ;腹腔干至肠系膜上动脉间距离为 7.4± 0 .33 mm。讨论了肝动脉变异及其临床意义。     

肝门区动脉的外科解剖

本文对西安地区30例成尸肝脏动脉的分布,变异及其临床解剖应用作了详细的调查与讨论分析,并与文献资料进行了比较,以期对临床肝脏手术有所帮助。     

A rare case of inferior mesenteric artery arising from the superior mesenteric artery,with a review of the review of the literature

Anatomical variations of the inferior mesenteric artery (IMA) are uncommon. Generally, the IMA is very stable, arises directly from the abdominal aorta at the level of the third lumbar vertebra. We describe here an extremely rare case in which the IMA arose from the superior mesenteric artery. The findings were made during routine dissection of the cadaver of a 79-year-old Japanese man. This present case is the ninth report of this variation and was associated with gastrophrenic trunk, hepatosplenic trunk, hypoplastic spleen and accessory spleen. Clinically, cases like this highlight the importance of knowing the IMA anatomy and the possibility of its numerous variations in surgical procedures such as right hemicolectomy, resection of the transverse colon, left hemicolectomy, sigmoidectomy, and en bloc resection of the head of the pancreas and the superior mesenteric vessels. The developmental significance of this variation is also discussed with a detailed review of the literature.     

Anatomic variation of the celiac trunk with special reference to hepatic artery patterns

Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) and the hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal pattern of the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and general surgeons, as well as vascular radiologists in this area.     

失血性休克的大鼠肠系膜动脉节律基因表达的变化

目的:建立失血性休克大鼠模型及探讨失血性休克大鼠肠系膜上动脉(SMA)节律基因表达的变化。方法:建立失血性休克大鼠模型并随机分为失血性休克组和空白对照组,通过RT-PCR检测模型肠系膜上动脉节律基因per1、per2 mRNA的表达水平。结果:休克组与对照组相比,前者肠系膜上动脉节律基因per1、per2的mRNA表达降低(p<0.05)。结论:失血性休克模型肠系膜上动脉节律基因per1、per2表达水平下调,提示失血性休克可以影响节律基因的表达。     

腹腔镜右半结肠切除术相关血管的活体解剖学观察

目的阐明腹腔镜右半结肠切除术(laparoscopic right hemicolectomy,LRH)相关血管的活体解剖学特点。方法对36例接受LRH的肿瘤病人进行术中观察和术后录像复习。结果肠系膜上静脉(superior mesenteric vein,SMV)为起于右髂窝上缘,位于小肠系膜和升结肠系膜交界部的蓝色条纹。肠系膜上动脉在系膜内难以目视辨认,走行于SMV左侧。回结肠血管出现率100%,为升结肠系膜内、十二指肠水平部下缘附近、搏动的条索。胃结肠干出现率77.8%(28/36),包含上右结肠静脉/右结肠静脉者占比为89.3%(25/28);后者亦可直接注入SMV。胃结肠干于胰切迹右缘的横结肠后间隙汇入SMV右壁。右结肠动脉在胰颈下缘起始,常与胃结肠干伴行或交叉。结论正确的间隙(肠系膜内间隙)、标志和线索(肠系膜上静脉),是LRH中血管定位的解剖学基础。     

压力对兔肠系膜上静脉形态的影响

采用恒压固定的方法，研究兔肠系膜上静脉（ＳＭＶ）的形态特点及门脲同压时的压力峰值对其形态的影响，结果表明：ＳＭＶ的管壁形态与人脐带静脉的结构很相似，是介于股动脉与股静脉之间的结构，在４ｋＰａ内压固定下，内弹力膜被拉直，管壁变薄，管壁平滑甩层厚度由５１．６８００μｍ变为３２．３２６０μｍｘｌｅｑｓｙｎｗｔａ ｔａ ｍｈ １．９１４６μｍ变为３．４９８０μｍ，短径上０．７８８４μｍ变为０．５２２８μｍ