摘要 背景与目的:胰腺切除手术复杂,术中意外出血风险较大。术前精准评估胰腺周围血管起源、走行有助于降低术中出血风险。目前,尚缺乏对国人胰周血管解剖的系统性研究。本研究目的在于探明国人胰背动脉(DPA)及胰十二指肠下动脉(IPDA)的解剖学特点,并探索最佳CT图像后处理方式。方法:收集2016年12月—2017年6月行腹部增强CT检查的患者影像学资料,进行多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)等技术处理,得到动脉期胰腺直接供血动脉的图像,由两名有经验并熟悉胰腺血管解剖的放射科医师观察DPA及IPDA,内容包括DPA及IPDA支数、发出部位、与上级血管根部的距离,并比较不同的CT后处理技术对相应血管的检出率。结果:期间共有762例患者行腹部增强CT检查,结合入组与排除标准,211例患者纳入研究,其中男性98例,女性113例;年龄16~92岁;BMI 17.5~35.2 kg/m~2。全组患者,DPA及IPDA检出率分别为95.3%及96.2%。58.7%的DPA来源于腹腔干(CA),其中,发自脾动脉者占49.1%(58/118),发出部位距离根部平均距离为4.6(2~10)mm;发自肝动脉者占39.8%(47/118),发出部位距离根部平均距离为6.4(2~10)mm;发自CA分叉部者及本身者分别占6.8%(8/118)及4.2%(5/118)。41.3%的DPA来自肠系膜上动脉(SMA),发出部位通常在SMA的9~12点位(94.0%,78/83),距离SMA根部平均距离为26(18~45)mm。各有171例(84.2%)、29例(14.3%)及3例(1.5%)分别存在1支、2支或3支IPDA。根据IPDA与第一空肠动脉(FJA)的关系,可将其分为共干发出、分别发出2种类型。IPDA与FJA共干发出者约占60.1%(122/203),发出部位通常位于SMA的4~7点位(75.4%,92/122),距离SMA根部的平均距离为42(18~54)mm。约39.9%的IPDA自接发自SMA,发出部位通常位于SMA的6~9点位,距离SMA根部平均距离为40(18~52)mm。共有10.4%(22/211)可见IPDA与DPA共干。1 mm重建、MIP及VR技术对DPA的显示率分别为93.8%(198/211)、95.3%(201/211)、94.3 Background and Aims:Pancreatectomy is a complex procedure with a high risk of accidental intraoperative bleeding.Accurate preoperative assessment of the origin and running course of the peripancreatic vessels is helpful to reduce the risk of intraoperative bleeding.There is still lacking systematic study of the anatomy of peripancreatic vessels in Chinese population.The purpose of this study is to ascertain the anatomical characteristics of the dorsal pancreatic artery(DPA)and the inferior pancreaticoduodenal artery(IPDA)in Chinese,and further to explore the best post-processing method of CT images.Methods:The imaging data of patients who underwent abdominal enhanced CT examination from December 2016 to June 2017 were collected for multiplanar reconstruction(MPR),maximum intensity projection(MIP),volume rendering(VR)and so on.The data of the DPA and IPDA were observed by two experienced radiologists who are familiar with the anatomy of pancreatic vessels,and the observed variables included the number of branches of the DPA and IPDA,the location of the origin,and the distance from the root of superior vessels.The detection rates of different CT post-processing techniques for corresponding vessels were also compared.Results:During the period,a total of 762 patients underwent abdominal enhanced CT examination.According to the inclusion and exclusion criteria,211 patients were enrolled,including 98 males and 113 females,with age from 16 to 92 years,and BMI from 17.5 to 35.2 kg/m~2.In the whole group of patients,the detection rates of the DPA and IPDA were 95.3%and 96.2%,respectively.The DPA arising from the celiac trunk(CA)accounted for 58.7%.Among them,49.1%(58/118)originated from the splenic artery,and the average distance from the origin to the root was 4.6(2–10)mm;39.8%(47/118)were derived from the hepatic artery,and the average distance from the origin to the root was 6.4(2–10)mm;in addition,6.8%(8/118)and 4.2%(5/118)of the DPA came from the bifurcation of the CA and CA itself,respectively.The DPA arising fr
机构地区 应急总医院影像科
出处 《中国普通外科杂志》 CAS CSCD 北大核心 2021年第3期313-320,共8页 Chinese Journal of General Surgery
