Clinical Anatomy Study Of Blood Supply Of Region Of Head Of Pancreas

Objectives: To provide the clinical anatomic basis for traditional excision and excision with laparoscope of head of pancreas and duodenum.Methods: (1) 20 antiseptic cadaver specimens were infused by red latex to observe the adjacent structure of head of pancreas; (2) Total pancreas companied with duodenum and spleen were harvested in 20 cadaver specimens to study the blood supply of head of pancreas; (3) 9 specimens of pancreas which were infused better than others were selected to study the blood supply of inner region of head of pancreas; (4) 5 specimens of head of pancreas and duodenum were harvested to study the blood supply pattern of region of head of pancreas and inner region of head of pancreas, which were contrasted to cadaveric specimens. (5) Celiac arteriogram and superior mesenteric angiography were taken to show anastomosis between these two arteries and their blood distribution. And the contrast study was executed.Results: (1) The adjacent of head of pancreas: (1) The structures which covered head of pancreas were stomach, omental bursa and mesocolon transversum in turns, from superficial to deep. (2) Inferior vena cava, right renal vein and common bile duct crossed behind the head of pancreas. Sometimes common bile duct may cut throughposterior surface or parenchyma of head of pancreas. (3) Superior mesenteric artery and vein were adjacent to the head of pancreas in the left which accompanied by rami coeliaci nervi vagi. (4)Truncus coeliacu and its branch truncus coeliacu were closely adjacent to head of pancreas in the cranial. (5)It was closely adjacent to antrum pylori and pars superior duodeni in the right-cranial conner. Gaster-duodenum vessels passed down through the intergroove of the above two structures. (6) It was encased by pars horizontal duodeni in the below. (2) Blood supply of region of head of pancreas and duodenum: (1) Blood supply was abundant, and originated from truncus coeliacu and superior mesenteric artery, respectively. These two origins both formed as arterial arcades at anterior and posterior of the region of head of pancreas and duodenum. The blood supply of head of pancreas also was the main blood supply of duodenum. (2) Anterior arterial arcades had two variances; the distance between duodenum and anterior arterial arcades at supra-anterior artery was 18.0mm. And at 1.47mm below the major papilla it turned into intergroove. Anterior arterial arcades divided laterally into 12 branches to anterior wall of duodenum, and divided medially into 4 branches to inner region of head of pancreas. (3) The origin of inferior panereaticoduodenal artery had two types; a lamellar transparent fascia wrapped the posterior surface of head of pancreas, and then stretched to posterior wall of duodenum; the distances between posterior panereaticoduodenal artery and duodenum at the superma extremity, major papilla level, left low extremity of posterior surface of pancreas were (11.7±3.3)mm, (10.9±4.2)mm, (13.0±3.6)mm, respectively. The posterior pancreaticoduodenal artery divided laterally into 14 branches. (3) Blood supply of head of pancreas: ? superficial layer blood supply was originated from the 4 medial branches from anterior arterial arcades. The 1st one was the widest and was the main nutrient artery. (2) Deep layer blood supply: superior part was supplied by the supreme 3 branches which origin from posterior artery arcades. The diameter of the 3rd one was (0.98±0.24)mm, and was themain nutrient branch. The inferior part was supplied by the 9th- 11th branches of posterior artery arcades. (3) Papilla artery was originated from the second order of 3rd branch of posteriosuperior artery arcades, the diameter was (0.38±0.10)mm; ? Inner blood supply of hamular process was mainly originated from descend branch of inferior pancreatic artery. (5) Nutrient artery had abundant communicating branches among the superficial and deep layer of head of pancreas and hamular process, and formed anastomosis at the ductus pancreaticus level.Conclusion: (1) Inner regions of head of pancreas are supplied by the branches of anterior and posterior arterial arcades of pancreas and duodenum. It can be divided into superior and inferior parts and superficial and deep layers. Hamular process of head of pancreas is supplied by descent branch of dorsal pancreatic artery. The nutrient arteries of head of pancreas have abundant anastomosis. (2) The excision of head of pancreas performed along the left side of common bile duct can effectively protect the blood supply of duodenum, common bile duct and major papilla. It is easy to execute and is a better way of excision of head of pancreas to remain the duodenum. (3) The right branch of dorsal pancreatic artery should be protected in the excision of body and tail of pancreas in lest of ischemic necrosis of hamular process.