Applied Anatomy Study Of Blood Supply For The Splenic And The Body And Tail Of Pancreas

Objectives:To supply the evidence of applied anatomy of distal pancreatectomy with preservation of the spleenMethods:(1)30antiseptic cadaver specimens were infused by latex to observe the shape of body of pancreas、the adjacent structure of head of pancreas and the structure between the tail of pancreas and spleen;(2) The main pancreatic ducts were separated from10dissociated pancreas specimens to observe the location of main pancreatic duct and its orientation, and measure the distance between the main pancreatic duct and the superior border、back of pancreas respectively;(3)9joint molten specimens. with Pancreatic splenic artery and the main pancreatic duct were observed the orientation between Pancreatic splenic artery and the main pancreatic duct and their distances;(4)10molten specimens of Pancreas vessel were observed the blood supply of inner region of in the body and tail of pancreas.Results:(1) The shape and size of the body and tail of pancreas:①The shape of23the body pancreas were three diamond podetium, the shape of4the body pancreas were quadrangular podetium and the shape of4the body pancreas were prolate; the length of the body pancreas was (80.92±8.07)mm, the thickness and height of the widest part were (19.57±3.03)mm、(30.36±2.90)mm respectively and of the narrowest were (14.50±3.45)mm、(21.37±2.27)mm respectively;②The shape of20the tail pancreas were three diamond podetium, the shape of7the tail pancreas were conical、the shape of2the tail pancreas were tabular triangle and the shape of1the tail pancreas were irregular shape; the length of tail of pancreas was (25.50±7.16)mm, the thickness and height of the narrowest part were (9.45±2.48)mm、(11.75±3.42)mm respectively.(2)The adjacent of tail of pancreas:①The structures which covered tail of pancreas were stomach, omental bursa and mesocolonr transverse in tuners, from superficial to deep.②Left curia of diaphragm、left adrenal gland and left renal upper pole crossed behind he tail of pancreas in turns, from right to left, and superior mesenteric vessel、pancreas vein and down-mesenteric vessel cut through;③Down-front of the body and tail of pancreas were affixed to transverse colon, and jejunum、duodenojejunal flexure and left colic flexure were adjacent to the back of the body and tail of pancreas in turns, from right to left;④Superior border was adjacent to pancreas artery.(3)The structure between the tail of pancreas and hilus of spleen:①12were affixed to each other,18were isolated by space and the average distance was (23.84±5.61)mm;②There were lienorenal ligaments、splenogastric ligament、spleen colon ligament and vessel cut through in the former both;③The distance between spleen leaf artery originated from pancreas artery and hilus lienis was (15.01±6.60)mm, and pancreas vein which was below the back of the pancreatic artery was between the tail of pancreas and hilus lienis.(4) The location and orientation of main pancreatic ducts:①The main pancreatic ducts was located at the1/2of section of the tail pancreas or the1/3junction of the center back of the body of pancreas section;②It was from the middle of tail of pancreas and was diagonally through the upper right of tail of pancreas. And flashed back at neck of pancreas down forward to the middle of head of pancreas. At the location of neck of pancreas, the backfocal distance of main pancreatic ducts and pancreas artery were both minimum,but became elongated at the location of body of pancreas.(5) The blood supply of inner region of body and tail of pancreas:①The occurrence rate of dorsal pancreatic artery was100%,and8specimens were originated from the1/3part of pancreas artery,2were originated from common hepatic artery. And then was down forward to left-right two branches. The right branch was emitted descending branch at hook department of Pancreatic head;②The occurrence rate of great pancreatic artery was100%, and8specimens were originated from the middle1/3part of pancreas artery,2were originated from inner1/3part of pancreas artery;③The occurrence rate of tail of pancreatic artery was80%, and was originated from the external1/3part of pancreatic artery, and the distance between the branch of Spleen leaf artery was (4.56±4.29)mm;④The occurrence rate of inferior pancreatic artery was90%, and8specimens were orientated through the whole of body-tail of pancrea,l specimen was orientated through the right2/3of body-tail of pancreas,the average distance was (75.28±10.75)mm;⑤Other branches:there were left gastroepiploic artery and spleen upper pole artery in4specimens.Conclusion:(1) When there is a preservation of the spleen and splenic vessels with the resection of the body and tail of pancreas,the proper method is to fracture the body of pancreas about2-3cm at the left of pancreatic neck and free splenic vessels along the tail of pancreas according to retrograde way,preserving all the branches from upper splenic artery,searching and ligating main pancreatic duct in the front of pancreatic stump,reducing the complication of pancreatic fistula.(2)The left branch of dorsal pancreatic artery supply blood for the tail of pancreas, The right branch of dorsal pancreatic artery supply blood for uncinate process of head of pancreas,when there is a pancreatic partial cystectomy,the proper method is to preserve the left and right branches of dorsal pancreatic artery selectively according to different resection parts which may avoid ischemic necrosis of residual pancreas after operation.