Applied Anatomy And Three-dimensional Reconstruction On Head Of Pancreas’ Blood Supply

Objective The study of the blood supply to caput pancreatic is explored by grossanatomy, specimen cast, and three-dimensional reconstruction, which provides theanatomical reference for clinical operation on caput pancreatic, duodenum and the endof common bile duct, and the regional arterial infusion of caput pancreatic.Materials and Methods1. The relation of caput pancreatic was observed and the origin, course and branchesof its nutrient arteries were measured with vernier caliper on12intact adultspecimens.2. The vessels distribution and vascular anastomosis were observed on2combinedpancreas-spleen specimens by casting the vessels around them.3. The systemic arteries were injected with lead oxide-gelatine mixture on6donatedspecimens. Pancreas, duodenum spleen and associated vessels were dissected, takenX-Ray and scanned with CT at anatomical position. The blood supply to caputpancreatic was three-dimension reconstructed with Mimics13.1and CT data. Thedistance between anterior superior pancreaticoduodenal and the superior border of theduodenum, arteriae pancreaticoduodenalis superior posterior and the superior borderof the duodenum, arteriae panceaticoduodenalis superior posterior and the medial sideof duodenal papilla, the diameter of the pancreatic duodenal artery, and the length ofthe dorsal pancreatic artery trunk were measured on reconstructed models. All thesemeasured values were compared with the measurement results obtained from grossdissection.Results1. Caput pancreatic is mainly nourished by anterior superior pancreaticoduodenal artery, posterior superior pancreaticoduodenal artery, aterior inferiorpancreaticoduodenal artery, posterior inferior pancreaticoduodenal artery and dorsalpancreatic artery, pancreaticoduodenal arches, transverse pancreatic artery and theright branch of the dorsal pancreatic artery.2. The anterior superior pancreaticoduodenal artery is100%presented in specimens, itis (18.53±0.45)mm in distance between the starting point of pancreaticoduodenalartery and the superior border of duodenal, and1.22±0.21mm in diameter atcommencement.3. The posterior superior pancreaticoduodenal artery pancreaticoduodenal artery is100%presented in specimens, it is (11.20±0.32)mm in distance between the start ofpancreaticoduodenal artery and the superior border of duodenal and (10.50±0.84)mmbetween the start of pancreaticoduodenal artery and the medial side of duodenalpapilla, respectively. It is (l.73±0.27)mm in diameter at commencement.4.95%of posterior inferior pancreaticoduodenal artery originates from superiormesenteric artery and5%from jejunal arteries, the posterior inferiorpancreaticoduodenal artery is1.13±0.03mm in diameter at commencement.5. The anterior inferior pancreaticoduodenal artery originates from the first or secondjejunal artery, nourishes inferior third of caput pancreas and the adjacent part ofduodenum, it is (l.68±0.54)mm in diameter.6. The distances of the posterior pancreaticduodenal arch at the top of the caputpancreas, major duodenal papilla, the bottom of the caput pancreas to duodenum are(1.06±0.23)cm,(1.15±0.28)cm and (1.33±0.25)cm respectively. There are about12(10-15) branches originating from lateral of the posterior pancreaticduodenal archand arriving at the posterior wall of duodenum and the caput pancreas.7. The distances of the anterior pancreaticoduodenal arch at the top of the caputpancreas, major duodenal papilla, the bottom of the caput pancreas to duodenum are(1.18±0.33)cm,(1.02±0.26)cm and (1.43±0.22)cm respectively. There are about11(8-14) branches originating from lateral of the anterior pancreaticduodenal arch and arriving at the anterior wall the duodenum and the caput pancreas.8. The vessel spatial relation is well demonstrated in three-dimension reconstructedmodel of caput pancreas. The following parameters are obtained usingthree-dimensional measurement. The distances from the superior border of duodenumto anterior superior pancreaticoduodenal artery or to posterior superiorpancreaticoduodenal artery are (18.17±0.63)mm and (10.87±0.59)mm respectively;the distance from posterior superior pancreaticoduodenal artery pancreaticoduodenalartery to the medial side of duodenal papilla is (10.16±0.27)mm. Posterior inferiorpancreaticoduodenal artery is (1.11±0.02)mm in diameter. Dorsal pancreatic artery’strunk is (6.54±0.48)mm in length. These parameters have no significance comparingto measurement results obtained from gross dissection.Conclusion1. In order to protect the posterior and anterior pancreaticoduodenal arches, thedistance between suture silk and right border of caput pancreas should be kept morethan15mm during the caput pancreatic-preserved duodenum resection.2. In order to accurately target the lesion within caput pancreas, the catheter shoud beput into the gastroduodenal artery or the inferior pancreaticoduodenal artery undercondition of the regional intra-arterial infusion.