中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (02): 179-186.DOI: 10.19538/j.cjps.issn1005-2208.2022.02.11

• 论蓍 • 上一篇    下一篇

352例胆道疾病病人腹腔干-肠系膜上动脉系统影像解剖学研究及其临床意义

李    斌1，王凤伟2，邱智泉1，张吉祥1，缪应鸟2，张清惠2，姜小清1   

  1. 1 海军军医大学第三附属医院（上海东方肝胆外科医院）胆道一科，上海200438；2 旭东数字医学影像，广东深圳518019
  • 出版日期:2022-02-01 发布日期:2022-01-27

  • Online:2022-02-01 Published:2022-01-27

摘要： 目的    开展胆道疾病病例腹腔干-肠系膜上动脉系统影像解剖学研究，并探讨其临床意义。方法    回顾性分析2016年12月至2021年5月海军军医大学第三附属医院胆道一科收治的352例胆道疾病病人薄层CT扫描图像资料并构建三维数字影像，归类分析腹腔干-肠系膜上动脉及其主要分支影像学形态特点。结果    影像学形态完全符合经典解剖学著作描述者仅64例（18.1%）。288例（81.8%）存在动脉异位起源（肝动脉25.6%，胰腺动脉支5.7%，右膈动脉6.3%，胃十二指肠动脉0.6%，胆囊动脉0.6%，胃左动脉0.6%，胃右动脉0.3%，胃网膜左动脉0.3%）、副肝动脉（9.7%）、异位走行（肝动脉、异位起源肝动脉及副肝动脉31.0%，异位起源胰腺动脉支5.7%，异位起源胃十二指肠动脉0.6%，异位起源胆囊动脉0.6%）、异常共干（腹腔干-肠系膜上动脉共干2.8%；其他动脉共干0.9%）、异常交通支（Bühler弓4.8%）以及动脉缺如（2.6%）等单一或多态并存的非经典解剖学形态。结论    腹腔干-肠系膜上动脉系统解剖形态多样。充分了解腹腔干-肠系膜上动脉系统解剖形态特点，将有助于合理规划胆道疾病外科手术方案、降低术中出血风险以及提高术后出血性并发症救治成功率。

关键词: 胆道疾病, 腹腔干-肠系膜上动脉系统, 异源动脉, 异行动脉, 手术

Abstract: Imaging anatomy of the celiac trunk-superior mesenteric artery system and its clinical significance in 352 cases of biliary tract disease        LI Bin*，WANG Feng-wei,QIU Zhi-quan,et al. *Biliary Tract Surgery Department I, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical Universit,Shanghai 200438,China
Corresponding author:JIANG Xiao-qing,E-mail:jxq1225@sina.com
Abstract    Objective    To study the imaging anatomy of the celiac trunk-superior mesenteric artery system in patients with biliary tract diseases and to explore the clinical significance. Methods    Thin-layer CT scan images from 352 patients with biliary tract diseases who admitted in the Department of Biliary Tract I of the eastern hepatobiliary surgery hospital from December 2016 to May 2021 were retrospectively analyzed, three dimentional digital images were constructed to categorize and analyze the imaging morphological characteristics of the celiac trunk-superior mesenteric artery and its main branches. Results    Only 64 cases (18.1%) were completely consistent with the description of classic anatomical works. Atypical anatomical patterns with single or polymorphic coexistence were presented in 288 cases (81.8%) , including arterial ectopic origin (hepatic artery 25.6%, pancreatic artery branch 5.7%, right phrenic artery 6.3%, gastroduodenal artery 0.6%, gallbladder artery 0.6%, left gastric artery 0.6%, right gastric artery 0.3%, and left gastroepiploic artery 0.3%), accessory hepatic artery (9.7%), ectopic course(hepatic artery, hepatic artery of ectopic origin and accessory hepatic artery 31.0%, ectopic origin pancreatic artery branch 5.7%, ectopic origin gastroduodenal artery 0.6%, ectopic origin gallbladder artery 0.6%), anomalous common trunk (2.8% for celiac trunk-superior mesenteric artery common trunk and 0.9% of other artery common trunk) , anomalous communicating branches (4.8% of arc of Bühler ) and arterial agenesis (2.6%). Conclusion    The anatomical pattern of the celiac trunk-superior mesenteric artery system is diverse. A thorough understanding of the anatomical features of the celiac trunk-superior mesenteric artery system prior to surgery will help to plan surgical procedures for biliary diseases, reduce the risk of intraoperative bleeding and improve the success rate of postoperative bleeding complications.

Key words: biliary tract disease, celiac trunk-superior mesenteric artery system, ectopic origin artery, ectopic walking artery, surgery