【作者】 王华；

【导师】 张崇智； 杨慧；

【作者基本信息】 天津医科大学 ， 人体解剖与组织胚胎学， 2010， 硕士

【摘要】 目的应用火棉胶包埋胰十二指肠区,行薄型化水平断层切片,为临床影像学检查和各科诊疗提供形态学依据。材料方法1.取经福尔马林固定的成年尸体14具(8男,6女)。腹部做十字切口,肉眼观察腹腔器官无病变后沿胃大弯侧切开大网膜,然后将胃向上翻起,切开后腹膜充分暴露胰十二指肠区,观察并记录该区域周围结构的毗邻关系。分别经第12胸椎上缘和第3腰椎下缘横断标本,选取其间的躯干部作为制备断层标本的材料。根据研究需要将标本修成18cm×12cm×10cm大小的标本块,剔除胰十二指肠区周围的无关组织,将该区及该区腹后壁组织保留进行火棉胶包埋。采用大脑切片机做连续水平断层切片,片厚0.5mm,切片按顺序编号后照相,应用3D-DOCTOR软件进行测量并记录数据,对重要的局部区域在体式显微镜下放大8-10倍进行观察。另选取两例标本,在十二指肠大乳头区进行局部取材,然后对该区域进行火棉胶-HE染色处理。2.选取天津医科大学第二附属医院放射科及兰州大学第一医院放射科2010年1-3月份期间的15名患者(9男,6女)腹部无明显病变及1例胆总管扩张患者的CT摄像片与解剖断层图片进行了观察和分析。结果①胰头是位于胰腺右侧的膨大部分,前后形扁,其位置的变化范围较大,主要位于第12胸椎与第2腰椎之间。胰头上方有肝总动脉及其分支走行；下方邻接十二指肠水平部；前下方与十二指肠升部连接的空肠毗邻；前面的中部邻接横结肠系膜根的右端；后面与下腔静脉、右肾静脉、左肾静脉终末部及胆总管毗邻,门静脉起点多位于胰头后上方；右上角紧邻胃幽门窦和十二指肠上部,胰头右侧连接十二指肠降部,两者之间相连紧密,难于分离。②火棉胶断层切片的层厚0.5mmm,大约可获得128到135个薄型连续横断切片或层面,胰十二指肠区的可见范围集中显现于110个层面。以经十二指肠乳头最大切面为标准层面,胰头平均分别出现在其上70个层面,其下40个层面。③火棉胶切片观察,胰头位于十二指肠降部的左前方,其最大前后径为(20.17±3.19)mm,最大左右径为(28.14±3.12)mm；钩突最大前后径(9.40±1.58)mm,最大左右径为(12.30±3.04)mm；胰管在肠系膜上静脉右缘突然转向后,走行在胰头靠后部,主胰管在胰头部管径为(1.04±0.34)mm；胆总管下段行于胰十二指肠沟中,后边可有胰腺组织覆盖；十二指肠乳头在十二指肠降部中1／3处占64.29%。在体式解剖镜下将胰胆管汇入十二指肠乳头处局部放大8倍发现,十二指肠左侧与胰头右侧毗邻处其肌层不连续,且与胰头处的胰腺小叶相连,胰管及胆总管末端括约肌清晰可见,壶腹部腔内可见锯齿状粘膜皱襞。④正常CT图片层厚3mm的图像相当于含有6个层面0.5mm的火棉胶切片,这就会使得每相邻两张CT图片之间的一些细小结构无法显示,CT图像可见胰头位于十二指肠降部左侧,脾静脉与肠系膜上静脉在胰头后上方汇成门静脉进入肝门,钩突位于肠系膜上静脉后方、肠系膜上动脉的右侧。胰管、胆管在不扩张的情况下显示不充分。结论①火棉胶包埋薄型化断层切片技术简单易操作、成本低廉,经济实用。包埋固定后的器官无变形,组织原位固定好。切片过程中组织器官无任何损耗,因而实验结果可靠,数据可信,为临床高分辨率影像学观察研究提供了最佳的形态学基础研究平台。②胰十二指肠区一层CT扫描图片的厚度相当于火棉胶切片厚度的6倍,且相邻两层CT图像之间的层距为3mm,同样相当于火棉胶切片厚度的6倍,这就使得相邻两层CT图像之间厚度相当于火棉胶切片厚度的12倍,会造成了一些细小结构的盲区,从而影响对一些小病灶的诊断。在CT图片上可以清楚的识别胰头、十二指肠、肠系膜上动静脉等相关结构,通过肠系膜上动静脉很容易找到钩突,并观察其形态变化。在胃肠充盈的条件下十二指肠乳头显示尚可,胰胆管在不扩张的情况下观察不佳。③在火棉胶薄型化断层切片上,十二指肠乳头形态及胰胆管汇合处表现在断面上清晰可见；肠系膜上静脉是区分胰头和胰颈的标志,肠系膜上动脉可作为判断胰头钩突是否增大的标志。该实验可为组织分辨率更高的影像学检查和临床各科诊疗提供详实的解剖学资料。更多还原

【Abstract】 Objiective:To make thin cross-sectional anatomy of the pancreaticoduodenal region by using collodion-embedded method, and provide anatomy data for the imaging diagnosis and clinical treatment of the diseases of the pancreaticoduodenal region.Methods:①The materials were obtained from 14 (8 men,6 women) formalin fixed adult cadavers without significant lesion of the abdominal organs. Made cross cut on the abdominal region, and then cut the greater omentum along the greater curvature of stomach, upward tilted the stomach, exposed the pancreaticoduodenal region after cutting the retroperitoneal, the conformation and adjacency of the region were observed. Specimens were cut from the twelfth thoracic vertebrae to the third lumbar vertebrae after the observation generally. According to the demand of research, the specimens were cut to 18cm×12cm×10cm; we rejected some tissue which had nothing to do with our study, embedded the remained tissue and organ with collodion, and then made series cross sectional planes about 0.5mm thickness by cerebrosection. Put the planes in order and took pictures, measured them by using the 3D-DOCTOR software. The interest views were magnified for about 8 to 10 times. The other two cases of samples selected from major duodenal papilla, then stain the pancreaticoduodenal region with Haematoxylin-eosin.②We choose 15 (9men,6weman)patients’CT imagings which took during the period from January to March in the Second Hospital of Tianjin Medical and First Hospital of Lanzhou University, to compared with the planes made by collodion-embedded method. All the 15 patients without the disease of abdominal, we also choose one case who had choledochectasia.Results:①The pancreatic head is the right intumescentia of the pancreas, its anteroposterior is flat, its location ranges from the twelfth thoracic vertebra to second lumber vertebra on the specimens we observed. There are hepatic artery and its branches above the pancreatic head. The horizontal part of duodenum locates under the pancreatic head. The anteroinferior side of the head is next to the jejunum, at the middle of the anterior of the head adjoins the right of the root of the transverse mesocolon. The inferior vena cava, right renal vein, the end of left renal vein and common bile duct locate posterior to the pancreatic head. The beginning of the portal vein situates posteriosuperior to pancreatic head, on the right upper of the pancreatic head, it is next to the pyloric antrum and the superior part of the duodenum, the gastroduodenal artery and vein go through the intergroove between them. To the right side of the pancreatic head is the descending part of the duodenum, their connection is too close to be separated.②At 0.5mm thickness of continuous cross sectional planes, we can get 128 to 135 planes on each specimen, pancreas appeared on average 110 levels, taking the max plane of duodenal papilla as a standard, the pancreatic head appears 70 layers above and 40 layers below。③On the planes made by collodion-embedded method, the pancreatic head was located on the left and anterior of the descending part of the duodenum, its maximal anteroposterior diameters, and maximal left and right diameters were (20.17±3.19) mm and (28.14±3.12) mm respectively. The uncinate processes’ maximal anteroposterior diameters and maximal left and right diameters were (9.40±1.58) mm and (12.30±3.04) mm respectively. The pancreatic duct went to the back of the pancreatic head suddenly at the right side of the superior mesenteric vein; its diameters were about (1.04±0.34) mm. The lower segment of the choledoch went through the pancreaticoduodenal groove and sometimes was covered by pancreatic tissue. The duodenal papilla was situated the medium 1/3 of the descending part of the duodenum about 64.29%. We observed from the duodenal papilla with pancreatic duct and choledoch was magnified 8 times by somatotype anatomical lens that, the muscle of the left of the duodenum adjacent and right of the pancreatic is discontinued, but connected with pancreatic lobule of the head of pancreas. We can see the pancreatic duct and the choledoch clearly, the mucosal fold is denticulated on the duodenal ampulla.④The CT image slice thickness 3mm equivalent to six levels of collodion sections image thickness 0.5mm, if so, some of the fine structures can not display in CT images. On the planes of CT, the pancreatic head situated the left of the descending part of the duodenum, the splenic vein and the superior mesenteric vein went together to the upward and backward of it, the uncinate process located behind of the superior mesenteric vein and the right of the superior mesenteric artery, pancreatic duct and bile duct can not be seen without dilatation.Conclusion:①The collodion-embedded method is pragmatic and easy to handle. After embedding, the fixed organs had no significant deformation and in situ fixed. Biopsy tissues and organs during the process without any loss, so the results are reliable and credible, which could provide best morphological basis for the research platform of clinic and radiology.②The CT image slice equivalent to six levels of collodion sections image, so some of the fine structures can not display in each CT image, this might affect the diagnosis of small lesions. On the CT imaging, the pancreatic head, the duodenum, the superior mesenteric vein and artery can be seen, we can distinguish the uncinate process by finding the mesenteric artery, and view the shape of it. The duodenal papilla can not be seen, we can not observe the pancreatic duct and bile duct without dilatation.③On the planes embedded by Collodion, the shape of the duodenum and the convergence of the cholangiopancreatography were easily to distinguish; the superior mesenteric vein is a landmark to identify the pancreatic head and neck; the superior mesenteric artery is a sign to evaluate the uncinate process augmentated or not. This study may provide anatomy data for the imaging examination and clinical diagnoses and treatment.更多还原