胆总管和肝总管的血供及其临床意义

根据胆总管的解剖学分段，观察了各段的营养动脉及其走行和分布。其中胆总管十二指肠后段，上段和肝总管的血供来源较多，相互吻合形成纵行吻合链，链的主干包括左，右边缘吻合动脉和Ⅱ型门静脉后动脉。位于胆总管胰段后面的动脉吻合环，是该段胆管血供的重要来源。针地胆总管血供的形态特点，讨论了临床应用要点。     

利用微血管铸型技术研究肝外胆管动脉的分布特征

目的　统计分析肝外胆管的血供来源和分布以及在十二指肠上段胆管的吻合动脉链之间的多环形血管网,为胆管外科手术提供临床解剖学理论依据。 方法　以丙烯酸树脂为动脉填充剂灌注6例肝外胆管动脉制备铸型标本,使用photoshop测量法测量微小血管内径,观测和分析肝外胆管的血供来源和分布情况。 结果　肝固有动脉左、右支在肝总管上方存在弓型交通支,十二指肠上段胆管左右边缘的吻合动脉链间有丰富的横向动脉,吻合动脉链的供血约53%来自下方,来自上方的约占46%,1%来自中段肝固有动脉。通过对每条横向动脉中部的内径和两侧起始部的内径测量,发现肝总管中段和上段的横向动脉较粗,中部的平均内径分别为（0.26±0.02）mm和（0.24±0.04）mm,与两侧的内径比也比较大,上段比值最大,为1.09,中段其次,为1,下段中部的平均内径为（0.14±0.03）mm;与两侧的内径比值为0.74。 结论　肝外胆管上、下方的血供来源比例相对均衡;肝外胆管手术应尽可能于动脉吻合相对较少的胆总管十二指肠上段和血管相对较细小肝总管下部做纵行小切口,以降低肝外胆管血供的损伤;肝总管段的血供丰富,支持现行原位肝移植离断部位在胆囊管汇合处上方的主张。     

胰体尾优势供血动脉的数字减影血管造影

目的 采用数字减影血管造影（DSA）方法,研究糖尿病患者胰体尾优势供血动脉的解剖特点,为临床胰腺介入治疗提供血管解剖依据。方法 糖尿病患者108例,男61例,女47例,于介入治疗手术室行胰体尾动脉造影。第一阶段进行腹腔干、胃十二指肠动脉、肠系膜上动脉造影,初步定位胰尾体部优势供血动脉,之后将导管直接置入目标动脉,行DSA,观察胰体尾显影情况。如置入失败,则采用脾动脉远端球囊堵塞近端造影的方法,对胰体尾进行显影。保存介入影像进行分析。结果 造影显示,胰体尾优势供血动脉分别为胰背动脉(58.3%,63/108)、胰大动脉(13.9%,15/108)、胰背动脉联合胰大动脉(11.1%,12/108)、胰横动脉(14.8%,16/108)和其他（1.9%,2/108）。优势动脉当中胰背动脉（共75例,胰背动脉单独63例,胰背联合胰大动脉12例）主要起源于脾动脉起始段(52.0%,39/75)、肝总动脉(21.3%,16/75)和肠系膜上动脉（24.0%,18/75）等;胰大动脉（共27例,胰背联合胰大动脉12例,胰大动脉单独15例）主要起源于脾动脉中段（96.3%,26/27）;而胰横动脉主要起源于胃十二指肠动脉（68.8%,11/16）和胰十二指肠动脉（31.2%,5/16）等。结论 胰体尾优势供血动脉的分布与起源存在较多变异情况,研究胰体尾部优势供血动脉有助于糖尿病患者胰腺介入治疗。     

肝外胆管的动脉血供及其临床意义

目的 :观察肝外胆管主要供血动脉 ,探讨预防术后胆管缺血的手术措施。方法 :对 15例乳胶灌注的尸体标本进行显微解剖 ,对其主要的供血动脉即胆囊动脉、胰十二指肠上后动脉及肝右动脉的分支进行观测。结果 :胰十二指肠上后动脉发出部位距胃十二指肠动脉起始部距离为 (0 .89± 0 .2 3)cm(0 .4 9～ 1.88cm) ,直径为 (0 .17± 0 .0 2 )cm(0 .12～ 0 .2 1cm) ,发出的分支为 3～ 5支。结论 :行肝移植手术时 ,保留胰十二指肠上后动脉可减少术后胆管缺血并发症的发生     

胰腺外科学分段的解剖学基础及其意义

目的：为胰腺外科学分段提供解剖学基础。方法：在６４具灌注标本和４具铸型标本上观察胰内动脉分布、吻合。结果：头由胰十二指肠上动脉和胰十二指肠下动脉供血；颈为一乏血管区；体和尾由胰背动脉、胰支、胰大动脉和胰尾动脉供血。结论：全部胰腺可分为左侧段和右侧段     

肝外胆道血供来源和分布及其临床意义

手术显微镜下解剖观测了４０例成人标本，结果表明，肝外胆道的血供来源于多条动脉，主要有胆囊动脉、胰十二指肠上后动脉、肝右动脉和门静脉后动脉，占肝外胆道血供的９４．５％。在胆道不同部位，血供分布比例不同，其中分布于胆总管十二指肠后段、上段及肝总管的比例最低，占１３．１％；而胆囊和胆囊管则高达５１．３％。探讨了肝外胆道动脉的分布规律及临床意义。     

《外科和放射解剖学》文题和摘要(1988年第10卷第4期)

副胆道静脉系副胆道静脉系起于胰十二指肠静脉和幽门十二指肠静脉,沿胆总管和肝动脉而行,在肝门分为静脉网,进入肝内。此静脉在发生上显然不属于门静脉系统,而是伴随胆道系统和肝动脉而发育成长的,此三种结构共同包裹在血管—胆管鞘内,在门静脉分布建立后,三者立即进入肝内,应该指出第Ⅰ和Ⅴ肝段出现也比     

副胆道静脉系

<正> 副胆道静脉系起于胰十二指肠静脉和幽门十二指肠静脉,沿胆总管和肝动脉而行,在肝门分为静脉网,进入肝内。此静脉在发生上显然不属于门静脉系统,而是伴随胆道系统和肝动脉而发育成长的,此三种结构共同包裹在血管-胆管鞘内,在门静脉分布建立后,三者立即进入肝内,     

肝外胆管供血动脉数字化三维重建图像与传统解剖学图像的比较

目的：对比观察肝外胆管供血动脉3D重建图像与传统解剖学图像，评价其各自的优缺点。方法2012年1—12月，对来自南方医科大学珠江医院肝胆一科的10例肝外胆管梗阻性疾病患者病例进行回顾性研究。将10例患者的上腹部亚毫米CT扫描数据导入腹部医学图像3D可视化系统(MI-3DVS)程序化构建肝外胆管供血动脉3D重建图像，并与传统解剖学图像进行对比分析。结果肝外胆管供血动脉3D重建图像真实，立体感强，可以从不同角度进行3D空间的解剖关系观察；传统解剖学图像只能显示平面的解剖结构，表现手法单一，但可根据手术显微镜所观察的尸体标本灌注情况，还原绘制胆管周围血管丛等3D重建图像无法显示的血管。结论3D图像真实直观，能真实还原组织器官结构的本来面貌，便于学习和理解，是解剖学研究和学习的新途径，也可以为个体化胆道外科手术方案提供指导，但不能完全替代传统解剖图像。     

胰腺供血动脉64层螺旋CT成像研究

目的:探讨64层螺旋CT动脉血管造影对胰腺动脉的显示能力。方法:应用64层螺旋CT对80例健康查体者行胰腺动脉血管造影检查,应用最大密度投影法(MIP)重建胰腺供血动脉。结果:胰腺供血动脉胰十二脂肠上前动脉(ASPDA)、胰十二脂肠上后动脉(PSPDA)、胰十二脂肠下前动脉(AIPDA)、胰十二脂肠下后动脉(PIPDA)、胰背动脉(DPA)、胰横动脉(TPA)、胰大动脉(PMA)、胰前动脉弓(AAA)、胰后动脉弓(PAA)在MIP图像上的显示率分别为100%(80例)、100%(80例)、98%(78例)、95%(76例)、95%(76例)、83%(60例)、90%(72例)、43%(34例)、35%(28例)。结论:64层螺旋CT胰腺动脉血管成像是一种简便、快速、无创显示胰腺供血动脉检查手段,MIP多角度三维重建能准确显示胰腺供血动脉解剖与变异。     

Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance

The purpose of this study is to describe the arterial supply of the entire extrahepatic bile duct system. The cross‐sectional area of all arteries that supply the ducts is measured under an operating microscope in 50 adult cadavers injected with red latex through the aorta. The extrahepatic bile duct system is divided into four topographic portions: cystic duct and gallbladder, right and left hepatic ducts, bile (common) duct and including its supra‐retroduodenal parts, and the pancreatic and intraduodenal portions. The arterial supply to each portion is carefully detailed. The ducts are supplied by more than seven arteries, of which the major arteries are the cystic artery, posterior superior pancreaticoduodenal artery, right hepatic artery, and retroportal artery. Collectively they provide 94.5% of the blood supply to the ducts. Arteries form three types of anastomotic patterns on the walls of the ducts, suggesting that ductal incisions can be made in ways that least disturb the blood supply. The patterns are: a network, a longitudinal anastomotic chain, and an arterial circle. These data emphasize the importance of the arterial supply in biliary surgery and especially the treatment of hemobilia. Clin. Anat. 12:245–249, 1999. © 1999 Wiley‐Liss, Inc.     

左外叶活体肝移植的解剖学研究

目的：模拟左外叶活体肝移植门静脉、肝动脉和胆管的切取方法。方法：解剖正常人肝脏标本30具，观察肝脏铸型标本30具，测量门静脉、肝动脉及胆管长度、管径及属支或分支分布情况。结果：左外叶门静脉的血供来自门静脉左支，主要为左外叶上段门静脉支、左外叶下段门静脉支；动脉主要来源于肝固有动脉、肝左动脉、肝中动脉，偶有迷走动脉支；胆道引流属支有左外叶上段胆管支、左外叶下段胆管支。结论：左外叶解剖变异较多，活体取肝前应仔细研究其结构特点，设计合理的切取模式；对门静脉、肝动脉和胆管支需行必要的整形，以便与受体相应的管道进行吻合。     

An anomalous right gastroepiploic artery arising from the superior mesenteric artery

During a routine dissection, the right gastroepiploic artery was found to arise from the superior mesenteric artery. The gastroduodenal artery ran in front of the common bile duct and descended along the posterior surface of the head of the pancreas (posterior superior pancreaticoduodenal artery). The enlarged pancreatic branch arising from the superior mesenteric artery mainly supplied the anterior surface of the head of the pancreas and then continued to become the right gastroepiploic artery. This route seemed to be formed due to the lack of a connection between the posterior superior pancreaticoduodenal artery and the common trunk of the anterior superior pancreaticoduodenal and right gastroepiploic arteries.     

The arterial blood supply of the pancreas: a review: IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study

The present article is the fourth part of a comprehensive review of the arterial blood supply of the pancreas and completes the study of the arterial vascularization of the pancreatic head dealing with the anterior inferior and posterior inferior pancreaticoduodenal aa. and with some minor sources of blood supply not involving the classical system of the pancreaticoduodenal arches. The aim of this review is to summarise the anatomical studies, starting from Haller’s reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomical concepts. For this purpose, 1015 selective angiographs (celiac trunk and its branches, superior mesenteric a.) were taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. These demonstrated the anterior inferior pancreaticoduodenal a., present in most instances, as arising from the inferior pancreaticoduodenal a., from a common trunk with the posterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the 1st jejunal a. or from the superior mesenteric a.; on the other hand, the posterior inferior pancreaticoduodenal a. was more variable, originating from the inferior pancreaticoduodenal a., from a common trunk with the anterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the superior mesenteric a., from the dorsal pancreatic a., or from a right accessory hepatic a. coming from the superior mesenteric a. In addition, minor branches to the head of the pancreas arose from the gastroduodenal a., the dorsal pancreatic a., the common hepatic a. and the inferior right phrenic a. Other origins of the inferior pancreaticoduodenal aa. previously reported, but not angiographically detectable with certainty, as well as further minor sources of blood supply to the head of the pancreas, have been listed. The differing opinions regarding the incidence of the various ways the inferior pancreaticoduodenal aa. arise are discussed and an attempt is made to explain the variability of the vascular anatomy of the pancreatic head on embryologic grounds.     

肝脏第IX段临床应用解剖及恶性肿瘤的介入栓塞化疗

目的探讨肝脏第IX段临床应用解剖及其占位性病变的介入治疗。方法对50例肝脏进行解剖观察;对6例肝脏第IX段占位性病变进行介入栓塞化疗。结果肝脏第IX段动脉主要来源于肝右动脉,部分来自肝中动脉或肝左动脉;门静脉主要来自门静脉右前叶上段支,小部分来自门静脉左支横部;胆管汇入右肝管;静脉血由数支细小静脉经第3肝门直接汇入肝后下腔静脉,部分汇入肝右静脉。第IX段肝脏肿瘤通过血管介入治疗后,肿瘤显著缩小;其中4例合并黄疸患者肝功能明显缓解。结论肝脏第IX段是一个结构上较为独立的区域,有其特殊的管道系统和引流系统,位置深隐,单独或联合手术切除较困难;通过介入技术可以对该区段进行相应的治疗。利用微导管采用超选技术,可以对肝脏第IX段的病变进行精确的治疗,微创、副作用小、可重复操作,能够弥补外科手术的局限性,达到甚至超过外科手术的治疗效果。     

树鼩肝移植的解剖基础

目的　为树鼩肝移植的开展提供解剖学基础。 方法　解剖12只成年树鼩观察肝脏形态、毗邻及主要血管、胆管的走形和分布,并在解剖基础上探讨和对3组树鼩采用“双袖套管法”行肝移植术。 结果　树鼩肝动脉直径（0.63±0.21）mm,均发自腹腔干;肝上下腔静脉距横膈（5.35±0.55）mm,直径（6.86±0.61）mm;肝下下腔静脉直径（5.28±0.58）mm;肝门静脉由肠系膜上静脉及脾静脉汇成,直径（3.86±　0.57）mm;胆总管由胆囊管及肝总管汇成,长度（15.5±2.6)mm;直径(0.75±0.12)mm。3组树鼩顺利行肝移植术操作,术后存活时间为3h、5h和6h。 结论　树鼩在解剖学基础上建立肝移植模型具有一定的可行性。     

Unusual blood supply to the pancreas by a dorsal pancreatic artery

A variation of the blood supply to the pancreas was observed in an 89-year-old female, in which the celiac trunk gave off four arteries the hepatic, splenic, left gastric arteries and an additional dorsal pancreatic artery. One of the branches the dorsal pancreatic artery joined with the superior mesenteric artery to form a longitudinal anastomosis. The anterior and posterior pancreaticoduodenal arcades arose from branches of the superior pancreaticoduodenal and the dorsal pancreatic arteries. The inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery, was missing. The majority of the pancreas was, therefore supplied by the dorsal pancreatic artery. The clinical implications of this finding are that the size, location and course of a dorsal pancreatic artery should be established given its central role in the blood supply to the pancreas observed in the present study.     

Variant anatomy of the cystic artery in adult Kenyans

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy.