胰体尾优势供血动脉的数字减影血管造影
Digital subtraction angiography of predominant artery feeding pancreatic body and tail
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。
Objective To investigate the anatomical characteristics of predominant artery feeding pancreatic body and tail (PBT). Methods One hundred and eight patients with diabetes (61 males and 47 females) underwent digital subtraction angiography (DSA). Selective DSA of the celiac trunk, gastroduodenal artery, and superior mesenteric artery were performed to localize the potential predominant feeding artery of the PBT. The feeding artery was catheterized and DSA was performed. All images were documented for later analysis. Results The feeding arteries for the PBT included the sole dorsal pancreatic artery (DPA, 58.3%), sole great pancreatic artery (GPA, 13.9%), both DPA and GPA (11.1%), and transverse pancreatic artery (TPA, 14.8%). The DPA originated from the first segment of the splenic artery (52.0%), common hepatic artery (21.3%), or superior mesenteric artery (24.0%). The GPA was mostly from the middle segment of the splenic artery (96.3%) The TPA was from either the gastroduodenal artery (68.8%) or the pancreaticoduodenal artery (31.2%). Conclusion The origins and identities of the predominant artery in the PBT are variable, which require comprehensive study before interventional therapy for diabetic patients.
Diabetes / Digital subtraction angiography / Pancreatic body and tail / Artery / Human
[1] Regine WF, Winter KA, Abrams RA, et al. Fluorouracil vs gemcitabine chemotherapy before and afterfluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial[J]. JAMA, 2008, 299(9): 1019-1026.
省自然科学基金资助项目;自然科学基金资助项目
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