肝胰壶腹组织及其周围细小结构的三维重建

刘健男, 张伟娜, 王三贵, 刘燕, 石玉莲, 刘家瑄, 李祥天, 肖钊明, 叶锡银, 黄文华, 戴景兴, 李严兵

中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (2) : 157-163.

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (2) : 157-163. DOI: 10.13418/j.issn.1001-165x.2025.2.08
断层影像解剖

肝胰壶腹组织及其周围细小结构的三维重建

  • 刘健男1,    张伟娜1,    王三贵2,    刘燕3,    石玉莲1,    刘家瑄1,    李祥天4,    
    肖钊明1,     叶锡银2,    黄文华1,    戴景兴1*,    李严兵1*
作者信息 +

Three-dimensional reconstruction of micro blood vessels, nerves and lymphatic system in the hepatopancreatic ampulla

  • Liu Jiannan1, Zhang Weina1, Wang Sangui2, Liu Yan3, Shi Yulian1, Liu Jiaxuan1, Li Xiangtian4, Xiao Zhaoming1, Feng Xiaohui2, Huang Wenhua1, Dai Jingxing1*, Li Yanbing1*
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摘要

目的    明确肝胰壶腹附近的细小动脉、静脉、交感神经、淋巴管道的配布及数量关系。  方法    将人肝胰壶腹的375张连续石蜡组织切片分成3组,分别进行苏木精与伊红染色、抗Tyrosine Hydroxylase组化染色、抗LYVE1抗体组化染色后扫描,用Photoshop进行图像配准。使用Mimics21.0分别将扫描切片进行叠加、分割、三维重建。在三维模型中,分析肝胰壶腹动脉、静脉、交感神经和淋巴管道及其分支在肝胰壶腹周围的分布和吻合情况,以及以上结构间的位置关系。  结果    肝胰壶腹区域的动脉、静脉相互伴行,弯曲走行,围绕在肝胰壶腹周围,紧密贴合肝胰壶腹管道分布;交感神经神经束分布清晰,围绕肝胰壶腹周围,伴随血管束走行;淋巴管道与血管伴行,围绕在肝胰壶腹管道表面与淋巴结周围。肝胰壶腹两层肌层结构区分清晰。  结论    本研究为肝外胆道、胆囊疾病的诊断和手术提供了准确的解剖学依据。

Abstract

Objectives    To clarify the branches, distribution, arrangement and quantitative relationship of micro arteries, veins, sympathetic nerves and lymphatic vessels around the hepatopancreatic ampulla.   Methods   375 continuous paraffin tissue sections were divided into three groups: those in the first group were stained with hematoxylin and eosin (HE), those in the second group with anti-tyrosine hydroxylase antibody, and those in the third group with anti-lymphatic vessel endothelial receptor-1 (LYVE1) antibody staining. The scanning data of the slides were registered by Photoshop and  the scanned data slices were superimposed,divided and 3D reconstructed by using Mimics 21.0. The distribution and anastomosis of arteries, veins, sympathetic nerves, lymphatic vessels, as well as their branches around the hepatopancreatic ampulla were analyzed in the three-dimensional models. The relationships among these four structures were also analyzed.   Results   The micro arteries and veins in the region of hepatopancreatic ampulla accompanied each other, bending walked around the ampulla and closely adhering to it. Sympathetic nerve  tracts were clearly distributed around the hepatopancreatic ampulla and were accompanied by the vascular bundles. Lymphatic vessels and blood vessels were concomitant, surrounding the surface of the hepatopancreatic ampulla and lymph nodes. The structure of the two muscle layers of the hepatopancreatic ampulla was clearly distinguished.   Conclusions   This study provides accurate anatomical basis for the diagnosis and surgery of extrahepatic biliary tract and gallbladder diseases. 

关键词

三维重建 /   /   / 肝胰壶腹 /   /   / 肝外胆道 /   /   / 精细解剖

Key words

3D reconstruction /   /   / Hepatopancreatic ampulla /   /   / Extrahepatic duct /   /   / Microanatomy

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刘健男, 张伟娜, 王三贵, 刘燕, 石玉莲, 刘家瑄, 李祥天, 肖钊明, 叶锡银, 黄文华, 戴景兴, 李严兵. 肝胰壶腹组织及其周围细小结构的三维重建[J]. 中国临床解剖学杂志. 2025, 43(2): 157-163 https://doi.org/10.13418/j.issn.1001-165x.2025.2.08
Liu Jiannan, Zhang Weina, Wang Sangui, Liu Yan, Shi Yulian, Liu Jiaxuan, Li Xiangtian, Xiao Zhaoming, Feng Xiaohui, Huang Wenhua, Dai Jingxing, Li Yanbing. Three-dimensional reconstruction of micro blood vessels, nerves and lymphatic system in the hepatopancreatic ampulla[J]. Chinese Journal of Clinical Anatomy. 2025, 43(2): 157-163 https://doi.org/10.13418/j.issn.1001-165x.2025.2.08
中图分类号: R322    

参考文献

[1] Liu Y, Meng S, Wei M, et al. Reconstruction of three-dimensional models for complex female pelvic tumors[J]. Int J Gynaecol Obstet, 2022, 157(3): 747-749. DOI: 10.1002/ijgo.14120.

[2]  Sato H, Kawabata H, Iwamoto H, et al. New gel immersion endoscopic ultrasonography technique for accurate periampullary evaluation[J]. Surg Endosc, 2024, 38(4): 2297-2304. DOI: 10.1007/s00464-024-10762-6. 

[3] Ichii H, Takada M, Kashiwagi R, et al. Three-dimensional reconstruction of biliary tract using spiral computed tomography for laparoscopic cholecystectomy[J]. World J Surg, 2002, 26(5): 608-611. DOI: 10.1007/s00268-001-0277-z.
[4]  Wu J, Xiang Y, You G, et al. An essential technique for modern hepato-pancreato-biliary surgery: minimally invasive biliary reconstruction[J]. Expert Rev Gastroenterol Hepatol, 2021, 15(3): 243-254. DOI: 10.1080/17474124.2021.1847081.
[5]  Portincasa P, Di Ciaula A, van Berge-Henegouwen GP. Smooth muscle function and dysfunction in gallbladder disease[J]. Curr Gastroenterol Rep, 2004, 6(2): 151-162. DOI: 10.1007/s11894-004-0043-0.
[6] Cleypool CGJ, Mackaaij C, Lotgerink BD, et al. Sympathetic nerve distribution in human lymph nodes[J]. J Anat, 2021, 239(2): 282-289. DOI: 10.1111/joa.13422.
[7]  南润玲, 尚培中, 苗建军, 等. 内窥镜十二指肠乳头肝胰壶腹括约肌切开术后并发重症急性胰腺炎的治疗[J]. 中华临床医师杂志(电子版), 2011, 5(18): 5487-5489. DOI: 10.3877/cma.j.issn.1674-0785. 2011. 18.059.
[8]  华尚伯, 陆贤, 顾卯林, 等. 腹腔镜下胆道镜保胆取石术治疗胆囊结石患者的效果[J]. 医疗装备, 2024, 37(6): 15-18. DOI: 10.3969/j.issn.1002-2376.2024.06.004.
[9] Kohli DR, Amateau SK, Desai M, et al. American Society for Gastrointestinal Endoscopy guideline on management of post-liver transplant biliary strictures: summary and recommendations[J]. Gastrointest Endosc, 2023,97(4):607-614. DOI: 10.1016/j.gie. 2022. 10.007.
[10]尹飞飞, 孙世波. 肝外伴肝内胆管结石的微创治疗现状与进展[J]. 中国普通外科杂志, 2014, 23(8): 1117-1120. DOI: 10.7659/j.issn.1005-6947.2014.08.021.
[11]Michalopoulos N, Papavramidis TS, Karayannopoulou G, et al. Neuroendocrine tumors of extrahepatic biliary tract[J]. Pathol Oncol Res, 2014, 20(4): 765-775. DOI: 10.1007/s12253-014-9808-4.
[12] Winter JM, Cameron JL, Olino K, et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis[J]. J Gastrointest Surg, 2010, 14(2): 379-387. DOI: 10.1007/s11605-009-1080-7.
[13] 刘养岁, 张昕辉, 李正臣, 等. 荧光胆道显影在腹腔镜复杂胆囊切除术中的应用[J]. 中国现代医学杂志, 2021, 31(7): 69-73. DOI: 10.3969/j.issn.1005-8982.2021.07.014.
[14]Frierson HF Jr. The gross anatomy and histology of the gallbladder, extrahepatic bile ducts, Vaterian system, and minor papilla[J]. Am J Surg Pathol, 1989, 13(2): 146-162. DOI: 10.1097/00000478-198902 000-00008.

基金

国家重点研发计划项目(2022YFF1202603)

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