十二指肠降部的解剖学特点及临床意义

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (3): 284-286.

十二指肠降部的解剖学特点及临床意义

田　东¹，　钟　利²，　吴　溢²，　王佳玮²，　王　喻²，　胡丹丹³，　赵国刚⁴，　付茂勇¹

川北医学院　1.附属医院胸心外科，　2.临床医学系，　3.医学影像系，　4.附属医院普外科，四川南充 637000

收稿日期:2010-10-07 出版日期:2011-05-25 发布日期:2011-05-21
通讯作者: 付茂勇，教授，硕士生导师，E-mail:fumaoyongmd@163.　com E-mail:22tiandong@163.com
作者简介:田　东(1986-)，男，四川南充人，在读硕士，研究方向：消化外科基础与临床，Tel: (0817)2262411

Anatomic features and clinical significance of the descending duodenum

TIAN Dong¹, ZHONG Li², WU Yi², WANG Jia-wei², WANG Yu², HU Dan-dan³, ZHAO Guo-gang⁴, FU Mao-yong¹

1.Department of Cardiothoracic Surgery, 4.Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China; 2. Department of Clinical Medical, 3.Department of Medical Imaging, North Sichuan Medical College, Nanchong 637000, China

Received:2010-10-07 Online:2011-05-25 Published:2011-05-21

摘要/Abstract

摘要：

目的　为内镜诊治十二指肠降部疾病及减少医源性损伤提供应用解剖学。方法　40例福尔马林固定成人尸体标本，解剖观测十二指肠降部的外形、长度，大乳头的形状、位置以及上曲、下曲、大乳头处的内周径、外周径、肠壁厚度。结果　十二指肠降部的外形有竖直形、弧形和不规则形，多为上细下粗，且大部分标本有狭窄，狭窄处肠腔内黏膜为纵形皱襞、稀疏低矮环形皱襞或平坦无皱襞。十二指肠降部长度为(8.2±1.9)cm；上曲、下曲、大乳头处的肠腔内周径分别为(4.8±1.7)cm、(5.8±1.3)cm、(6.9±2.3)cm；肠管外周径分别为(7.0±1.3)cm、(8.8±1.2)cm、(9.2±1.6)cm；内侧肠壁厚度分别为(2.29±0.63)mm、(1.91±0.49) mm、(1.75±0.73)mm；外侧肠壁厚度分别为(1.63±0.53) mm、(1.42±0.37)mm、(1.54±0.40) mm。十二指肠大乳头的形状多变，与上曲的距离为(4.3±1.9)cm。结论　行内镜检查和治疗十二指肠降部疾病时，掌握和认真观察其解剖学特点，对寻找病变部位及减少医源性损伤有重要意义。

关键词: 十二指肠降部, 应用解剖, 内窥镜, 损伤

Abstract:

Objective　To provide applied anatomic data for the diagnosis and treatment of the descending duodenal diseases and reducing iatrogenic endoscopic injury.　Methods　Forty adult cadaveric specimens fixed with formalin were dissected. The shape and the length of descending duodenum, the shape and location of major duodenal papilla, and the inner diameter, outside diameter, wall thickness at the superior, inferior flexure duodenum and major duodenal papilla were observed respectively.　Results　The descendent duodenum shaped as vertical, curved or irregular. Most specimens showed the thin upper and thick lower parts, and the narrow part. The mucosa of longitudinal, sparse circular and flat folds could be observed separately. The average length of the descending duodenum was about (8.2±1.9) cm, and the inner diameter at the superior, inferior flexure duodenum and major duodenal papilla (4.8±1.7)cm,(5.8±1.3)cm, and (6.9±2.3)cm, respectively. The average outside diameter was (7.0±1.3)cm, (8.8±1.2)cm,(9.2±1.6)cm, respectively, and inner wall thickness (2.29±0.63)mm,(1.91±0.49)mm, and (1.75±0.73)mm, the outer wall thickness (1.63±0.53)mm, (1.42±0.37)mm, and(1.54±0.40)mm. The major duodenal papilla showed the irregular shape. The distance between the major duodenal papilla and the superior flexure duodenum was about(4.3±1.9) cm.　Conclusions　It is necessary to understand the anatomic features of descending duodenum for treating the diseases of this area.

Key words: Descending duodenum, Applied anatomy, Endoscope, Injury

中图分类号:

R322.45

田　东, 钟　利, 吴　溢, 王佳玮, 王　喻, 胡丹丹, 赵国刚, 付茂勇. 十二指肠降部的解剖学特点及临床意义[J]. 中国临床解剖学杂志, 2011, 29(3): 284-286.

TIAN 　Dong, ZHONG 　Li, TUN 　Yi, WANG Jia-Wei, WANG 　Yu, HU Dan-Dan, DIAO Guo-Gang, FU Mao-Yong. Anatomic features and clinical significance of the descending duodenum[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(3): 284-286.

参考文献

[1] 梁成柏, 罗和生. 十二指肠降部病变内镜诊断188例
[J]. 中华消化内镜杂志, 2010, 27(6): 322-325.

[2] 陈安海, 赵　逵, 麻　坤, 等. 十二指肠降部病变的内镜诊断分析
[J]. 中华消化内镜杂志, 2003, 20(2): 132-133.

[3] 钱月楼, 王秋桂, 陈小武, 等. 胆总管、胰管汇合部的应用解剖
[J]. 中华消化内镜杂志, 1998, 15(6): 342-344.

[4] Preetha M, Chung YF, Chan WH, et al. Surgical management of endoscopic retrograde cholangiopancreatography-related perforations
[J]. ANZ J Surg, 2003, 73(12): 1011-1014.

[5] 施维锦. 重视医源性胆胰肠结合部损伤的预防和治疗
[J]. 中华消化外科杂志, 2009, 8(3): 168-170.

[6] 张　宁, 刘　卫, 蔡　磊, 等. 延迟发现胆胰肠结合部损伤的诊断和治疗
[J]. 中华消化外科杂志, 2009, 8(3): 184-186.

[7] 王树生, 王钦尧, 曹亦军, 等. 胆总管远端穿通伤
[J]. 中华肝胆外科杂志,2005, 11(3): 164-166.

[8] 田伏洲, 王雨, 汤礼军, 等. 胆胰十二指肠结合部穿孔的处理
[J]. 消化外科, 2003, 2(2): 113-115.

[9] Horiguchi S, Kamisawa T. Major duodenal papilla and its normal anatomy
[J]. Dig Surg, 2010, 27(2): 90-93.

[10] Yi SQ, Ohta T, Miwa K, et al. Surgical anatomy of the innervation of the major duodenal papilla in human and Suncus murinus, from the perspective of preserving innervation in organ-saving Procedures
[J]. Pancreas, 2005, 30(3): 211-217.

[11]Drake SF, Morgan EH, Herbison CE, et al. Iron absorption and hepatic iron uptake are increased in a transferrin receptor 2 (Y245X) mutant mouse model of hemochromatosis type 3
[J]. Am J Physiol Gastrointest Liver Physiol, 2007, 292(1): G323-328.

[12]王钦尧, 朱黎庆. 胆胰肠结合部的解剖与损伤发生机制
[J]. 中华消化外科杂志, 2009, 8(3): 171-173.

[13]吴志勇, 赵刚. 胆胰肠结合部术中损伤的合理治疗方式
[J]. 中华消化外科杂志, 2009, 8(3): 174-175.

[14]Fatima J, Baron TH, Topazian MD. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management
[J]. Arch Surg, 2007, 142(5): 448-454.

[15] Wu HM, Dixon E, May GR, et al. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review
[J]. HPB(Oxford). 2006, 8(5): 393-399.

[16] 代小思. 对十二指肠乳头旁憩室形成原因的探讨
[J]. 中国临床解剖学杂志,2009, 27(5): 532-534.