Relative Anatomic Research Around Pancreatic Interfascial Space and Safe Surgical Plane-Regard Pancreas as Axis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Guangwei ¹ , GU Yuanlong ² , ZHAI Niankuan ² , LIU Minfeng. ²

1. The First Department of General Surgery,The 152nd Hospital of PLA, Pingdingshan 467000, Henan Province, China;;
2. Department of Hepatobiliary Surgery,No. 3 Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China;

Corresponding author：

Keywords：

Interfascial space; Applied anatomy; Surgical plane; Prerenal fascia; Toldts fascia

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To study the vascular applied anatomy，the anatomic features of fascial，and interfascial space around the pancreas and duodenum，observe marker and safe surgical plane of pancreaticoduodenal region，and provide clinical anatomy basis for surgery of duodenum， pancreatic head，and distal common bile duct．
Methods　 Anatomical observations were performed in 7 formalin fixed cadavers on duodenum，distal common bile duct，and pancreatic peripheral blood supply．Transverse mesocolon，pancreatic capsule and potential interfascial space，surgical plane and anatomic marker for reorganization around pancreas were observed．
Results 　Gastropancreatic fold and hepatopancreatic fold formed by pancreatic capsule were good markers to locate the root of left gastric artery and common hepatic artery．A vessel-free plane between the behind pancreas and the anterior lamella of Gerota fascia could be used to make lymphadenectomy and pancreatic dissection behind pancreas and duodenum．Gerota fascia should be regarded as a safe posterior border to avoid injuring vessels and adrenal gland by mistake．The descending part and horizontal part of duodenum were mainly supplied by the anterior and posterior pancreaticoduodenal arterial arcade．The anterior and posterior pancreaticoduodenal arterial arcade should be protected in duodenum-preserving resection of pancreatic head．
Conclusions 　Full understanding of pancreatic fascial and interfascial space formed in embryonic development is very important．Operation along the interfascial spaces is safe without bleeding and organ injury，which is essential in oncosurgery．

Citation： WANG Guangwei,GU Yuanlong,ZHAI Niankuan,LIU Minfeng.. Relative Anatomic Research Around Pancreatic Interfascial Space and Safe Surgical Plane-Regard Pancreas as Axis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(2): 177-180. doi: Copy

1.	Keith L, Moore TV．The Developing Human：Clinically Oriented Embryology[M]．7th ed．Philadelphia：W．B．Saunders Company, 2003：256-270．.
2.	黄子星 ,陈光文 ,宋彬．胰腺癌血管侵犯的 CT术前评价[ J]．中国普外基础与临床杂志 , 2009, 16(11)：939-943．.
3.	李国新 ,张策 ,余江．腹腔镜辅助远端胃癌 D2根治术 : 基于解剖的艺术[ J]．外科理论与实践 , 2007, 12(6)：533-538．.
4.	王遵义 ,朱丽华 ,刘伟．右半结肠癌根治切除术中寻找解剖平面的体会 (附 36例报告 )[J]．中国普外基础与临床杂志 , 2008, 15(4)：281-283．.
5.	王正康 ,汪亚晴．腹腔内融合筋膜与癌根治术[ J]．国外医学外科学分册 , 1990, 17(2)：82-85．.
6.	徐恩多, 舒强．胃癌根治术的胚胎解剖学基础[ J]．普外临床 , 1991, 6(6)：358-362．.
7.	陈刚 ,李学成 ,熊晓峰 ,等．肝脏虚拟手术系统在肝右叶肿瘤手术中的临床应用[ J]．中国普外基础与临床杂志 , 2010, 17(1)：64-67．.
8.	刘战培 ,蒲青凡 ,周勇． 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[ J]．中国普外基础与临床杂志 , 2008, 15(3)：195-200．.
9.	徐建 ,刘忠诚 ,赵琪琴 ,等．腹腔镜远端胃癌根治术淋巴结清扫相关解剖学的临床应用研究[ J]．中国普通外科杂志 , 2009, 18(4)：318-321．.
10.	Thayer SP, Fernandez-del Castillo C, Balcom JH, et al．Complete dorsal pancreatectomy with preservation of the ventral pancreas: A new surgical technique[J]．Surgery, 2002, 131(5)：577-580．.
11.	Uchida T, Takada T, Ammori BJ, et al．Three-dimensional reconstruction of the ventral and dorsal pancreas: a new insight into anatomy and embryonic development[J]．J Hepatobiliary Pancreat Surg, 1999, 6(2)：176-180．.
12.	Sakamoto Y, Nagai M, Tanaka N, et al．Anatomical segmentectomy of the head of the pancreas along the embryological fusion plane：a feasible procedure?[J]． Surgery, 2000, 128(5)：822831．.
13.	Cho A, Arita S, Koike N, et al．Ventral pancreatectomy associated with segmental duodenectomy including the major papilla[J]. Hepatogastroenterology, 2007, 54(80)：2392-2394．.
14.	Tadokoro H, Takase M, Nobukawa B．Unusual fusion between ventral and dorsal primordia causes anomalous pancreaticobiliary junction[J]．Pathol Int, 2008, 58(8)：498-502．.
15.	袁通立 ,周敬武 ,宾昌辉 ,等．保留十二指肠乳头的胰十二指肠切除术[ J]．中国普外基础与临床杂志 , 2007, 14(4)：464465．.
16.	王春友．胰头部良性和低恶性病变手术治疗的器官保留与损伤控制[ J]．中国实用外科杂志 , 2009, 29(8)：622-624．.

1. Keith L, Moore TV．The Developing Human：Clinically Oriented Embryology[M]．7th ed．Philadelphia：W．B．Saunders Company, 2003：256-270．.
2. 黄子星 ,陈光文 ,宋彬．胰腺癌血管侵犯的 CT术前评价[ J]．中国普外基础与临床杂志 , 2009, 16(11)：939-943．.
3. 李国新 ,张策 ,余江．腹腔镜辅助远端胃癌 D2根治术 : 基于解剖的艺术[ J]．外科理论与实践 , 2007, 12(6)：533-538．.
4. 王遵义 ,朱丽华 ,刘伟．右半结肠癌根治切除术中寻找解剖平面的体会 (附 36例报告 )[J]．中国普外基础与临床杂志 , 2008, 15(4)：281-283．.
5. 王正康 ,汪亚晴．腹腔内融合筋膜与癌根治术[ J]．国外医学外科学分册 , 1990, 17(2)：82-85．.
6. 徐恩多, 舒强．胃癌根治术的胚胎解剖学基础[ J]．普外临床 , 1991, 6(6)：358-362．.
7. 陈刚 ,李学成 ,熊晓峰 ,等．肝脏虚拟手术系统在肝右叶肿瘤手术中的临床应用[ J]．中国普外基础与临床杂志 , 2010, 17(1)：64-67．.
8. 刘战培 ,蒲青凡 ,周勇． 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[ J]．中国普外基础与临床杂志 , 2008, 15(3)：195-200．.
9. 徐建 ,刘忠诚 ,赵琪琴 ,等．腹腔镜远端胃癌根治术淋巴结清扫相关解剖学的临床应用研究[ J]．中国普通外科杂志 , 2009, 18(4)：318-321．.
10. Thayer SP, Fernandez-del Castillo C, Balcom JH, et al．Complete dorsal pancreatectomy with preservation of the ventral pancreas: A new surgical technique[J]．Surgery, 2002, 131(5)：577-580．.
11. Uchida T, Takada T, Ammori BJ, et al．Three-dimensional reconstruction of the ventral and dorsal pancreas: a new insight into anatomy and embryonic development[J]．J Hepatobiliary Pancreat Surg, 1999, 6(2)：176-180．.
12. Sakamoto Y, Nagai M, Tanaka N, et al．Anatomical segmentectomy of the head of the pancreas along the embryological fusion plane：a feasible procedure?[J]． Surgery, 2000, 128(5)：822831．.
13. Cho A, Arita S, Koike N, et al．Ventral pancreatectomy associated with segmental duodenectomy including the major papilla[J]. Hepatogastroenterology, 2007, 54(80)：2392-2394．.
14. Tadokoro H, Takase M, Nobukawa B．Unusual fusion between ventral and dorsal primordia causes anomalous pancreaticobiliary junction[J]．Pathol Int, 2008, 58(8)：498-502．.
15. 袁通立 ,周敬武 ,宾昌辉 ,等．保留十二指肠乳头的胰十二指肠切除术[ J]．中国普外基础与临床杂志 , 2007, 14(4)：464465．.
16. 王春友．胰头部良性和低恶性病变手术治疗的器官保留与损伤控制[ J]．中国实用外科杂志 , 2009, 29(8)：622-624．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Relative Anatomic Research Around Pancreatic Interfascial Space and Safe Surgical Plane-Regard Pancreas as Axis

Abstract Full text Figures/Tables Video References Cited by

Format

Content