Applied Anatomy of Local Resection of Duodenal Papillary Neoplasm

Objective: To provide anatomic data for local resection of duodenal papillary neoplasm.Methods: The lengths and widths of choledochus,pancreatic duct,ampulla hepatopancreatica and mamillary region,the angle between choledochus and pancreatic duct,the distribution of blood vessels in ampulla hepatopancreatica region,the location of duodenal papilla,the opening of minor duodenal papilla,the opening of pancreatic duct,etc,were dissected and observed on 50 cadavers.Results: There were average 2.2 arterial branches to the papillae of Santorini and Vater's ampulla.They all originated from the superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery,and 45.9% of them appeared between nine and twelve points as in an o'clock.The lengths of choledoch,pancreatic duct and Vater's ampulla were(32.1±8.7)mm,(9.9±4.1)mm and(12.6±2.8)mm,respectively.The corresponding widths were(7.3±2.1)mm,(3.2±0.7)mm,and(7.3±1.2)mm,respectively.The mean angle between choledoch and pancreatic duct was 35.6°(ranged from 20° to 45°).The 8.45%±4.39% of duodenal papilla located at upper 1/3 segment of descendant duodenum,72.33%±6.72% at medium 1/3 segment,and 19.22%±4.12% at lower 1/3 segment.The Nipple eyelet opening at longitudinal fold of duodenum accounted for 74.3%±6.68%.The cases possessing minor duodenal papilla accounted for 41.43%±3.65%.The cases whose openings of bile duct and pancreatic duct forming V shape occupied 37.1%±7.43%,and Yshape occupied 62.9%±6.32%.Conclusions: This study provides morphological bases for choosing site and depth of resection in the treatment of duodenal papillary neoplasm,and should benefit preventing from postoperative complications.