Three-dimensional duct distribution of the head of the pancreas using compute -graphic soft

2002 Fiscal Year Final Research Report Summary

• Project/Area Number: 12671257
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Digestive surgery
• Research Institution: JICHI MEDICAL SCHOOL
• Principal Investigator: KURIHARA Katsumi Jichi Medical School of Medicine, assitant professor, 医学部, 講師 (20275697)
• Co-Investigator(Kenkyū-buntansha): NAGAI Hideo Jichi Medical School of Medicine, professor, 医学部, 教授 (00164385)
• Project Period (FY): 2000 – 2002
• Keywords: PP / Wirsung / Santorini / Ventral pancreas / Dorsal pancreas / compute -graphic soft / Reconstruction

Research Abstract

Background ; With the recent development of imaging techniques, it has become possible to detect and diagnose low-grade malignant tumors of the pancreas, such as intraductal papillary-mucinous tumors and endocrine tumors, before symptoms appear. Extended resection for these tumors should be avoided to conserve the postoperative quality of life. However, limited resection without the knowledge of surgical anatomy, ontogenetic pancreatic segments and duct structures of the head of the pancreas would induce troublesome complications associated with pancreatic fistula.
Objective ; The aim of this study was to investigate the three-dimensional ductal distribution of the human pan creatic head and to determine the ontogenetic ductal junction of the dorsal and ventral anlagen by reconstructing the ductal distribution of the human pancreatic three-dimensionally.
Materials and methods ; We examined 45 fresh pancreata obtained at autopsy. After gelatin-mixed barium sulfate solution was infused int o the main pancreatic duct, the pancreas was subjected to stereoductography and three-dimensional computed tomography (3D-CT), followed by 1mm-thick serial sectioning for computer-assisted 3D-reconstrustion and immunohistochemical staining of pancreatic polypeptide (PP) on 4オ-thick microscopic sections for identification of the dorsal and the ventral pancreatic anlagen.
Results ; All the branches from the Santorini duct drained PP-poor areas. Most tributaries from the Wirsung duct drained PP-rich areas, but the anterior inferior branches sprouting at the site within 1.5 cm proximal to the junction of the Wirsung and Santorini ducts (WS junction) drained a PP-poor portion.
The plane dividing the PP-rich and -poor portions was flat or slightly convex anteriorly in all the cases. There was no ductal communication between the dorsal and ventral pancreases. The ontogenetic ductal junction of the ventral and dorsal anlagen (VD junction) almost existed on the dividing plane and around 1.5cm proximal to the morphological WS junction.
Conclusion ; Dissection along the dividing plane in cluding the ontogenetic VD junction seems to be a technically feasible method of hemi-resection of the pancreatic head.