The Choice of the Optimal Level of Intersection of the Pancreas Taking Into Account Variants of the Topography of Arterial Vessels and Pancreatic Duct

Abstract

Objective. To determine the optimal level of intersection of the pancreas based on the features of the topography of the arterial vessels and the pancreatic duct of the isthmus and the body of the pancreas. Methods. 44 complexes of the upper floor of the abdominal cavity were studied. An injection mass with the subsequent fixation complexes in a formalin solution was introduced into the arterial vessels. The pancreatic tissue was crossed over the superior mesenteric vein along vertical lines drawn on one, two, three, four, and five cm to the left of the superior mesenteric vein. Depending on the diameter, the arteries were divided into the following types: 1 type (diameter - 0.5 - 1.0 mm); 2 type (diameter - 1.1 - 1.5 mm); 3 type (diameter more than 1.6 mm). The sections were used to assess the topography of the main tubular structures, the number and diameter of arterial vessels greater than 0.5 mm, the number of vessels of a certain type and the mean vessel diameter of this type. Results. On the cross - section above the superior mesenteric vein, as well as on the section made 1 cm to the left of it, vessels of type 1 (0.5-1.0 mm) prevailed. At the same time, two more pronounced arterial vessels were noted. These arteries were located, as a rule, extra-organically and had a relatively constant topography. The location of the pancreatic duct corresponded to the central part of the section. On transverse sections of the pancreas made along lines located from 2 cm to 5 cm to the left of the superior mesenteric vein; up to 5 arterial vessels were recorded.The location of the arterial vessels was inconsistent and did not have limited topographic zones. On sections from 2 to 5 cm to the left of the superior mesenteric vein, damage to the dorsal pancreatic artery was noted, and on sections 4 and 5 cm to the left of the superior mesenteric vein, a peripheral location of the pancreatic duct was found. Conclusion. The optimal level of intersection of the pancreas is the area above the superior mesenteric vein and 1 cm left of the superior mesenteric vein. What this paper adds It was revealed that the region of the pancreas from the superior mesenteric vein to 1 cm left of the superior mesenteric vein is considered to be the most optimal for transection of the pancreatic tissue from the anatomical point of view. Here, as a rule, two arterial vessels meet. It was found that the topography of these arteries is relatively constant, which makes it possible to suture them selectively.