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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。
Objective To provide applied anatomy for endoscopic diagnosis of duodenal descending disease and reduction of iatrogenic injury. Methods Forty adult formalin-fixed adult cadaver specimens were dissected to observe the contour and length of the descending part of the duodenum, the shape and location of the big nipple, and the inner and outer diameters of the upper and lower kyphosis, Wall thickness. Results The shape of the descending part of the duodenum was vertical, curved and irregular. Most of the descending parts of the duodenum were fine and coarse, most of the specimens were narrow. The mucosa in the narrow part of the intestine was vertical folds, Pinyin or flat without wrinkle 襞. The length of the descending part of the duodenum was (8.2 ± 1.9) cm. The mean diameter of the intestine in the upper, lower and large nipples was (4.8 ± 1.7) cm, (5.8 ± 1.3) cm, (6.9 ± 2.3) ) cm. The mean diameter of intestine was (7.0 ± 1.3) cm, (8.8 ± 1.2) cm and (9.2 ± 1.6) cm respectively. The thickness of medial wall was (2.29 ± 0.63) mm and 1.75 ± 0.73) mm. The thickness of the lateral wall was (1.63 ± 0.53) mm, (1.42 ± 0.37) mm and (1.54 ± 0.40) mm, respectively. Duodenal big nipple shape changeable, and the song distance (4.3 ± 1.9) cm. Conclusion Endoscopic examination and treatment of descending part of the duodenum disease, grasp and carefully observe the anatomical features, to find the lesion and reduce iatrogenic injury is important.