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CNAA / Theses / 2009 / June /

Anatomical variants of the choledocho-pancreatic junction and papilla of Vater in choosing the diagnostic and treatment procedures


Author: Suman Serghei
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2009
Scientific adviser: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Ion Podubnii
doctor, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 10 June, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document16.00 Mb / in romanian

Keywords

biliopancreatic jonction, papila Vater, juxtapapillary diverticulum, pancreatic resections, trapezium of the pancreatic head, coledoco-wirsungian triangle

Summary

Anatomical variants of the choledocho-pancreatic junction and papilla of Vater in choosing the diagnostic and treatment procedures The goal of the study is the reduction of postoperative complications specific in surgical interventions on biliary-pancreatic junction and papilla of Vater, by elaborating surgical approach, in clinical, anatomic, topographic and morpho-metric aspect. The study presents a complex, spatial and structural analysis of clinical, anatomical, morpho-metric, histological, neuro-histological and endoscopic data, regarding the variants of biliary-pancreatic junction and papilla of Vater. Using these goals and optimizing some of them, for the study’s goal achievement were made and studied totally 530 of objects.

The main importance, especially clinic, is the form and ramification type of vessels, number of branches, mainly for biliopancreatoduodenal zone, the level of participation in interand intrasistem anastomosis. The vessels architecture and complex anatomical relation of biliopancreatoduodenal zone mainly determine mobilization possibilities and the volume of caput pancreatis excision with keeping duodenum vascularization. In this study were analyzed factors of distal biliary stricture formatting: the length of stricture is directly proportional with diverticulum length, the ratio between diverticulum axis and duodenum, distal choledocum, diverticulum diameter; the diameter of diverticulum aperture is smaller than diverticulum sac. This study shows that separation of ventral pancreas from dorsal is possible, regarding anatomic and embryological aspects. Complete fusion between ventral pancreas and dorsal one is determined only in superior 1/3 of caput pancreatic.

The main anatomic formations relationship of pancreatic head were studied in limits of cefalopancreatic trapezium. This one is an orientation instrument in pancreatic head anatomy – major anatomic guide mark in surgery technique of partial pancreatic excision. The elaboration of device for anatomical corrosive specimens confection and perfection of an original method in studding sanguine vessels allowed obtaining more qualitative pieces. Study of some anatomic particularities, specific components of biliopancreaticduodenal complex doesn’t blur regarding the whole avalanche of new data offered by usual exploration methods and experimental ones, oppositely these methods have to be based on detailed knowledge of morphologic substrate particularities, to push forward conceptual element in interpretation of these structures and to turn to good account, regarding the sick man benefit.