Fusion plane between dorsal and ventral pancreas and it's clinical significance / 中华肝胆外科杂志

Pancreas arises from dorsal and ventral anlagen,and there is an embryological fusion plane between them.The embryological fusion plane can be discriminated by immunohistochemical staining for an anti-pancreatic polypeptide or computed tomography.The embryological fusion plane can not only guide the management of benign or low malignant potential tumors,but also determine the clinicopathological characteristics of pancreatic head cancer and patients'survival,and the embryological fusion plane plays an important role in the management of pancreatic disease.In this review,the research progressions and clinical significance in the embryological fusion plane of dorsal and ventral pancreas are described.

Research progress of pancreatic head cancer arising from dorsal and ventral pancreas / 中华消化外科杂志

Pancreas arises from dorsal and ventral anlagens on an embryological basis,with a difference in histocytology.Immunohistochemical staining for an anti-pancreatic polypeptide can be performed to discriminate between the dorsal and ventral pancreas because of the difference in the amount of pancreatic polypeptide contained by the dorsal and ventral pancreas.Differences of survival in patients were approved due to the difference in histocytology between the dorsal and ventral pancreas,including the ability of local invasion,lymph node metastases,and nerve plexus invasion.

Research progress of pancreatic head cancer arising from dorsal and ventral pancreas / 中华消化外科杂志

Pancreas arises from dorsal and ventral anlagens on an embryological basis,with a difference in histocytology.Immunohistochemical staining for an anti-pancreatic polypeptide can be performed to discriminate between the dorsal and ventral pancreas because of the difference in the amount of pancreatic polypeptide contained by the dorsal and ventral pancreas.Differences of survival in patients were approved due to the difference in histocytology between the dorsal and ventral pancreas,including the ability of local invasion,lymph node metastases,and nerve plexus invasion.

Fetal Topographical Anatomy of the Pancreatic Head and Duodenum with Special Reference to Courses of the Pancreaticoduodenal Arteries

PURPOSE: The purpose of this study is to provide better understanding as to how the "double" vascular arcades, in contrast to other intestinal marginal vessels, develop along the right margin of the pancreatic head. MATERIALS AND METHODS: In human fetuses between 8-30 weeks, we described the topographical anatomy of the vessels, bile duct, duodenum as well as the ventral and dorsal primordia of the pancreatic head with an aid of pancreatic polypeptide immunohisto-chemistry. RESULTS: The contents of the hepatoduodenal ligament crossed the superior side of the pylorus. Moreover, the right hepatic artery originating from the superior mesenteric artery ran along the superior aspect of the pancreatic head. An arterial arcade, corresponding to the posterior pancreaticoduodenal arteries, encircled the superior part of the pancreatic head, whereas another arcade, corresponding to the anterior pancreaticoduodenal arteries, surrounded the inferior part. The dorsal promordium of the pancreas surrounded and/or mixed the ventral primordium at 13-16 weeks. Thus, both arterial arcades were likely to attach to the dorsal primordium. CONCLUSION: The fetal anatomy of the pancreaticoduodenal vascular arcades as well as that of the hepatoduodenal ligament were quite different from adults in topographical relations. Thus, in the stage later than 30 weeks, further rotation of the duodenum along a horizontal axis seemed to be required to move the pylorus posterosuperiorly and to reflect the superior surface of the pancreatic head posteriorly. However, to change the topographical anatomy of the superior and inferior arterial arcades into the final position, re-arrangement of the pancreatic parenchyma might be necessary in the head.

Establishment of the Guideline for the Anatomical Resection of the Ventral and Dorsal Portion of the Pancreatic Head

PURPOSE: This study was designed to delineate the anatomical details of the pancreatic head for a ventral or dorsal segmental pancreatic resection along the embryological fusion plane, and to determine the feasibility of both procedures. METHODS: The resected pancreaticoduodenectomy specimens were analyzed (n=8), with the pancreatic and distal common bile ducts visualized by pancreatography (n=8). Immunohistochemical staining, with pancreatic polypeptide (PP), was performed in serially sliced specimens (n=3). The immunohistochemical and H&E staining were performed to evaluate the composition of the anatomical structures of the two differentially stained pancreas. RESULTS: What was presumed to be the embryological fusion plane was discovered between two differentially stained segments. This started just above the anterior inferior pancreaticoduodenal artery, directed to the posterior superior part of the pancreatic head and ended at the anterior surface of the distal common bile duct. The duct of Wirsung and the distal common bile duct were included in the posterior segment of the pancreas (ventral pancreas). There were two types of pancreatic duct arrangement, with the differences between the two types being; (1) the distance between the fusion point of the ventral and dorsal pancreatic ducts and the papilla of Vater, and (2) the stream of the Santorini duct. The branches of the pancreatic ducts were scattered over the entire pancreatic head region in multiple-directions. CONCLUSION: The fusion plane of the ventral and dorsal pancreas seems to initiate just above the anterior inferior pancreaticoduodenal artery, in a posterior-superior direction along the anterior surface of the distal common bile duct. A ventral pancreatectomy seems an impractical procedure with regard to the postoperative morbidity and operative difficulty, while a dorsal pancreatectomy seems to be more practical and feasible in its clinical aspects.