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Surgical anatomy of innervation of the gallbladder in humans and Suncus murinus with special reference to morphological understanding of gallstone formation after gastrectomy

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World Journal of Gastroenterology 2007年第14期13卷 2066-2071页

作者： Shuang-Qin yi Tetsuo Ohta Akihiko Tsuchida Hayato Terayama Munekazu Naito Jun Li Heng-Xiao Wang nozomi yi Shigenori Tanaka Masahiro Itoh Department of Anatomy Tokyo Medical University 6-1-1 Shinjuku Shinjukuku Tokyo 160-8402 Japan Department of Gastroenterologie Surgery Kanazawa University 13-1 Takara-Machi Kanazawa 920-8420Japan Third Department of Surgery Tokyo Medical Kanazawa University 13-1 Takara-Machi Kanazawa 920-8420Japan Department of Anatomy and Neuroembryology Kanazawa University 13-1 Takara-Machi Kanazawa 920-8420Japan

AIM： To clarify the innervation of human gallbladder,with special reference to morphological understanding of gallstone formation after gastrectomy.METHODS： The liver, gallbladder and surrounding structures were immersed in a 10 mg/L solution of alizarin red S in ethanol to stain the peripheral nerves in cadavers （n = 10）. Innervation in the areas was completely dissected under a binocular microscope. Similarly,innervation in the same areas of 10 Suncus murinus （S. murinus） was examined employing whole mount immunohistochemistry.RESULTS： Innervation of the gallbladder occurred predominantly through two routes. One was from the anterior hepatic plexus, the innervation occurred along the cystic arteries and duct. Invariably this route passed through the hepatoduodenal ligament. The other route was from the posterior hepatic plexus, the innervation occurred along the cystic duct ventrally. This route also passed through the hepatoduodenal ligament *** results were obtained in S. murinus.CONCLUSION： The route from the anterior hepatic plexus via the cystic artery and/or duct is crucial for preserving gallbladder innervation. Lymph node dissection specifically in the hepatoduodenal ligament may affect the incidence of gallstones after ***, the route from the posterior hepatic plexus via the common bile duct and the cystic duct to the gallbladder should not be disregarded. Preservation of the plexus may attenuate the incidence of gallstone formation after gastrectomy.

关键词： Innervation Gallstone Hepatoduodenalligament Gastrectomy Whole mount immunohistochemistry

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Surgical anatomy of the innervation of pylorus in human and Suncus murinus, in relation to surgical technique for pylorus-preserving pancreaticoduodenectomy

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World Journal of Gastroenterology 2006年第14期12卷 2209-2216页

作者： Shuang-Qin yi Fei Ru Tetsuo Ohta Hayato Terayama Munekazu Naito Shogo Hayashi Sichen Buhe nozomi yi Takayoshi Miyaki Shigenori Tanaka Masahiro Itoh Department of Anatomy Tokyo Medical University 6-1-1 Shinjuku Shinjuku-ku Tokyo 160-8402 Japan Department of Medicine Johns Hopkins Medical Institutions 600 North Wolfe Street Baltimore Maryland 21287 United States Department of Gastroenterologic Surgery Kanaza- wa University 13-1 Takara-Machi Kanazawa 920-8420 Japan Department of Anatomy and Neuroembryology Kanazawa University 13-1 Takara-Machi Kanazawa 920-8420 Japan

AIM： To clarify the innervation of the antro-pyloric region in humans from a clinico-anatomical perspective. METHODS： The stomach, duodenum and surrounding structures were dissected in 10 cadavers, and immersed in a 10mg/L solution of alizarin red S in ethanol to stain the peripheral nerves. The distribution details were studied to confirm innervations in the above areas using a binocular microscope. Similarly, innervations in 10 Suncus murinus were examined using the method of whole-mount imm unohistochemistry. RESULTS： The innervation of the pyloric region in humans involved three routes： One arose from the anterior hepatic plexus via the route of the suprapyloric/supraduodenal branch of the right gastric artery; the second arose from the anterior and posterior gastric divisions, and the third originated from the posterior-lower region of the pyloric region, which passed via the infrapyloric artery or retroduodenal branches and was related to the gastroduodenal artery and right gastroepiploic artery. For Suncus murinus, results similar to those in humans were observed. CONCLUSION： There are three routes of innervation of the pyloric region in humans, wherein the route of the right gastric artery is most important for preserving pyloric region innervation. Function will be preserved by more than 80% by preserving the artery in pylorus-preserving pancreaticoduodenectomy （PPPD）. However, the route of the infrapyloric artery should not be disregarded. This route is related to several arteries （the right gastroepiploic and gastroduodenal arteries）, and the preserving of these arteries is advantageous for preserving pyloric innervation in PPPD. Concurrently, the nerves of Latarjet also play an important role in maintaining innervation of the antro-pyloric region in PPPD. This is why pyloric function is not damaged in some patients when the right gastric artery is dissected or damaged in PPPD.

关键词： Innervation Quality of life Pylorus-preserving pancreaticoduodenectomy Suncus murinus Whole mount immunohistochemistry

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