1. 胰腺钩突的大体位置 （Location）

胰腺钩突（Uncinate Process of the Pancreas）是胰头（Head of the Pancreas）最下部的一个向左后上方突出的、呈钩状或楔形的部分。Uncinate，Having a hooked shape， “钩状的；钩曲的”。钩突是胰腺胚胎发育过程中腹侧胰芽（Ventral Pancreatic Bud）的主要衍生物，最终与背侧胰芽（Dorsal Pancreatic Bud）融合形成完整的胰腺。

胰腺钩突位于腹腔深部，上腹部腹膜后间隙（Retroperitoneal Space），紧贴第1、2腰椎椎体前方。钩突与胰颈（Neck of Pancreas）和胰体（Body of Pancreas）相接，犹如一个“钩子”，从后方钩住肠系膜上血管。

Uncinate process – a hook-like projection from the lower part of the head, extending medially to lie beneath the body of the pancreas. It lies posterior to the superior mesenteric vessels and deeply embedded in the retroperitoneum.

2. 正常胰腺钩突的毗邻关系 (Relationships)

胰腺钩突的核心是与肠系膜上血管（Superior Mesenteric Vessels） 的密切关系。

The pancreas is supplied by the pancreatic branches of the splenic artery. The head is additionally supplied by the superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.

2.1 前方 (Anteriorly):

  • 肠系膜上静脉 (Superior Mesenteric Vein, SMV) 和 肠系膜上动脉 (Superior Mesenteric Artery, SMA)。

  • 肠系膜上静脉在钩突前方上行，与脾静脉（Splenic Vein）在胰颈后方汇合形成门静脉（Portal Vein）。肠系膜上动脉则位于肠系膜上静脉的左后方。钩突的前表面与这些血管紧密相邻，其间是疏松结缔组织。

2.2 后方 (Posteriorly):

  • 下腔静脉 (Inferior Vena Cava, IVC) 和 腹主动脉 (Abdominal Aorta)。

  • 钩突的后面直接与下腔静脉的下段以及腹主动脉的远端相邻，意味着钩突的病变可能向后侵犯这些最大的体循环动静脉。

2.3 左侧 (To the Left):

  • 肠系膜上动脉的起始部 (Origin of the Superior Mesenteric Artery) 和 腹腔干 (Coeliac Trunk / Celiac Artery) 的根部。

  • 钩突的左侧缘紧贴肠系膜上动脉从腹主动脉发出的起始段，更上方则与腹腔干相邻，这是术中分离钩突最关键的区域。

2.4 右侧 (To the Right):

  • 包括胰头其余部分和十二指肠降部及水平部 (Descending and Horizontal Parts of the Duodenum)。

  • 钩突的右侧与胰头的其余部分相延续，并共同被“C”形的十二指肠环所包绕。

2.5 上方 (Superiorly):

简述胰腺钩突的位置毗邻及钩突癌的临床表现

  • 胰颈和门静脉-肠系膜上静脉汇合部 (Portal-Superior Mesenteric Venous Confluence)。

  • 钩突的上缘与胰颈相连，其尖端常指向门静脉和肠系膜上静脉的后方。

2.6 下方 (Inferiorly):

  • 十二指肠水平部 (第三部分) (Horizontal Part of the Duodenum) 和 空肠近端 (Proximal Jejunum)。

  • 钩突的下方与小肠的起始段相邻。


3. 胰腺钩突癌的临床症状

胰腺钩突癌的早期症状不典型，包括体重减轻，腹痛，黄疸等典型症状，但容易侵犯肠系膜上血管。

Patients with carcinoma of the uncinate process of the pancreas exhibit nonspecific symptoms with weight loss and upper abdominal pain as the most significant ones. Importantly, despite the uncinate process being part of the head of the pancreas, jaundice does not appear to be an early symptom. Furthermore, the close anatomical relationship between the uncinate process and the superior mesenteric vessels results in early vascular involvement in these cancers.

对于胰腺钩突癌CT是最好的检查方法。由于距离胆总管和胰管较远，ERCP用处不大。CA19-9升高意义很大。

CTIn carcinoma of the uncinate process of the pancreas, CT scan is believed to be the best diagnostic tool. Due to the increased distance of the common bile duct and pancreatic duct from the uncinate process, Endoscopic Retrograde Cholangio-Pancreatography is of little use. CA19-9 is a valuable tool and its sensitivity and specificity has been demonstrated at over 80%. 

钩突部的肿瘤（如胰腺癌，Pancreatic Adenocarcinoma）早期症状隐匿，但极易侵犯或包绕（Encasement）肠系膜上动脉和静脉。在CT或MRI影像上，评估肿瘤与这些血管（尤其是SMA）的关系是判断肿瘤可切除性 (Resectability) 的核心标准。如果肿瘤包绕SMA超过180°，通常被认为是不可切除的。


急慢性胰腺炎可导致钩突部水肿、坏死或形成假性囊肿（Pseudocyst）。这些病变可能压迫前方的肠系膜上静脉，导致门静脉系统压力增高，或引起十二指肠梗阻。

扩展阅读：

  1. https://pathology./pancreas/basics

  2. https://pmc.ncbi.nlm./articles/PMC2827061/

  3. https:///the-pancreas-6/

  4. https:///abdomen/viscera/pancreas/

  5. https:///uncinate-process

  6. https://www./doi/full/10.2214/AJR.08.1138

  7. https://pubs./doi/10.1148/rg.352140136

  8. https://www./figure/Anatomy-of-the-duodenum-Contrast-enhanced-curved-planar-reformation-A-axial-B-MIP_fig1_370292057

  9. https://www./figure/Cross-sectional-imaging-of-an-uncinate-process-ductal-adenocarcinoma-using-tools-of_fig7_232236976

  10. https://www./figure/a-A-tumor-in-the-pancreatic-uncinate-process-UP-contacting-the-SMV-yellow-arrow_fig1_366624889

  11. https://www./figure/Axial-CT-scan-for-patient-1-A-Axial-CT-showing-the-head-uncinate-process-of-the_fig1_375590781

  12. https://pubs./doi/abs/10.1148/rg.2020200045?journalCode=radiographics