The Branching Pattern of the Inferior Pancreaticoduodenal Artery in Patients with a Replaced Right Hepatic Artery
The Branching Pattern of the Inferior Pancreaticoduodenal Artery in Patients with a Replaced Right Hepatic Artery
复制标题
右肝动脉置换患者胰十二指肠下动脉的分支模式
DOI：
10.1177/000313481808400621
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
K. Dono
中科院分区：
文献类型：
--
作者：
Y. Tomimaru;Kaishu Tanaka;Kozo Noguchi;Shunji Morita;H. Imamura;K. Dono
了解胰十二指肠下动脉（IPDA）的解剖结构对胰十二指肠切除术的患者很重要，特别是在动脉优先入路中，导致一些研究关注IPDA的解剖结构。然而，这些研究仅涵盖了肝动脉解剖无变异的病例，这是一种常见的动脉变异，这表明有必要对具有该变异的病例进行IPDA解剖研究。利用多排计算机断层扫描图像，从我院714例行多排计算机断层扫描确定胰头动脉的患者中挑选出肝右动脉（rRHA）置换病例。研究了rRHA病例的IPDA分支模式。三维重建以直观地了解代表性病例的分支模式。发现rRHA 139例（19.5%）；rRHA起源于肠系膜上动脉（SMA）（1型，74.1%）、腹腔轴（2型，18.0%）和其他（3型，7.9%）。IPDA分支模式分类；IPDA起源于SMA （A型），后、前IPDA分别起源于rRHA和SMA （B型），或IPDA起源于rRHA （C型）。A型69例，B型23例，C型11例。2型中A型16例，B型9例。11例3型患者均为c型，rRHA患者均有IPDA分支。这将有助于识别rRHA病例，其中动脉优先入路在胰十二指肠切除术（1-B、1-C和2-B型）中技术上不太可行。
Understanding the anatomy of the inferior pancreaticoduodenal artery (IPDA) is important in patients undergoing pancreaticoduodenectomy, especially in an artery-first approach, resulting in some studies focusing on IPDA anatomy. However, the studies have covered only cases without variation in hepatic arterial anatomy, a common arterial variant, suggesting the necessity of the investigation of IPDA anatomy in cases with the variant. Using images of multidetector row computed tomography, cases with replaced right hepatic artery (rRHA) were picked out among 714 patients undergoing multidetector row computed tomography for determining arteries of the pancreatic head at our institution. IPDA branching pattern was investigated in the rRHA cases. Three-dimensional reconstruction was performed to visually understand the branching pattern in representative cases. rRHA was identified in 139 cases (19.5%); rRHA originating from the superior mesenteric artery (SMA) (type 1; 74.1%), celiac axis (type 2; 18.0%), and others (type 3; 7.9%). IPDA branching pattern was categorized; IPDA originated from SMA (type A), posterior and anterior IPDA originated from rRHA and SMA, respectively (type B), or IPDA originated from rRHA (type C). Of type 1 cases, 69, 23, and 11 cases showed type A, B, and C pattern, respectively. Of type 2 cases, 16 and 9 cases showed type A and B, respectively. All 11 type 3 cases showed type C. IPDA branching pattern was determined in the rRHA cases. This would help identification of rRHA cases where the artery-first approach is technically less feasible at pancreaticoduodenectomy (type 1-B, 1-C, and 2-B).