Disposal of Replaced Common Hepatic Artery Coursing Within the Pancreas During Pancreatoduodenectomy: Report of a Case
Disposal of Replaced Common Hepatic Artery Coursing Within the Pancreas During Pancreatoduodenectomy: Report of a Case
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胰十二指肠切除术中在胰腺内走行的替换肝总动脉的处理：病例报告
DOI：
10.1007/s00595-005-3040-5
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发表时间：
2005
期刊：
影响因子：
2.5
通讯作者：
A. Sakuma
中科院分区：
文献类型：
--
作者：
Satoshi Yamamoto;K. Kubota;K. Rokkaku;T. Nemoto;A. Sakuma
肝总动脉起源于上级肠系膜动脉是一种罕见的异常。我们在此报告一位62岁男性因下段胆管癌而接受胰脏切除术。计算机断层扫描（CT）显示RCHA沿胰腺腹侧沿着延伸。腹部血管造影显示RCHA起源于SMA，其与来自胃左动脉的迷走肝左动脉相通。未观察到胃十二指肠动脉，但观察到胃网膜右动脉的直接分支。回顾了英国文献中的类似病例。证实RCHA首先沿胰腺腹侧沿着行进，然后在胰腺内行进。夹闭RCHA不影响肝脏中的动脉血流，随后将RCHA分开而不进行重建。在5例RCHA在胰腺腹侧内或沿着行进的病例中，有3例未发现胃十二指肠动脉，而是观察到胃网膜右动脉的直接分支。结合CT和血管造影结果有助于诊断在胰腺腹侧内或沿腹侧沿着的异常RCHA以及选择最佳的手术方式。除了保留左肝动脉外，我们依照一般惯例施行胰脏切除术。
A replaced common hepatic artery (RCHA) originating from the superior mesenteric artery (SMA) is a rare anomaly. We herein report such a case in a 62-year-old man who was scheduled to undergo a pancreatoduodenectomy for lower bile duct cancer. Computed tomography (CT) showed the RCHA to run along the ventral side of the pancreas. Abdominal angiography showed an RCHA originating from the SMA, which communicated with an aberrant left hepatic artery from the left gastric artery. No gastroduodenal artery was observed, but instead a direct ramification of a right gastroepiploic artery was seen. Similar cases from the English literature were reviewed. The RCHA was confirmed to course first along the ventral side of, and then within, the pancreas. Clamping of the RCHA did not influence the arterial flow in the liver, and the RCHA was subsequently divided without reconstruction. In three of the five reviewed cases in which the RCHA coursed either within or along the ventral side of the pancreas, no gastroduodenal artery was found, but instead a direct ramification of a right gastroepiploic artery was observed. A combination of CT and angiographic findings can help in both the diagnosis of an anomalous RCHA coursing either within or along the ventral side of the pancreas as well as in selecting optimal operative procedures. Pancreatoduodenectomy was performed with a curative resection according to our usual practice except for the fact that we preserved the aberrant left hepatic artery.