Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery
Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery
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DOI：
10.1002/jhbp.819
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发表时间：
2020-09-19
影响因子：
3
通讯作者：
Nakamura, Masafumi
中科院分区：
文献类型：
--
作者：
Mori, Yasuhisa;Nakata, Kohei;Nakamura, Masafumi
背景本研究旨在评价先天性胆管扩张症（CBD）患者肝右动脉（RHA）的解剖变异以及腹腔镜手术治疗CBD的适当入路。方法回顾性分析1996 - 2018年36例腹腔镜或开腹手术治疗胆总管囊肿的临床资料。将这36例患者的RHA起源和过程的放射学评价与195例无CBD的对照患者进行比较。结果肝总管前交叉的发生率在CBD患者中显著高于无CBD患者（33%vs10%，P = 0.0001）。无论RHA的过程如何，RHA均无术中损伤。在12例前型RHA患者中有11例（92%）的CHD在RHA尾侧分开，在24例后型RHA患者中有13例（54%）（P = 0.03）。结论CBD患者RHA穿越CHD前壁的发生率高于非CBD患者。在腹腔镜手术时代，在CBD手术期间，在每种情况下保留RHA是必要的。
Background The present study aimed to evaluate anatomical variations of the right hepatic artery (RHA) in patients with congenital biliary dilatation (CBD) and the appropriate approach in laparoscopic surgery for CBD. Methods The medical records of 36 patients who underwent laparoscopic or open surgery for CBD from 1996 to 2018 were retrospectively reviewed. Radiological evaluation of the origin and course of the RHA in these 36 patients were compared with 195 control patients without CBD. Results The incidence of the RHA crossing anterior to the common hepatic duct (CHD) was significantly higher in patients with CBD than in those without CBD (33% versus 10%,P = .0001). There was no intraoperative injury of the RHA, irrespective of the course of the RHA. The CHD was divided at the caudal side of the RHA in 11 of 12 patients (92%) with the anterior type of RHA, and in 13 of 24 patients (54%) with the posterior type of RHA (P = .03). Conclusions Patients with CBD had a higher incidence of the RHA crossing anterior to the CHD than patients without CBD. Preservation of the RHA in each situation is necessary during surgery for CBD in the era of laparoscopic surgery.