Laparoscopic repositioning of an aberrant right hepatic artery and hepaticojejunostomy for pediatric choledochal cyst: A case report.
Laparoscopic repositioning of an aberrant right hepatic artery and hepaticojejunostomy for pediatric choledochal cyst: A case report.
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DOI：
10.1016/j.ijscr.2021.106300
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发表时间：
2021-09
影响因子：
0.6
通讯作者：
Ieiri S
中科院分区：
文献类型：
--
作者：
Masuya R;Miyoshi K;Nakame K;Nanashima A;Ieiri S
肝右动脉穿过肝总管腹侧是一种相对常见的异常。此迷走右肝动脉不仅干扰胆总管切开及胆总管囊肿肝管空肠吻合术，而且可引起术后吻合口狭窄。一名14岁的患者出现上腹痛，并被诊断为胆总管囊肿（Todani分类中的IVA型）和胰胆管连接异常。腹部增强电脑断层显示位于总肝管腹侧的迷走右肝动脉。计划行腹腔镜胆总管囊肿切除术和肝管空肠吻合术。术中发现也显示了异常的右肝动脉腹侧穿过肝总管，如术前计算机断层扫描所示。腹腔镜背侧复位的迷走右肝动脉进行，因为它似乎压缩肝总管，并有可能导致术后吻合口狭窄。我们施行腹腔镜下肝管空肠吻合术，将迷走右肝动脉背侧置换，以促进吻合，防止术后吻合口狭窄。术后过程顺利，没有发现吻合口狭窄的迹象。肝右动脉异常是肝管空肠吻合术后吻合口狭窄的主要原因。一旦发生吻合口狭窄或狭窄，往往很难治疗，因此，预防吻合口狭窄非常重要。胆总管囊肿伴迷走右肝动脉者，背侧复位可有效预防术后吻合口狭窄及胆汁淤积。肝右动脉穿过肝总管前部是一种相对常见的异常。迷走右肝动脉可引起术后吻合口狭窄。我们施行腹腔镜下肝管空肠吻合术，将迷走右肝动脉背侧置换。
The right hepatic artery crossing the ventral side of the common hepatic duct is a relatively frequent abnormality. This aberrant right hepatic artery not only interferes with dissection of the common bile duct and hepaticojejunostomy for choledochal cyst but can also cause postoperative anastomotic stenosis. A 14-year-old patient presented with upper abdominal pain and was diagnosed with a choledochal cyst (Type IVA in Todani Classification) and pancreaticobiliary maljunction. Abdominal enhanced computed tomography showed aberrant right hepatic artery located at the ventral side of the common hepatic duct. Laparoscopic choledochal cyst resection and hepaticojejunostomy were planned. Intraoperative findings also showed the aberrant right hepatic artery crossing the common hepatic duct ventrally as detected on preoperative computed tomography. Laparoscopic dorsal side repositioning of the aberrant right hepatic artery was performed because it appeared to compress the common hepatic duct and risked causing postoperative anastomotic stenosis. We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally to facilitate suturing and prevent postoperative anastomotic stenosis. The postoperative course was uneventful, with no findings suggestive of anastomotic stenosis. The abnormality of the right hepatic artery is reported to be a primary cause of anastomotic stenosis after hepaticojejunostomy. Once anastomotic stenosis or stricture develops, it is often difficult to treat. The prevention of the stenosis is important. In choledochal cyst with aberrant right hepatic artery, dorsal repositioning is effective for preventing postoperative anastomotic stenosis and cholestasis. The right hepatic artery crossing the anterior aspect of the common hepatic duct is a relatively frequent abnormality. The aberrant right hepatic artery can cause the postoperative anastomotic stenosis. We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally.
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