Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report.
Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report.
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DOI：
10.1016/j.ijscr.2016.05.016
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发表时间：
2016
影响因子：
0.6
通讯作者：
Fujii Y
中科院分区：
文献类型：
--
作者：
Nanashima A;Imamura N;Tsuchimochi Y;Hiyoshi M;Fujii Y
迷走肝右动脉常起源于上级肠系膜动脉。在胰头癌的胰头切除术中，联合切除迷走肝右动脉是实现R0切除的必要条件。联合切除术中，由于存在经肝门板的肝中动脉和肝左动脉交通动脉，故不一定需要动脉吻合。在解剖平面上无肿瘤暴露的R0切除改善了胰腺癌患者的预后。本病例报告旨在告知胰腺外科医生我们的经验，在手术治疗迷走胰腺动脉。一位63岁女性因阻塞性黄疸入住我院外科，发现胰头肿瘤，为改善肝功能障碍，于胆道内放置内镜逆行鼻胃管引流管。内视镜细针穿刺显示胰头癌侵犯胆总管、起源于上级肠系膜动脉的迷走肝右动脉及门静脉。增强计算机断层扫描显示右肝动脉和左肝动脉之间的交通动脉通过肝门板。通过术前影像学检查，行胰管切除联合迷走肝右动脉和门静脉切除术，不吻合动脉。术中多普勒超声检查证实了肝动脉血流，并实现了R0切除，在解剖平面上没有肿瘤暴露。患者的术后病程顺利。在本病例报告中，围手术期详细检查影像诊断肝动脉交通，以实现根治性切除胰头癌是必要的。通过这种处理，实现了肝动脉的不吻合，并强调了R0切除的必要性。通过术前和术中影像学处理，联合切除迷走肝右动脉不吻合行胰头癌切除术。然而，影像学诊断的改进和R0切除术的谨慎管理是重要的。
The aberrant right hepatic artery is often arising from superior mesenteric artery. Combined resection of the aberrant right hepatic artery is necessary in pancreaticoduodenectomy for pancreatic head cancer to achieve R0 resection. Arterial anastomosis of combined resection is not always necessary because of existence of communicating artery from the middle and left hepatic artery via hepatic hilar plate. R0 resection without tumor exposure at the dissected plane improves prognosis of pancreatic cancer patients. This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. A 63-year-old woman was admitted to our institute’s Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient’s postoperative course was uneventful. In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.