Awareness of hepatic arterial variants is required in surgical oncology decision making strategy: Case report and review of literature.
Awareness of hepatic arterial variants is required in surgical oncology decision making strategy: Case report and review of literature.
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DOI：
10.3892/ol.2018.8106
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发表时间：
2018-05
期刊：
影响因子：
2.9
通讯作者：
Polkowski W
中科院分区：
文献类型：
--
作者：
Sitarz R;Berbecka M;Mielko J;Rawicz-Pruszyński K;Staśkiewicz G;Maciejewski R;Polkowski W
手术治疗胰腺癌仍然是金标准，然而，识别胰腺和附近器官的血管供应仍然是根治性切除的关键困难。在胰头切除术中，必须对区域动脉血管进行癌性解剖。约 50-70% 的患者存在正常的腹腔和肝动脉解剖结构，并且已描述了多种变异。了解多发动脉异常对于肝胰胆外科手术至关重要，以避免不必要的并发症。本研究根据现有文献进行了综述，介绍了腹腔干和肝总动脉 (CHA) 异常及其临床重要性。诊断患有胰头癌的患者住院进行分期和根治性手术治疗计划。计算机断层扫描 (CT) 显示胰头和 CHA 内有一个巨大的肿瘤肿块，直接从肠系膜上动脉分支。三维 CT 重建显示出明显的血管异常，并在手术中得到证实。尽管CHA起源异常，但每例均进行了保留幽门的胰十二指肠切除术和区域淋巴结清扫术，且未出现术中并发症。患者术后临床过程平稳，可以立即进行辅助化疗。在胰腺癌的多学科治疗中，外科医生和放射科医生必须了解异常的解剖结构，以避免潜在的并发症。由于用于术前分期的CT扫描对血管异常具有诊断价值，因此需要做出适当的手术决策。
Surgery for the treatment of pancreatic cancer remains the gold standard, however, the identification of the vascular supply of the pancreas and the nearby organs remains a crucial difficulties in a curative resection. During pancreatic head resection for carcinoma dissection of regional arterial vasculature is mandatory. Normal coeliac and hepatic arterial anatomy occurs in ~50–70% of patients and multiple variations have been described. Knowledge of multiple arterial anomalies is essential in hepato-pancreatico-billary surgery to avoid unnecessary complications. The present study presents coeliac trunk and common hepatic artery (CHA) anomalies along with their clinical importance, as reviewed according to the available literature. Patients diagnosed with cancer of the pancreatic head were hospitalized for staging and planning of radical surgical therapy. Computed tomography (CT) revealed a large tumour mass in the head of the pancreas and CHA, which branched directly from the superior mesenteric artery. A three-dimensional CT reconstruction revealed a demonstrative vascular anomaly, which was confirmed during an operation. Despite the anomalous origin of the CHA, pylorus preserving pancreatoduodenectomy and regional lymph node dissection without intraoperative complications was performed in each case. The patient's postoperative clinical course was uneventful and adjuvant chemotherapy could be administered without delay. In the multidisciplinary treatment of pancreatic carcinoma the surgeon and radiologist must be aware of the aberrant anatomy in order to avoid potential complications. As CT scans used for the preoperative staging are of diagnostic value for vascular anomaly, it is required for appropriate surgical decision making.
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