Pancreaticoduodenectomy in the presence of a common hepatic artery originating from the superior mesenteric artery. Technical implications
Pancreaticoduodenectomy in the presence of a common hepatic artery originating from the superior mesenteric artery. Technical implications
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DOI：
10.1016/j.ijsu.2015.03.010
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发表时间：
2015-05-01
影响因子：
15.3
通讯作者：
Smadja, Claude
中科院分区：
文献类型：
--
作者：
Le Bian, Alban Zarzavadjian;Costi, Renato;Smadja, Claude
胰腺癌切除术（PD）被认为是一项技术要求很高的任务。胰腺血管化[腹腔动脉轴和上级肠系膜动脉（SMA）]的解剖变异可能存在潜在危及生命的血管损伤风险。我们回顾性报告了2例肝总动脉（CHA）起源于SMA的患者的改良PD技术。在外科手术之前已知CHA解剖结构模式。主要改良包括在分离CHA和胃十二指肠动脉之前切割胰腺。未报告术中事件。围手术期结局不显著，未报告血管损伤或肝缺血。计划PD的外科医生必须在深度成像（CT扫描和3D血管造影）中进行分析，并试图找到这些模式。此外，可能会遇到一些罕见的动脉变异，并改变典型的手术计划。了解之前的手术动脉模式并牢记消耗性或重要血管可以完成不寻常但有效的手术。(C)2015年出版集团有限公司。由爱思唯尔有限公司出版。保留所有权利。
Pancreaticoduodenectomy (PD) is considered a technically demanding task. Anatomic variations in duodenopancreatic vascularization [celiac axis and the superior mesenteric artery (SMA)] may carry a risk of potentially life-threatening vascular injury. We retrospectively report a modified PD technique performed in two patients presenting with a Common Hepatic Artery (CHA) originating from SMA. The CHA anatomical pattern was known prior surgical procedure. The main modification consisted in cutting pancreas prior dividing the CHA and the gastroduodenal artery. No intraoperative incident was reported. Perioperative outcomes were unremarkable, no vascular injury or hepatic ischemia was reported. Surgeons planning a PD must analyze in depth imaging (CT-scan with 3D angiography) and try to find these patterns. Furthermore, some rare arterial variations may be met and change typical surgical plan. Knowing prior procedure the arterial pattern and keeping in mind expendable or vital vessels allow to accomplish unusual but effective operations. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.