Whipple术中对异位起源于肠系膜上动脉并绕门静脉后方上行的肝总动脉的处理方法  

Surgical technique for a common hepatic artery which originates from the superior mesenteric artery and going behind the portal vein during a Whipple＇s procedure

作　　者：欧阳柳[1] 刘安安[1] 宋彬[1] 郝骏[1] 彭智勇[1] 梁兴[1] 邵成浩[1] 金钢[1] 胡先贵[1] 

机构地区：[1]第二军医大学附属长海医院胰腺外科,上海200433

出　　处：《中华肝胆外科杂志》2014年第5期366-369,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨在Whipple术中保护异位起源于肠系膜上动脉并绕门静脉后方上行的肝总动脉的方法。方法回顾性分析第二军医大学附属上海长海医院胰腺外科2011年9月至2013年5月4例Whipple手术资料。4例患者肝总动脉均异位起源于肠系膜上动脉并绕门静脉后方上行，总结避免此种异位肝总动脉损伤的方法。结果按照我们的方法，4例患者在Whipple术时均未损伤异位的肝总动脉。手术时间160～215min，平均192min。术中出血200～800ml，平均400ml。术中输血0～600ml，平均150ml。术后肝功能无明显变化。术后住院9—22d，平均17d，均顺利出院。结论在行Whipple术前，应了解肝总动脉的正常解剖及变异。术前行增强CT或CT血管造影（CTA）检查，并仔细读片，分析肝总动脉的起源及其走行；术中采取试夹闭“胃十二指肠动脉”，触摸“肝固有动脉”搏动，仔细解剖腹腔干根部，在解剖不清时不轻易切断任何一根血管等措施，可以有效避免此种异位肝总动脉的损伤。Objective To discuss the technique in protecting a common hepatic artery when it originates from the superior mesenteric artery and going behind the portal vein during a Whipple＇s procedure. Methods The data of 4 patients with a common hepatic artery which originated from the superior mesenteric artery which went behind the portal vein and were admitted from September 2011 to May 2013 at the Department of Pancreatic Surgery of Changhai Hospital Affiliated to The Second Military Medical University were analyzed retrospectively. The method to protect the common hepatic artery anormaly was discussed. Results Following our technique, the common hepatic artery anormaly in the 4 patients was identified and preserved during the Whipple＇s procedure. The duration of surgery ranged from 160 to 215 min, with an average of 192 min. Intraoperative blood loss ranged from 200 to 800 ml, with an average of 400 ml, intraoperative blood transfusion ranged from 0 to 600 ml, with an average of 150 ml. The liver function did not change dramatically. The postoperative length of hospital stay ranged from 9 to 22 d, with an average of 17 d. All the 4 patients were discharged home smoothly. Conclusions Before a Whipple＇s procedure, the anatomy of the common hepatic artery should be known. It is necessary to have an enhanced CT scan or CTA, and we must read all the images carefully, and analyze the origin and the course of the common hepatic artery. It is necessary to occlude the ＂ gastroduodenal artery＂ , touch the pulsation of the ＂ hepatic proper artery＂ , dissect the root of the coeliac trunk carefully, and avoid cutting off any vessels when the dissection is not clear. These methods are beneficial to protect a common hepatic artery anormaly effectively.

关 键 词：解剖变异 肝总动脉 肠系膜上动脉 胰十二指肠动脉 WHIPPLE手术 

分 类 号：R656[医药卫生—外科学]