腹腔镜胰十二指肠切除围手术期动脉变异的处理策略  

Preoperative treatment strategy of laparoscopic pancreaticoduodenectomy in patients with arterial anomalies

作　　者：李佳[1] 彭创[1] 厉鸥[1] 郭超[1] 杨平洲[1] 易为民[1] 蒋波[1] 吴金术[1] Li Jia;Peng Chuang;Li Ou;Guo Chao;Yang Pingzhou;Yi Weimin;Jiang Bo;Wu Jinshu(Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1]湖南省人民医院湖南师范大学附属第一医院肝胆外科,湖南长沙410005

出　　处：《中华肝胆外科杂志》2018年第12期838-842,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：湖南省科技厅科技计划重点项目(2015sK2050);湖南省教育厅科学研究基金(17c0963);中国博士后科学基金(2017M620347).

摘　　要：目的探讨腹腔镜下胰十二指肠切除(LPD)围手术期动脉变异的诊断与处理策略。方法采用横断面研究方法,分析2016年1月至2017年12月湖南省人民医院收治的16例逆时针凹D动脉变异患者的临床资料。结果手术时间(370.0±109.0)min,失血量(92.0±45.0)IIll。14例术前阅片发现并术中证实替代肝右动脉(rRHA)5例,肝总动脉(cHA)起源于肠系膜上动脉(sMA)3例,肝右动脉(RHA)横跨胆总管(cBD)前方3例,腹腔干(cA)与sMA共干2例,右肾动脉(RRA)变异1例。另外2例术前阅片未发现变异,其中1例术中解剖明确胰背动脉(DPA)起源于cHA,另1例胆囊动脉、胃右动脉(RGA)起源于肝左动脉(LHA)。术后并发生化漏3例,腹腔局限性积液2例,胸腔积液2例,胃肠吻合口出血、胃排空延迟、脐下切口感染、肝固有动脉(PHA)假性动脉瘤各1例。病理检查16例均为胰腺或壶腹部恶性肿瘤,肿瘤均获得R0切除。结论动脉变异在LPD术中常见。术前针对性阅片、区域划分法结合逆时针切除,能早期发现、鉴别并保护变异动脉,降低术后严重并发症风险。Objective To study the preoperative diagnosis and treatment strategy of laparoscopic pancreatoduodenectomy (LPD)in patients with arterial anomalies.Methods The clinical data of 16 patients with arterial anomalies who underwent counterclockwise LPD at the Hunan People's Hospital from January 2016to December 2017were analyzed.Results The operation time was 370.0±109.0min.The blood loss was 92.0±45.0ml.In 14patients,arterial anomalies were found preoperatively and were confirmed intraoperatively.The number of patients with a replaced right hepatic artery (rRHA),common hepatic artery (CHA)which originated from superior mesenteric artery (SMA),right hepatic artery (RHA)crossing in front of common bile duct (CBD),celiac artery (CA)and SMA with a common origin,right renal artery (RRA)anomaly were 5,3,3,2,and 1,respectively.In 2patients,the anomalies were not found before operation :a dorsal pancreatic artery (DPA)originating from CHA,and a cystic artery and a right gastric artery (RGA)originating from left hepatic artery (LHA).Operative complications included biochemical fistula in 3patients ;peritoneal local effusion in 2patients ;pleural effusion in 2patients ;gastrointestinal anastomosis bleeding in 1patient;delayed gastric emptying in 1patient;a proper hepatic artery (PHA)pseudoaneurysm in 1patient;and a subumbilical incision infection in 1patient.The pathological results showed all the 16 patients had malignant tumors of the pancreas or ampulla.All the tumors were resected by R0resection. Conclusion Arterial anomaly was common in LPD.Preoperative targeted radiological reading of X-rays,regional anatomical division combined with counterclockwise resection could result in early detection,identification and help to protect the arterial anomaly from injury and reduce the risk of serious postoperative compli- cations.

关 键 词：动脉变异 逆时针切除 胰十二指肠切除 腹腔镜 

分 类 号：R657.5[医药卫生—外科学]