肝动脉变异在肝门淋巴结廓清中的临床意义  

Clinical significance of hepatic artery variation in hepatic portal lymphadenectomy

作　　者：霍明生 鲁正[1] 崔培元[1] 吴斌全[1] 吴华[1] 吴维[1] 许文青[1] 

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,安徽省蚌埠市233004

出　　处：《中国肿瘤临床》2015年第1期61-65,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨肝动脉变异在肝门淋巴结廓清中的识别与预防损伤策略。方法:回顾性分析2013年1月至2014年7月蚌埠医学院第一附属医院肝胆外科62例肝门淋巴结廓清中12例肝动脉变异患者术中处理情况。结果:12例肝动脉变异类型分为:MichelsⅢ型3例(25.0%),MichelsⅥ型2例(16.7%),MichelsⅨ型1例(8.3%),Hiatt 6型1例(8.3%),肝右动脉与肝总管空间位置变异2例(16.7%),肝左右动脉共同起源于肝总动脉2例(16.7%),以及肝右动脉起自胃十二指肠动脉1例(8.3%)。12例患者无肝动脉损伤;2例发生术后并发症,其中1例胰漏,另1例切口感染;无术后出血、胆漏及肝脓肿等并发症发生。整体恢复良好。结论:在熟知各种肝动脉解剖变异类型的前提下,术前完善的影像学检查与评估,加以术中谨慎且精细的操作,将使肝动脉损伤明显减少。Objective：To investigate the recognition and injury prevention strategies of hepatic artery variations during hepatic portal lymphadenectomy. Methods：A retrospective analysis was performed, and 12 patients of hepatic arterial variation among 62 pa-tients with hepatic portal lymphadenectomy were the subjects. The study was conducted in the First Affiliated Hospital of Bengbu Medi-cal College between January 2013 and July 2014. The intraoperative treatment and postoperative complications were recorded. Results：Among 12 cases of hepatic artery variation, we found the following cases：3 cases （25.0%） of Michels′ Type III, 2 cases （16.7%） of Mi-chels′ Type VI, 1 case （8.3%） of Michels′ Type IX, 1 case （8.3%） of Hiatt′s Type 6, 2 cases （16.7%） of spatial location variation between right hepatic artery and hepatic duct, 2 cases （16.7%） of left and right hepatic artery originating from a common hepatic artery, and 1 case （8.3%） of right hepatic artery originating from the gastroduodenal artery. No injury of hepatic artery occurred. Two cases had post-operative complications, including 1 case of pancreatic leakage and 1 case of incision infection;postoperative hemorrhage, bile leakage, hepatic abscess did not occur in these two cases. Patients recovered well in general. Conclusion：Hepatic arterial injury can be signifi-cantly reduced by the following：increased familiarity with the various types of hepatic artery variations;complete imaging examina-tions for inspection and evaluation before surgery;and careful and meticulous operations in surgery.

关 键 词：肝动脉变异 肝门淋巴结廓清 肠系膜上动脉 肝动脉损伤 

分 类 号：R735[医药卫生—肿瘤]