Clinical significance of variant hepatic artery in pancreatic resection:A comprehensive review  

作　　者：Ye-Cheng Xu Feng Yang De-Liang Fu 

机构地区：[1]Department of Pancreatic Surgery,Huashan Hospital,Shanghai 200040,China [2]Department of Pancreatic Surgery,Pancreatic Disease Institute,Huashan Hospital,Shanghai 200040,China

出　　处：《World Journal of Gastroenterology》2022年第19期2057-2075,共19页世界胃肠病学杂志（英文版）

基　　金：Supported by National Key R&D Program of China(Dr Yang),No.2017YFC1308604.

摘　　要：The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels.A variant of the hepatic artery,which is not a rare finding during pancreatic surgery,is prone to intraoperative injury.Inadvertent injury to the hepatic artery may affect liver perfusion,resulting in necrosis,liver abscess,and even liver failure.The preoperative identification of hepatic artery variations,detailed planning of the surgical approach,careful intraoperative dissection,and proper management of the damaged artery are important for preventing hepatic hypoperfusion.Nevertheless,despite the potential risks,planned artery resection has become acceptable in carefully selected patients.Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods.The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery.Here,we comprehensively reviewed the anatomical basis of hepatic artery variation,its incidence,and its effect on the surgical and oncological outcomes after pancreatic resection.In addition,we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion.Overall,the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.

关 键 词：Hepatic artery PANCREATECTOMY PANCREATICODUODENECTOMY Arterial reconstruction Celiac axis resection OUTCOME Prognosis 

分 类 号：R657.5[医药卫生—外科学]