腹腔镜胰十二指肠切除术中肝动脉变异的识别与处理:附9例报道  

Identification and management of hepatic artery variation in laparoscopic pancreaticoduodenectomy:a report of 9 cases

作　　者：傅琪涵 陈平平[1] 曾勇超 唐荣[1] 章家超 李启进 乔欣 张震生[1] FU Qihan;CHEN Pingping;ZENG Yongchao;TANG Rong;ZHANG Jiachao;LI Qijin;QIAO Xin;ZHANG Zhensheng(Department of Hepatobiliary and Pancreatic Surgery,Hainan Provincial People’s Hospital,Haikou 570311,P.R.China)

机构地区：[1]海南省人民医院肝胆胰外科,海口570311

出　　处：《中国普外基础与临床杂志》2023年第9期1037-1041,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜胰十二指肠切除手术中遇到的肝动脉变异及其意义。方法回顾性收集2020年1月至2023年1月期间笔者所在团队收治的26例行腹腔镜胰十二指肠切除手术患者的临床资料,分析根据相关临床及影像学资料术前评估的肝动脉变异情况及其类型,以及术中采取的针对性措施和患者的预后。结果根据术前腹部增强CT、动脉计算机断层扫描血管造影成像以及术中对肝十二指肠韧带骨骼化,26例行腹腔镜胰十二指肠切除手术患者中有9例存在肝动脉变异:1例为替代肝左动脉,2例为替代肝右动脉,2例为副肝左动脉,3例为肝总动脉起源于肠系膜上动脉;另1例为右肝动脉发自腹主动脉,该例动脉变异在传统分型中没有。对来源于肠系膜上动脉的变异肝动脉在术中采取后路入进行分离血管,对来源于胃左动脉的变异肝动脉术中则采用前路入的方式进行分离。9例肝动脉变异患者术后均恢复良好,均未出现严重并发症。结论针对腹腔镜胰十二指肠切除手术中遇到的各种肝动脉变异,需要术前仔细评估;术中应根据血管直径大小以及阻断后肝脏血运变化情况决定是否保留该变异血管;术中进行合理操作,以避免损伤肝动脉。Objective To explore the hepatic artery variations encountered in laparoscopic pancreaticoduodenectomy(LPD)surgery and its significance.Methods The clinical datas of 26 patients who underwent LPD from January 2020 to January 2023 were retrospectively collected.Preoperative evaluation of hepatic artery variability and its types based on relevant clinical and imaging data,as well as targeted measures taken during surgery,and patients’prognosis were analyzed.Results According to preoperative abdominal enhanced CT,arterial computer tomography angiography imaging and intraoperative skeletonization of the hepatoduodenal ligament,hepatic artery variation was found in 9 of 26 patients undergoing LPD.The left hepatic artery was substituted in 1 case,the right hepatic artery was substituted in 2 cases,2 cases were the left accessory hepatic artery,and the common hepatic artery originated from the superior mesenteric artery in 3 cases.There was 1 case,right hepatic artery coming from the abdominal aorta,whose arterial variation was not included in the traditional typing.The variant hepatic artery from superior mesenteric artery was separated by posterior approach during operation,and the variant hepatic artery from left gastric artery was separated by anterior approach during operation.Nine patients with hepatic artery variation recovered well after operation,and no serious complications occurred.Conclusions Various hepatic artery variations during LPD need to be carefully evaluated before surgery.During surgery,it should be determined whether to retain the mutated blood vessel based on its diameter and changes in liver blood flow after occlusion,so that reasonable operation can be performed during the operation to avoid hepatic artery damage.

关 键 词：腹腔镜胰十二指肠切除手术 肝动脉变异 分型 

分 类 号：R656[医药卫生—外科学]