Blecha Matthew J, Frank Angela R, Worley Todd A, Podbielski Francis J
St. Joseph Hospital, Chicago, Illinois, USA.
JSLS. 2006 Oct-Dec;10(4):511-3.
Presented herein is a case in which an aberrant right hepatic artery (RHA) passes anterior to the infundibulum and fundus of the gallbladder and courses to an unusually anterior hepatic entry.
A 54-year-old female with a history of biliary colic was scheduled for laparoscopic cholecystectomy. Laparoscopic dissection revealed an aberrant right hepatic artery (RHA) anterior to the infundibulum and fundus of the gallbladder. Further dissection revealed the cystic artery to branch laterally off this RHA over the gallbladder fundus anteriorly. The cystic artery then wrapped posterolaterally on the gallbladder's surface to its neck. After the gallbladder was removed, the aberrant RHA was readily visible traveling across the gallbladder bed and entering the liver at an unusually anterior location. Intraoperative images are included. The procedure was completed laparoscopically without complication.
The origins and paths of both the cystic and right hepatic arteries have several documented anomalies. We are unaware of any reports of an RHA that transverses the entire neck and fundus of the gallbladder before such an anterior hepatic entry.
This case serves as a striking reminder of the variations in extrahepatic biliary and vascular anatomy. Ligation of this uniquely located aberrant RHA could have led to intraoperative hemorrhage or potential hepatic ischemia.
本文介绍了一例异常右肝动脉（RHA）经胆囊漏斗部和底部前方走行并以异常靠前的位置进入肝脏的病例。
一名有胆绞痛病史的54岁女性计划接受腹腔镜胆囊切除术。腹腔镜解剖显示胆囊漏斗部和底部前方存在异常右肝动脉（RHA）。进一步解剖发现胆囊动脉从该RHA在胆囊底部前方横向分支。然后，胆囊动脉在胆囊表面向后外侧包绕至胆囊颈部。切除胆囊后，可见异常RHA穿过胆囊床并在异常靠前的位置进入肝脏。文中包含术中图像。该手术通过腹腔镜完成，无并发症。
胆囊动脉和右肝动脉的起源及走行存在多种已记录的变异情况。我们未发现有任何关于右肝动脉在如此靠前进入肝脏之前横穿整个胆囊颈部和底部的报道。
该病例强烈提醒人们肝外胆道和血管解剖存在变异。结扎这条位置独特的异常右肝动脉可能导致术中出血或潜在的肝脏缺血。
