Section of General Surgery, Mayo Clinic, Jacksonville, FL 32224, USA.
HPB (Oxford). 2009 Mar;11(2):161-5. doi: 10.1111/j.1477-2574.2009.00037.x.
Aberrant arterial anatomy is a common finding during foregut surgery. Anomalies to the right hepatic lobe are especially relevant during pancreaticoduodenectomy (PD) and their recognition serves to protect the blood supply to the liver and bile ducts. We report our experience with aberrant right hepatic arterial anatomy (ARHAA) found during PD.
All patients who underwent PD between February 2003 and June 2007 were retrospectively reviewed and those with ARHAA were identified. Preoperative imaging studies were assessed by one radiologist, graded according to the presence of ARHAA and compared with the original interpretations.
We found ARHAA in 31 of 191 patients (16.2%). Operative management included dissection and preservation in 24, transection and reconstruction in four, and transection and primary anastomosis in three patients. Reconstruction of ARHAA was carried out through interposition grafts in two patients and implantation into the gastroduodenal stump in two patients. No cases of arterial thrombosis, liver infarction, abscess formation or biliary fistula were demonstrated in the immediate postoperative period. Review of preoperative imaging interpretations found that only nine of 23 reports indicated the presence of ARHAA; however, the retrospective review of the images found that ARHAA was readily apparent in 24 patients.
Recognition of aberrant vasculature to the liver before PD is important. Preoperative imaging studies will often be adequate to identify these anomalies, but interpreting radiologists may not be aware of its clinical significance. Surgeons performing PD must be adept at managing ARHAA safely.
异常的动脉解剖结构是前肠手术中常见的发现。在胰十二指肠切除术（PD）中，右肝叶的异常尤其相关，其识别有助于保护肝脏和胆管的血液供应。我们报告了在 PD 期间发现的异常右肝动脉解剖结构（ARHAA）的经验。
回顾性分析了 2003 年 2 月至 2007 年 6 月期间接受 PD 的所有患者，并确定了 ARHAA 患者。一名放射科医生评估了术前影像学研究，根据 ARHAA 的存在进行分级，并与原始解释进行比较。
我们在 191 名患者中的 31 名（16.2%）中发现了 ARHAA。手术管理包括 24 例解剖和保留、4 例横断和重建、3 例横断和直接吻合。通过在两名患者中进行中间移植物重建和在两名患者中植入胃十二指肠残端重建 ARHAA。在术后即刻，没有发生动脉血栓形成、肝梗死、脓肿形成或胆瘘。对术前影像学解释的回顾发现，23 份报告中只有 9 份表明存在 ARHAA；然而，对图像的回顾性回顾发现，24 例患者中 ARHAA 很明显。
在 PD 之前识别肝脏的异常血管结构很重要。术前影像学研究通常足以识别这些异常，但解释放射科医生可能不知道其临床意义。进行 PD 的外科医生必须能够安全地处理 ARHAA。
