Jah Asif, Jamieson Neville, Huguet Emmanuel, Praseedom Raaj
Department of Hepatobiliary and Transplant Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Surg Today. 2009;39(8):669-74. doi: 10.1007/s00595-009-3947-3. Epub 2009 Jul 29.
An aberrant right hepatic artery (ARHA) is a common anomaly and its implications for patients undergoing a pancreaticoduodenectomy (PD) have not yet been previously reported. We compared the outcomes following PD in patients with and without an ARHA. A novel classification of the anatomical course of ARHA, and surgical techniques for its identification and preservation are described herein.
All patients undergoing PD between June 1, 2002, and May 31, 2007, were divided into two groups, one with ARHA and the other without. These groups were compared to identify differences in the intraoperative variables, the oncological clearance, the postoperative complications, and the survival.
A total of 135 patients underwent PD of which 28 (20.8%) patients were found to have either accessory or replaced right hepatic arteries (ARHA group). There were no significant differences in the intraoperative variables (blood loss and operative time) and the incidence of postoperative complications (pancreatic leak and delayed gastric emptying). Oncological clearance (nodal yield and resection margins) and survival were also similar in the two groups.
The surgical and oncological outcomes of PD remain unaffected by the presence of ARHA provided that the anatomy is recognized and appropriately managed. Aberrant right hepatic artery can be classified into three types according to their anatomical relationship with the head of the pancreas.
肝右动脉变异（ARHA）是一种常见的解剖变异，其对接受胰十二指肠切除术（PD）患者的影响此前尚未见报道。我们比较了有和没有ARHA的患者接受PD后的结果。本文描述了一种ARHA解剖走行的新分类方法，以及其识别和保留的手术技巧。
将2002年6月1日至2007年5月31日期间所有接受PD的患者分为两组，一组有ARHA，另一组没有。比较这两组患者的术中变量、肿瘤清除情况、术后并发症及生存率的差异。
共有135例患者接受了PD，其中28例（20.8%）患者存在副肝右动脉或替代肝右动脉（ARHA组）。术中变量（失血量和手术时间）及术后并发症（胰瘘和胃排空延迟）的发生率在两组间无显著差异。两组的肿瘤清除情况（淋巴结收获量和切缘）及生存率也相似。
只要能识别并妥善处理其解剖结构，ARHA的存在并不影响PD的手术和肿瘤学结局。肝右动脉变异可根据其与胰头的解剖关系分为三种类型。
