Moszkowicz David, Peschaud Frédérique, El Hajjam Mostafa, Saiag Philipe, Nordlinger Bernard
Department of Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France.
Surg Radiol Anat. 2011 Aug;33(6):547-50. doi: 10.1007/s00276-010-0770-x. Epub 2011 Jan 9.
We describe the case of a hepatic artery originating from a hepato-mesenteric trunk and traveling through the head of the pancreas, found preoperatively in a 44-year-old woman presenting two metachrone intra-pancreatic metastasis of a skin melanoma. Few cases with this anatomic variation have been found in the published literature consulted and this is the first case of duodenopancreatectomy for melanoma metastasis associated with this anatomic variant. In this patient, multidetector CT image with angiography and 3-D reconstruction demonstrated that the common hepatic artery arose from the superior mesenteric artery without any other arterial supply to the liver. Pancreatoduodenectomy with arterial conservation and without reconstruction was performed. Routine preoperative computerized tomographic angiography helps to recognize the hepatic vascular anatomy and thereby prepares the surgeon to better deal with at risk vascular variants intraoperatively. During pancreatic resection, every attempt should be made to preserve the variant hepatic vessels, particularly if they irrigate the entire liver. Increased alertness of the vascular anatomy would decrease the probability of intraoperative vascular injury and consequent postoperative complications such as biliary necrosis, biliary anastomotic leaks or hemorrhage.
我们描述了一例肝动脉起源于肝肠系膜干并穿过胰头的病例，该病例术前在一名44岁女性中发现，其患有皮肤黑色素瘤的两处异时性胰腺内转移。在所查阅的已发表文献中，很少发现有这种解剖变异的病例，这是首例因黑色素瘤转移而进行的十二指肠胰切除术与这种解剖变异相关。在该患者中，多层螺旋CT血管造影和三维重建图像显示，肝总动脉起源于肠系膜上动脉，肝脏无任何其他动脉供血。进行了保留动脉且未进行重建的胰十二指肠切除术。术前常规计算机断层血管造影有助于识别肝血管解剖结构，从而使外科医生在术中更好地应对有风险的血管变异。在胰腺切除术中，应尽一切努力保留变异的肝血管，特别是当它们为整个肝脏供血时。提高对血管解剖结构的警惕性将降低术中血管损伤以及随之而来的术后并发症如胆坏死、胆吻合口漏或出血的可能性。
