Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
World J Surg. 2011 Jun;35(6):1340-4. doi: 10.1007/s00268-011-1075-x.
A supraportal right posterior hepatic artery (RPHA), which runs cranially to the right portal vein and goes to the liver, has never been described.
The course of the RPHA to the right portal vein was evaluated, using (1) computed tomography (CT) arteriography and portography in 300 patients who underwent multidetector row CT (radiologic study) and (2) operative records in 203 patients who underwent left-sided hepatectomy for perihilar cholangiocarcinoma (surgical study).
In the radiologic study, an infraportal type RPHA was observed in 239 (79.7%) patients, a supraportal type in 35 (11.7%), and a combined type in 26 (8.7%). In the surgical study, an infraportal type was observed in 179 (88.2%) patients, a supraportal type in 11 (5.4%), and a combined type in 13 (6.4%). In two patients with the combined type RPHA, the supraportal hepatic artery of the right posterior superior segment (A7) was injured during surgery. In another two patients with advanced carcinoma involving the supraportal PRHA, combined hepatic artery resection and reconstruction was necessary. Overall, in 4 (17.4%) of the 24 hepatectomized patients with supraportal or combined type RPHA, iatrogenic injury during surgery or cancer invasion of the hepatic artery occurred due to the course of the RPHA itself. In contrast, 179 hepatectomized patients with infraportal type RPHA did not have such course-dependent complications.
The supraportal RPHA runs just beneath the right hepatic duct, which may function as an anatomic trap during hepatobiliary and transplant surgery.
肝后上腔门静脉右后动脉（RPHA）向头侧走行于右门静脉上方，通向肝脏，尚未见文献报道。
采用（1）300 例行多层螺旋 CT（MSCT）肝动脉造影和门静脉造影的患者和（2）203 例行左半肝切除术治疗肝门部胆管癌的患者的手术记录，对 RPHA 至右门静脉的走行进行评估。
在影像学研究中，239 例（79.7%）患者为门静脉下型 RPHA，35 例（11.7%）为门静脉上型，26 例（8.7%）为混合型。在手术研究中，179 例（88.2%）患者为门静脉下型，11 例（5.4%）为门静脉上型，13 例（6.4%）为混合型。在 2 例 RPHA 混合型患者中，手术中损伤了肝后上腔门静脉右后上段（A7）动脉；在另外 2 例累及门静脉上型 RPHA 的晚期癌患者中，需要联合切除和重建肝动脉。总体而言，24 例 RPHA 门静脉上型或混合型患者中，有 4 例（17.4%）在手术中发生医源性损伤或动脉受癌侵犯，这与 RPHA 的走行有关。相比之下，179 例门静脉下型 RPHA 患者没有出现与动脉走行相关的并发症。
门静脉上型 RPHA 位于右肝管下方，在肝胆和移植手术中可能成为解剖陷阱。
