First Surgical Unit, Gr. T. Popa University of Medicine and Pharmacy Iasi, St. Spiridon Hospital, Independentei Bld. 1, 700111 Iasi, Romania.
Hepatobiliary Pancreat Dis Int. 2011 Dec;10(6):638-43. doi: 10.1016/s1499-3872(11)60108-2.
Pancreaticoduodenectomy is the treatment of choice for periampullary and pancreatic head tumors. In case of hepatic artery abnormalities, early pancreatic transection during pancreaticoduodenectomy may prove inappropriate. Early retroportal lamina dissection improves exposure of the superior mesenteric vessels and anatomic variants of the hepatic artery, where safeguarding is mandatory.
We describe our early retroportal lamina approach in patients with anatomic variants of the hepatic artery before pancreatic transection.
This approach was used during 42 pancreaticoduodenectomies with a hepatic artery anatomic variant which was spared in 40 patients. Arterial reconstruction was performed in 2 patients. Five patients with a hepatic artery variant and adenocarcinoma involving the portomesenteric junction required venous resection and reconstruction.
Early retroportal lamina dissection during pancreaticoduodenectomy in patients with hepatic artery anatomic variants enables easier exposure, avoiding injuries that might compromise the liver arterial supply. When the portomesenteric vein is involved, this approach facilitates en bloc "no touch" venous resection and reconstruction.
胰十二指肠切除术是治疗壶腹周围和胰头肿瘤的首选方法。在肝动脉异常的情况下，胰十二指肠切除术中早期进行胰腺横断可能不合适。早期门静脉后板解剖可改善肠系膜上血管和肝动脉解剖变异的显露，在这些情况下必须进行保护。
我们描述了在胰腺横断前有肝动脉解剖变异的患者中采用的早期门静脉后板入路。
该方法在 42 例有肝动脉解剖变异的胰十二指肠切除术中使用，其中 40 例患者的动脉得到保留。2 例患者进行了动脉重建。5 例肝动脉变异合并累及门腔静脉汇合部的腺癌患者需要进行静脉切除和重建。
在有肝动脉解剖变异的患者中，胰十二指肠切除术中早期进行门静脉后板解剖可更方便地显露，避免可能危及肝动脉供应的损伤。当门腔静脉受累时，这种方法有利于整块“无接触”静脉切除和重建。
