Lupaşcu Cristian, Moldovanu Radu, Andronic Dan, Ursulescu Corina, Vasiluţă Ciprian, Răileanu Ghiocel, Fotea Vasile, Târcoveanu Eugen
University of Medicine and Pharmacy, Romania.
Hepatogastroenterology. 2011 Nov-Dec;58(112):2112-4. doi: 10.5754/hge09656.
Pancreaticoduodenectomy is the best treatment for the patients with malignant tumors of the pancreatic head. However, the procedure is also recommended in some benign pancreatic tumors. The posterior approach allows early dissection of the superior mesenteric artery, portal vein and retroportal pancreatic lamina, before any pancreatic or digestive transection. We present a 42 year old woman diagnosed with a pancreatic tumor. The clinical and biological data suggested the diagnosis of insulinoma. The computed tomography showed a nodule located in the pancreatic head with a typical vascular pattern for endocrine tumor. The exam also revealed a rare vascular variant, a common hepatic artery which arises from the superior mesenteric artery. A pancreaticoduodenectomy has been performed. We used the posterior approach which allowed the correct dissection and exposure of the abnormal common hepatic artery. The postoperative course was uneventful. Posterior approach during the pancreaticoduodenectomies avoids arterial injuries that might compromise the liver arterial supply. It is especially indicated when preoperative imaging studies diagnose anatomic variants of the hepatic arteries.
胰十二指肠切除术是胰头恶性肿瘤患者的最佳治疗方法。然而，在一些良性胰腺肿瘤中也推荐采用该手术。后入路允许在进行任何胰腺或消化道横断之前，早期解剖肠系膜上动脉、门静脉和门静脉后胰腺板层。我们报告一位42岁被诊断为胰腺肿瘤的女性。临床和生物学数据提示诊断为胰岛素瘤。计算机断层扫描显示位于胰头的一个结节，具有内分泌肿瘤典型的血管模式。检查还发现一种罕见的血管变异，即起源于肠系膜上动脉的肝总动脉。已实施胰十二指肠切除术。我们采用后入路，得以正确解剖并暴露异常的肝总动脉。术后病程顺利。胰十二指肠切除术中的后入路可避免可能损害肝脏动脉血供的动脉损伤。当术前影像学检查诊断出肝动脉的解剖变异时，尤其适合采用该入路。
