Sakamoto Yusuke, Fujikawa Takahisa, Tanaka Akira
Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8555, Japan.
Surg Case Rep. 2017 Dec;3(1):78. doi: 10.1186/s40792-017-0352-9. Epub 2017 Jun 19.
Anatomical variations of hepatic arteries may be problematic in pancreaticoduodenectomy (PD). We experienced pancreatic head cancer in a patient with rare variation of hepatic artery and performed PD successfully with the resection of this artery. A 75-year-old woman showed pancreatic head tumor on CT. Preoperative CT detected rare variation of hepatic artery; posterior segmental branch of right hepatic artery (RHA-PB) originating from posterior inferior pancreaticoduodenal artery. The image also demonstrated that there was a junction between RHA-PB and anterior branch of right hepatic artery (RHA-AB). We performed PD for suspected pancreatic head cancer. We divided RHA-PB for complete resection of cancer because we preoperatively knew that there was the junction between RHA-PB and RHA-AB. She was discharged uneventfully, and there was no evidence of local recurrence throughout the whole course. Careful preoperative assessment of hepatic blood supply is the key to perform successful PD even in this troublesome situation.
肝动脉的解剖变异在胰十二指肠切除术（PD）中可能会带来问题。我们遇到一名患有罕见肝动脉变异的胰头癌患者，并成功地对该动脉进行了切除后实施了PD手术。一名75岁女性在CT检查中显示有胰头肿瘤。术前CT检测到肝动脉存在罕见变异；右肝动脉后段分支（RHA-PB）起源于胰十二指肠后下动脉。图像还显示RHA-PB与右肝动脉前支（RHA-AB）之间存在连接。我们对疑似胰头癌患者实施了PD手术。由于术前知道RHA-PB与RHA-AB之间存在连接，所以我们将RHA-PB进行了分离以完整切除肿瘤。她顺利出院，在整个病程中均无局部复发迹象。即使在这种棘手的情况下，术前仔细评估肝脏血供也是成功实施PD手术的关键。
