Alexakis Nicholas, Bramis Konstandinos, Toutouzas Konstandinos, Zografos George, Konstadoulakis Manoussos
Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
J Surg Oncol. 2019 Jun;119(8):1122-1127. doi: 10.1002/jso.25461. Epub 2019 Mar 28.
BACKGROUND/AIM: Anatomic vascular abnormalities of the hepatic arteries are frequent. The aim of the study was to analyze the influence of hepatic arterial variations on postoperative morbidity and resection margin status after pancreatoduodenectomy (PD).
MATERIALS/METHODS: Patients who underwent PD over a 7-year period (2010-2017) were included in the study. Patients with variant hepatic arterial anatomy were matched 1:2 for age, sex, ASA score, and histology.
A total of 232 patients underwent PD. Variant hepatic arterial anatomy was found in 35 (15.1% of the total patient population). The most common variation was an accessory right hepatic artery (8.19%) and a replaced right hepatic artery (5.60%) arising from the superior mesenteric artery. These 35 patients were compared with 70 patients with no hepatic artery variations. Postoperative surgical complications occurred in 12.1% and 26.5% (P = 0.08) and in-hospital mortality was 6% and 5.4% ( P = 0.99) between patients with and without variant hepatic arteries. There was no difference in positive resection margins (R1) (18.2% vs 20.5%, P = 0.99) between the two groups.
An aberrant hepatic artery does not increase morbidity or R1 resection in patients undergoing PD.
背景/目的：肝动脉的解剖血管异常很常见。本研究的目的是分析肝动脉变异对胰十二指肠切除术（PD）术后发病率和切缘状态的影响。
材料/方法：本研究纳入了在7年期间（2010 - 2017年）接受PD的患者。肝动脉解剖结构变异的患者在年龄、性别、美国麻醉医师协会（ASA）评分和组织学方面按1:2进行匹配。
共有232例患者接受了PD。发现35例（占总患者人数的15.1%）存在肝动脉解剖结构变异。最常见的变异是副右肝动脉（8.19%）和起源于肠系膜上动脉的替代右肝动脉（5.60%）。将这35例患者与70例无肝动脉变异的患者进行比较。肝动脉变异患者与无变异患者之间的术后手术并发症发生率分别为12.1%和26.5%（P = 0.08），住院死亡率分别为6%和5.4%（P = 0.99）。两组之间的阳性切缘（R1）无差异（18.2%对20.5%，P = 0.99）。
异常肝动脉不会增加接受PD患者的发病率或R1切除率。
