Kubo Norihito, Wajima Naoki, Muroya Takahiro, Hasebe Tatsuya, Akaishi Takanobu, Tsuruta Satoru, Hakamada Kenichi
Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2019 Apr;46(4):766-768.
We report successfull aparoscopic distalgastrectomy in a patient with early gastric cancer and an Adachi type Ⅵ arterial variant. The case is a male in his 50's who was detected a type 0-Ⅱc lesion on the antrum of the stomach and diagnosed as tub2. Laparoscopic distalgastrectomy was performed, with the pathologic diagnosis of cT1bN0M0, cStage Ⅰ. MD-CT showed absence of the common hepatic artery ventralto the portalvein, consistent with an Adachi type Ⅵ arterialvariant. The interface between pancreatic and fatty tissue was separated in suprapancreatic dissection, and was extended between the hepatoduodenal ligament and splenic artery, with exposure of the surface of the portal vein. Thus, safe dissection of No. 8a area was achieved. Discussion: Adachi classified the celiac artery branches into 6 types and 28 groups. Type Ⅵ, a variant of the common hepatic artery located on the dorsalaspect of the portalvein, has a reported frequency of 2%. Because it is a variant of the hepatic artery, a landmark of suprapancreatic dissection, careful observation is required to determine the anatomy. Although tactile sensation is limited in laparoscopic surgery, arterial pulsation is clearly visible. To ensure a safe procedure, it is important to identify vesselanatomy both pre- and intraoperatively.
我们报告了一例早期胃癌合并AdachiⅥ型动脉变异患者成功接受腹腔镜远端胃切除术的病例。该病例为一名50多岁男性，在胃窦部发现0-Ⅱc型病变，诊断为tub2。实施了腹腔镜远端胃切除术，病理诊断为cT1bN0M0，c期Ⅰ。MD-CT显示门静脉腹侧无肝总动脉，符合AdachiⅥ型动脉变异。在胰上区解剖中分离了胰腺与脂肪组织之间的界面，并延伸至肝十二指肠韧带和脾动脉之间，暴露了门静脉表面。因此，实现了8a区的安全解剖。讨论：Adachi将腹腔动脉分支分为6型28组。Ⅵ型是位于门静脉背侧的肝总动脉变异，报道的发生率为2%。由于它是肝动脉的变异，是胰上区解剖的一个标志，因此需要仔细观察以确定解剖结构。虽然腹腔镜手术中的触觉有限，但动脉搏动清晰可见。为确保手术安全，术前和术中识别血管解剖结构很重要。
