Morinaga Takeshi, Imai Katsunori, Morita Keisuke, Yamamoto Kenichiro, Ikeshima Satoshi, Horino Kei, Shimada Shinya, Baba Hideo
Department of Surgery, Kumamoto General Hospital, Community Health Care Organization, Kumamoto, Japan.
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Surg Case Rep. 2019 Nov 19;5(1):180. doi: 10.1186/s40792-019-0746-y.
Hepatic artery anomalies are often observed, and the variations are wide-ranging. We herein report a case of pancreatic cancer involving the common hepatic artery (CHA) that was successfully treated with pancreaticoduodenectomy (PD) without arterial reconstruction, thanks to anastomosis between the root of CHA and proper hepatic artery (PHA), which is a very rare anastomotic site.
A 78-year-old woman was referred to our department for the examination of a tumor in the pancreatic head. Contrast-enhanced computed tomography (CT) revealed a low-density tumor of 40 mm in diameter located in the pancreatic head. The involvement of the common hepatic artery (CHA), the root of the gastroduodenal artery (GDA), and portal vein was noted. Although such cases would usually require PD with arterial reconstruction of the CHA, it was thought that the hepatic arterial flow would be preserved by the anastomotic site between the root of the CHA and the PHA, even if the CHA was dissected without arterial reconstruction. PD with dissection of the CHA and PHA was safely completed without arterial reconstruction, and sufficient hepatic arterial flow was preserved through the anastomotic site between the CHA and PHA.
We presented an extremely rare case of an anastomosis between the CHA and PHA in a patient with pancreatic cancer involving the CHA. Thanks to this anastomosis, surgical resection was successfully performed with sufficient hepatic arterial flow without arterial reconstruction.
肝动脉异常较为常见，其变异范围广泛。我们在此报告一例累及肝总动脉（CHA）的胰腺癌病例，该病例成功接受了胰十二指肠切除术（PD），且未进行动脉重建，这得益于CHA根部与肝固有动脉（PHA）之间的吻合，此吻合部位非常罕见。
一名78岁女性因胰头部肿瘤前来我院检查。增强计算机断层扫描（CT）显示胰头部有一个直径40毫米的低密度肿瘤。发现肝总动脉（CHA）、胃十二指肠动脉（GDA）根部及门静脉受累。虽然此类病例通常需要进行CHA动脉重建的PD手术，但认为即使在不进行动脉重建的情况下解剖CHA，通过CHA根部与PHA之间的吻合部位也可保留肝动脉血流。在未进行动脉重建的情况下，安全地完成了CHA和PHA解剖的PD手术，通过CHA与PHA之间的吻合部位保留了充足的肝动脉血流。
我们展示了一例累及CHA的胰腺癌患者中CHA与PHA之间极为罕见的吻合病例。得益于这种吻合，在有充足肝动脉血流的情况下成功进行了手术切除，且未进行动脉重建。
