Sayyed Raza, Baig Mariam, Khan Asghar, Niazi Imran Khalid, Syed Aamir Ali, Hanif Faisal
Surgical Oncologist, Patel Hospital.
Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
J Pak Med Assoc. 2020 Feb;70(2):337-340. doi: 10.5455/JPMA.9783.
We present our experience of incidence and management of aberrant hepatic arterial anatomy encountered during pancreaticoduodenectomy (PD). Patients undergoing PD between December 2014 and November 2016 at the Shaukat Khanum Memorial Cancer Hospital, Lahore were included in this short report. Preoperative imaging and operative findings of these patients were reviewed to evaluate the hepatic arterial anatomy and classified according to Hiatt classification. Sixty-four PD were performed with aberrant arterial anatomy identified in 24 (37.5%) of the cases. Most common anomaly was replaced right hepatic artery (rRHA) arising from the superior mesenteric artery seen in seven (11%) of the patients. Aberrant vessels were recognised and preserved in 23 cases. In one patient, the rRHA was coursing through the pancreatic parenchyma needing resection and reconstruction with uneventful postoperative recovery. Hepatic arterial anomalies are common and it is possible to preserve these vessels with careful surgical dissection using artery first technique.
我们介绍了在胰十二指肠切除术（PD）期间遇到的肝动脉解剖变异的发生率及处理经验。本简短报告纳入了2014年12月至2016年11月在拉合尔的沙卡特汗姆纪念癌症医院接受PD的患者。回顾了这些患者的术前影像学检查和手术发现，以评估肝动脉解剖结构，并根据海厄特分类法进行分类。共进行了64例PD，其中24例（37.5%）发现有动脉解剖变异。最常见的异常是7例（11%）患者的右肝动脉由肠系膜上动脉发出。23例中识别并保留了异常血管。1例患者的右肝动脉穿过胰腺实质，需要切除并重建，术后恢复顺利。肝动脉变异很常见，采用先处理动脉的技术进行仔细的手术解剖有可能保留这些血管。
