Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines.
Sci Rep. 2020 Apr 3;10(1):5856. doi: 10.1038/s41598-020-62587-7.
There are still lot of controversies whether aberrant left hepatic artery (ALHA) originating from left gastric artery should be ligated or preserved during gastric cancer (GC) surgery. We aimed to investigate this issue. We reviewed ALHA cases who had laparoscopic gastrectomy for gastric cancer at Seoul National University Hospital (SNUH) from 2012 to 2016. Type of ALHA variants using Michel's classification of hepatic arterial anatomy and diameter of each vessel were evaluated by 2 radiologists. Postoperative hepatic function and surgical outcome were collected until 6 months after surgery. Results showed that if the diameter of ALHA was larger than 1.5 mm, a transient elevation of SGOT and SGPT on postoperative day 2 was observed in the ligated cases. No differences were observed in operation time, amount of blood loss, overall complication rate, hospital stay, and number of lymph nodes retrieved between the ligated and preserved replaced left hepatic artery (RLHA) and accessory left hepatic artery (acLHA) group. In this study, we conclude that ligation of ALHA seems to be safe as none of the patients suffered adverse outcome. A transient rise in postoperative SGOT and SGPT levels were seen after ligating ALHA >1.5 mm in diameter regardless of subtype.
目前，对于在胃癌手术中是否应结扎或保留起源于胃左动脉的异常左肝动脉（ALHA），仍存在许多争议。我们旨在探讨这个问题。我们回顾了 2012 年至 2016 年在首尔国立大学医院（SNUH）接受腹腔镜胃癌手术的 ALHA 病例。由 2 名放射科医生根据 Michel 肝动脉解剖分类评估了 ALHA 变异类型和每个血管的直径。收集了术后 6 个月的肝功能和手术结果。结果表明，如果 ALHA 的直径大于 1.5mm，则结扎组在术后第 2 天观察到 SGOT 和 SGPT 短暂升高。结扎组与保留替代左肝动脉（RLHA）和副左肝动脉（acLHA）组在手术时间、出血量、总并发症率、住院时间和淋巴结检出数方面无差异。在这项研究中，我们得出结论，结扎 ALHA 似乎是安全的，因为没有患者出现不良后果。无论亚型如何，结扎直径大于 1.5mm 的 ALHA 后，术后 SGOT 和 SGPT 水平会短暂升高。
