Zhang Wei, Wang Kun, Liu Songyang, Wang Yingchao, Liu Kai, Meng Lingyu, Chen Qingmin, Jia Baoxing, Liu Yahui
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
Medicine (Baltimore). 2020 May 22;99(21):e20403. doi: 10.1097/MD.0000000000020403.
Hepatic artery variations increase the difficulty of laparoscopic pancreaticoduodenectomy (LPD). The safety and efficacy of LPD in the presence of aberrant hepatic arteries (AHA) must be further verified.Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. Variation type, intraoperative management, and clinical treatment outcomes were compared.There were 54 cases (24.8%) of AHA. The most common hepatic artery variation was accessory right hepatic artery (RHA) from the superior mesenteric artery (SMA, n = 12, 5.5%), followed by replaced RHA from the SMA (n = 10, 4.6%), accessory left hepatic artery from the SMA (n = 10, 4.6%), and replaced common hepatic artery from the SMA (n = 6, 2.8%). Each type of arterial variation was successfully preserved in all cases, and there were no significant effects on the evaluated surgical indices, conversion rate, incidence of postoperative complications, or follow-up results.Our findings indicated that preservation of AHAs during total LPD is feasible. There were no significant effects on surgical indices, incidence of postoperative complications, or follow-up outcomes.The influence of AHA on the safety and efficacy of LPD must be further verified. Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. There were 54 cases (24.8%) of AHA. There were no significant effects of AHAs on surgical indices, incidence of postoperative complications, or follow-up outcomes.
肝动脉变异增加了腹腔镜胰十二指肠切除术(LPD)的难度。存在异常肝动脉(AHA)时LPD的安全性和有效性必须进一步验证。对接受LPD和术前动脉血管造影的肝动脉正常和变异的患者进行回顾性分析。比较变异类型、术中处理及临床治疗结果。有54例(24.8%)存在AHA。最常见的肝动脉变异是发自肠系膜上动脉(SMA)的副右肝动脉(RHA,n = 12,5.5%),其次是发自SMA的替代RHA(n = 10,4.6%)、发自SMA的副左肝动脉(n = 10,4.6%)和发自SMA的替代肝总动脉(n = 6,2.8%)。所有病例中每种动脉变异均成功保留,对评估的手术指标、转化率、术后并发症发生率或随访结果均无显著影响。我们的研究结果表明,在全LPD过程中保留AHA是可行的。对手术指标、术后并发症发生率或随访结果均无显著影响。AHA对LPD安全性和有效性的影响必须进一步验证。对接受LPD和术前动脉血管造影的肝动脉正常和变异的患者进行回顾性分析。有54例(24.8%)存在AHA。AHA对手术指标、术后并发症发生率或随访结果均无显著影响。