Amato Bruno, Patrone Renato, Quarto Gennaro, Compagna Rita, Cirocchi Roberto, Popivanov Georgi, Granata Vincenza, Belli Andrea, Izzo Francesco
Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy.
Department of Surgical Sciences, University of Perugia, Perugia, Italy.
Open Med (Wars). 2020 Sep 11;15(1):898-904. doi: 10.1515/med-2020-0104. eCollection 2020.
Hepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons.
A new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer.
The duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure.
This original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies.
The authors believe that this "one shot" technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.
肝动脉瘤较为罕见，其治疗对外科医生而言是一项挑战。
介绍了一种治疗肝总动脉（CHA）动脉瘤的新技术：该技术所需的血管外科解剖操作极少，仅在动脉瘤底部使用一个直线型血管吻合器。易于实现动脉瘤排除，从而形成逆行血栓。通过胃十二指肠动脉确保肝左右动脉的肝脏血供，并且可在术前通过暂时夹闭断面区域，借助视觉控制、酶评估及术中超声检查进行监测。我们报告了一例开放性手术治疗，同时切除结肠癌继发的肝脏和肾上腺转移灶。
血管手术时长为30分钟，未出现并发症。术后检查证实了该手术的有效性。
这种原创技术可补充到目前已描述的用于治疗CHA动脉瘤的各种开放和血管内技术中。作为开放性手术是可取的，尤其是在存在相关病变的情况下。
作者认为这种通过对CHA远端进行血管吻合器“一次操作”的技术微创且有效地实现了动脉瘤的排除。
