Subbiah Nagaraj Satish, Kaman Lileswar, Dahiya Divya, Ramavath Krishna, Kalra Naveen, Behera Arunanshu
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2020 Dec 16;12(12):e12106. doi: 10.7759/cureus.12106.
Introduction Knowledge of celiac artery variations is imperative to perform complex hepato-biliary pancreatic surgical procedures to avoid inadvertent complications. Multi-detector computed tomographic (MDCT) angiography aids in detecting these variations preoperatively. Surgical confirmation is considered the gold standard. Aims and objectives Preoperative assessment of celiac artery variations by MDCT angiography and surgical confirmation intraoperatively in resectable hepato-biliary pancreatic cancers. Patients and methods MDCT angiography was performed in 40 patients with clinical evidence of resectable hepato-biliary-pancreatic cancers. Three dimensional (3D) reconstructions were performed to confirm the celiac artery variations. Surgery was performed as per the institute's protocol in all these patients for resection of tumor and confirmation of celiac artery anatomy. Variations were confirmed surgically that were identified through imaging. Results MDCT angiography identified normal trifurcated celiac artery anatomy in 33 (82.5%) patients and variant anatomy in seven (17.5%) patients. The most common variation was a replaced right hepatic artery (r-RHA) from the superior mesenteric artery (SMA) in four (10%) of patients. A replaced left hepatic artery (r-LHA) from the celiac trunk, a common hepatic artery (CHA) from the abdominal aorta, and an accessory right hepatic artery (ac-RHA) from the proper hepatic artery itself were identified in one (2.5%) patient each, respectively. All these findings were confirmed intraoperatively. There was a 100% statistical correlation between imaging and surgical findings. Conclusion Surgical confirmation of radiological data of celiac artery variations is the gold standard to avoid disastrous complications such as inadvertent vascular bleeds, biliary injuries, and hepatic necrosis. Since the presence of variations warrants the preservation or excision of the arterial system without oncological compromise and minimizing surgical complications.
引言 了解腹腔干变异对于实施复杂的肝胆胰外科手术以避免意外并发症至关重要。多排螺旋计算机断层扫描（MDCT）血管造影有助于术前检测这些变异。手术确认被视为金标准。目的 术前通过MDCT血管造影评估腹腔干变异，并在可切除的肝胆胰癌手术中进行术中手术确认。患者与方法 对40例有可切除的肝胆胰癌临床证据的患者进行MDCT血管造影。进行三维（3D）重建以确认腹腔干变异。所有这些患者均按照该机构的方案进行手术，以切除肿瘤并确认腹腔干解剖结构。通过影像学识别出的变异在手术中得到确认。结果 MDCT血管造影在33例（82.5%）患者中识别出正常的腹腔干三分叉解剖结构，在7例（17.5%）患者中识别出变异解剖结构。最常见的变异是4例（10%）患者中由肠系膜上动脉（SMA）发出的替代右肝动脉（r-RHA）。分别在1例（2.5%）患者中识别出由腹腔干发出的替代左肝动脉（r-LHA）、由腹主动脉发出的肝总动脉（CHA）以及由肝固有动脉本身发出的副右肝动脉（ac-RHA）。所有这些发现均在术中得到确认。影像学和手术结果之间存在100%的统计学相关性。结论 腹腔干变异的放射学数据的手术确认是避免诸如意外血管出血、胆管损伤和肝坏死等灾难性并发症的金标准。由于变异的存在需要在不影响肿瘤学效果的情况下保留或切除动脉系统，并尽量减少手术并发症。
