Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand.
Langenbecks Arch Surg. 2021 Sep;406(6):2081-2090. doi: 10.1007/s00423-021-02178-w. Epub 2021 May 1.
It has been reported that there are left and right hepatic arterial arcades via the blood vessels around the hilar bile duct; therefore, when the hilar bile duct is preserved, hepatic artery reconstruction may not be necessary. We compared the short-term and long-term outcomes in patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy (PD) with right hepatic artery resection without right hepatic artery reconstruction (RHAR group) with those patients who underwent conventional PD.
All data were retrospectively collected from patient records. A 1:4-propensity score-matched case-control study was conducted in patients with distal cholangiocarcinoma who received treatment at Tokyo Women's Medical University from February 1985 to April 2015.
There was no statistical difference in the overall morbidity rate between the two groups. No patient in the RHAR group (10 patients) had liver failure, liver abscess, or cholangitis in the postoperative period; one patient died postoperatively because of a bleeding pseudoaneurysm in the gastroduodenal artery. The PD group (40 patients) had a significantly better median time regarding the recurrence (34 vs. 11 months, p=0.027) and 5-year disease-free survival (35% vs. 10%, p=0.027) rates than the RHAR group, which may be attributed to the presence of a more severe disease in patients in the RHAR group.
We concluded that pancreaticoduodenectomy with right hepatic artery resection without reconstruction has a comparable overall morbidity rate with that of a conventional pancreaticoduodenectomy surgery and may be performed as an alternative procedure when tumor invasion of the right hepatic artery is suspected.
据报道，在肝门胆管周围血管存在左右肝动脉弓，因此当肝门胆管被保留时，可能不需要进行肝动脉重建。我们比较了行胰十二指肠切除术（PD）时行右肝动脉切除而不重建右肝动脉（RHAR 组）与行常规 PD 的远端胆管癌患者的短期和长期结果。
所有数据均从患者病历中回顾性收集。对 1985 年 2 月至 2015 年 4 月在东京女子医科大学接受治疗的远端胆管癌患者进行了 1:4 倾向评分匹配的病例对照研究。
两组患者的总并发症发生率无统计学差异。RHAR 组（10 例）患者在术后均未发生肝功能衰竭、肝脓肿或胆管炎；1 例患者术后因胃十二指肠动脉假性动脉瘤破裂出血死亡。PD 组（40 例）患者的中位复发时间（34 个月比 11 个月，p=0.027）和 5 年无病生存率（35%比 10%，p=0.027）明显优于 RHAR 组，这可能是由于 RHAR 组患者疾病更为严重。
我们得出结论，胰十二指肠切除术伴右肝动脉切除而不重建与常规胰十二指肠切除术的总并发症发生率相当，当怀疑右肝动脉受肿瘤侵犯时，可作为一种替代手术方法。
