Namba Yosuke, Oishi Koichi, Okimoto Sho, Moriuchi Toshiyuki, Bekki Tomoaki, Mukai Shoichiro, Saito Yasufumi, Fujisaki Seiji, Takahashi Mamoru, Fukuda Toshikatsu, Ohdan Hideki
Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Radiol Case Rep. 2021 Apr 30;16(7):1650-1654. doi: 10.1016/j.radcr.2021.03.062. eCollection 2021 Jul.
In hepatobiliary and pancreatic surgery, an understanding of hepatic artery anomalies is of great importance to surgeons. Cases of the proper hepatic artery originating from the superior mesenteric artery and the gastroduodenal artery originating from the celiac trunk are extremely rare. To our knowledge, there are no reports of these arterial variants being diagnosed before hepatobiliary and pancreatic surgery. A 73-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy and lymphadenectomy for duodenal carcinoma. Preoperative vascular construction with 3-dimensional computed tomography showed variants of the proper hepatic artery and gastroduodenal artery. The proper hepatic artery originated from the superior mesenteric artery, and the gastroduodenal artery originated from the celiac trunk. Intraoperative findings and preoperative vascular construction from 3-dimensional computed tomography were found to be matched exactly; both the proper hepatic artery and gastroduodenal artery were preserved. By diagnosing a rare arterial variant preoperatively, we were able to perform the surgery safely. In hepatobiliary and pancreatic surgery, understanding any potential variation of the hepatic artery before surgery is crucial to ensure the best patient outcomes.
在肝胆胰外科手术中，了解肝动脉变异对外科医生极为重要。肝固有动脉起源于肠系膜上动脉以及胃十二指肠动脉起源于腹腔干的病例极其罕见。据我们所知，尚无在肝胆胰外科手术前诊断出这些动脉变异的报道。一名73岁女性因十二指肠癌接受了保留胃的胰十二指肠次全切除术及淋巴结清扫术。术前三维计算机断层扫描血管成像显示了肝固有动脉和胃十二指肠动脉的变异。肝固有动脉起源于肠系膜上动脉，胃十二指肠动脉起源于腹腔干。术中发现与术前三维计算机断层扫描血管成像结果完全相符；肝固有动脉和胃十二指肠动脉均得以保留。通过术前诊断出罕见的动脉变异，我们得以安全地进行手术。在肝胆胰外科手术中，术前了解肝动脉的任何潜在变异对于确保患者获得最佳治疗效果至关重要。
