Aghalarov Ilgar, Lutz Theodor, Uhl Waldemar, Belyaev Orlin
Department of General and Visceral Surgery, St. Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Department of Radiology and Nuclear Medicine, St. Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Visc Med. 2021 Jun;37(3):219-221. doi: 10.1159/000510484. Epub 2020 Oct 8.
An anomalous anatomy of the celiac trunk, and particularly of the right hepatic artery, may have a significant impact on major hepatobiliary and pancreatic surgery. According to some authors, every third patient has an aberrant right hepatic artery. We present a very rare case of replaced right hepatic artery (RRHA) arising from the gastroduodenal artery associated with an accessory left hepatic artery originating from the left gastric artery in a 54-year-old woman with a pancreatic head carcinoma. The patient underwent total pancreatectomy on account of a soft lipomatous pancreas with heterogeneous changes of the pancreatic body and tail. We preserved the RRHA and achieved R0 resection margins. Preoperative evaluation of CT angiograms, an awareness of any anomalous arterial anatomy of the upper abdomen, and a meticulous surgical technique are the key to performing oncologically radical surgery without threatening the arterial liver supply.
腹腔干的解剖变异，尤其是右肝动脉的变异，可能对肝胆胰大手术产生重大影响。据一些作者称，每三名患者中就有一名存在右肝动脉异常。我们报告了一例非常罕见的病例，一名54岁患有胰头癌的女性，其右肝动脉由胃十二指肠动脉发出，同时存在一条副左肝动脉发自胃左动脉。由于胰腺体尾部呈软质脂肪瘤样且有不均匀改变，该患者接受了全胰切除术。我们保留了右肝动脉并实现了R0切除边缘。术前CT血管造影评估、对上腹动脉解剖变异的认识以及细致的手术技巧是在不危及肝脏动脉供血的情况下进行肿瘤根治性手术的关键。
