Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China.
Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai 200040, China.
World J Gastroenterol. 2022 May 21;28(19):2057-2075. doi: 10.3748/wjg.v28.i19.2057.
The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels. A variant of the hepatic artery, which is not a rare finding during pancreatic surgery, is prone to intraoperative injury. Inadvertent injury to the hepatic artery may affect liver perfusion, resulting in necrosis, liver abscess, and even liver failure. The preoperative identification of hepatic artery variations, detailed planning of the surgical approach, careful intraoperative dissection, and proper management of the damaged artery are important for preventing hepatic hypoperfusion. Nevertheless, despite the potential risks, planned artery resection has become acceptable in carefully selected patients. Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods. The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery. Here, we comprehensively reviewed the anatomical basis of hepatic artery variation, its incidence, and its effect on the surgical and oncological outcomes after pancreatic resection. In addition, we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion. Overall, the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.
胰十二指肠区域的解剖结构复杂，与周围血管关系密切。肝动脉的一种变异在胰腺手术中并不罕见，容易在术中受伤。肝动脉的意外损伤可能会影响肝脏灌注，导致肝坏死、肝脓肿，甚至肝衰竭。术前识别肝动脉变异、详细规划手术入路、仔细术中解剖以及妥善处理受损动脉对于防止肝灌注不足至关重要。尽管存在潜在风险，但在精心选择的患者中，计划性动脉切除已被接受。动脉重建有时对于预防术后缺血性并发症是必要的，可以使用各种方法进行。在联合腹腔干切除的胰切除术等复杂手术中，异常右肝动脉或起源于肠系膜上动脉的共同肝动脉的存在可能会减轻手术的复杂性。在这里，我们全面回顾了肝动脉变异的解剖基础、其发生率以及对胰腺切除术后手术和肿瘤学结果的影响。此外，我们还就肝动脉损伤和肝灌注不足的预防和处理提供了建议。总的来说，如果术前准确识别并在术中适当处理，肝动脉变异不会恶化手术和肿瘤学结果。
