Department of Gastrointestinal Surgery, Shaoxing People's Hospital Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, 312000, China.
Department of Special Examination, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, 312000, China.
World J Surg Oncol. 2022 Dec 7;20(1):388. doi: 10.1186/s12957-022-02858-x.
Knowledge of celiac trunk anatomy is important in gastrointestinal surgery, hepatopancreatobiliary surgery, transplantation and interventional radiology. Variations in the celiac trunk are common and should be predicted prior to these interventions.
A 58-year-old woman was admitted to our department for surgical treatment of gastric cancer (GC) confirmed by gastroduodenoscopy and gastric antrum biopsy. In the contrast-enhanced computed tomography (CT), we found an absence of both the celiac trunk artery (CA) and the common hepatic artery (CHA). Therefore, we used computerized three-dimensional (3D) vascular reconstruction technology to reconstruct the abdominal trunk and its branch vessels before operation.
Computerized 3D vascular reconstruction confirmed an extremely rare vascular anomaly: the absence of both CA and CHA. The splenic artery (SA) and gastroduodenal artery (GDA) originated from the abdominal aorta (AA). The left gastric artery (LGA) originated from the AA directly above the junction of SA and the GDA. The left hepatic artery (LHA) originated from the left gastric artery (LGA). The right hepatic artery (RHA) originated from the superior mesenteric artery (SMA). Laparoscopic radical resection of GC was performed. This anomaly was also confirmed intraoperatively. This patient was discharged on the 10th day after surgery without any postoperative complication. There were no signs of tumor recurrence during the 6-month follow-up.
Correct identification of abnormal abdominal large blood vessels and their relationship with tumors before surgery is of great significance to avoid intraoperative blood vessel damage, major postoperative complications and the missing of lymph node dissection.
在胃肠外科、肝胆胰外科、移植和介入放射学中，了解腹腔干解剖结构非常重要。腹腔干的变异很常见，在这些介入治疗之前应该预测到这些变异。
一名 58 岁女性因胃镜和胃窦活检证实的胃癌（GC）而被收入我院接受手术治疗。在对比增强 CT 中，我们发现腹腔干动脉（CA）和肝总动脉（CHA）均缺失。因此，我们在手术前使用计算机化三维（3D）血管重建技术重建了腹部干及其分支血管。
计算机化 3D 血管重建证实了一种极为罕见的血管异常：CA 和 CHA 均缺失。脾动脉（SA）和胃十二指肠动脉（GDA）起源于腹主动脉（AA）。胃左动脉（LGA）起源于 SA 和 GDA 交界处上方的 AA。左肝动脉（LHA）起源于胃左动脉（LGA）。右肝动脉（RHA）起源于肠系膜上动脉（SMA）。我们为该患者实施了腹腔镜根治性 GC 切除术。术中也证实了这一异常。患者术后第 10 天出院，无术后并发症。在 6 个月的随访期间，没有肿瘤复发的迹象。
在术前正确识别异常的腹部大血管及其与肿瘤的关系，对于避免术中血管损伤、严重的术后并发症和淋巴结清扫遗漏具有重要意义。
