Hayashi Hikota, Hirahara Noriyuki, Matsubara Takeshi, Takao Satoshi, Okamura Hiroki, Nakamura Kosuke, Kishi Takashi, Taniura Takahito, Zotani Hitomi, Ishitobi Kazunari, Tajima Yoshitsugu
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane, 693-8501, Japan.
Surg Case Rep. 2023 Aug 23;9(1):148. doi: 10.1186/s40792-023-01698-5.
Duplicated left gastric artery (LGA) is a rare anomaly. With an incidence of only 0.4%, its clinical significance remains largely unrecognized.
A 65-year-old man underwent robot-assisted distal gastrectomy for early gastric cancer. After division of the left gastric vein in the left gastropancreatic fold, a slim LGA (LGA-1) was identified and dissected. Careful dissection of the left gastropancreatic fold toward the root of the celiac artery revealed another LGA (LGA-2), which was dissected without difficulty. Postoperative reevaluation of the three-dimensional-computed tomography (CT) angiography reconstructed using the preoperative CT scan identified a 2.7 mm LGA-1, branching from the splenic artery, and a 3.0 mm LGA-2, branching from the celiac artery. To the best of our knowledge, this is only the third reported case of a duplicate LGA in a patient who underwent laparoscopic gastrectomy. Our case is the first to report the use of robot surgery.
Although duplicate LGA is rare and receives little clinical attention, surgeons should keep this vascular anomaly in mind during preoperative evaluation since there is an increased risk for intraoperative bleeding during gastrectomy.
胃左动脉重复是一种罕见的血管异常。其发生率仅为0.4%，临床意义在很大程度上仍未得到充分认识。
一名65岁男性因早期胃癌接受了机器人辅助远端胃切除术。在胃胰襞左侧分离胃左静脉后，发现并解剖了一条纤细的胃左动脉（LGA-1）。向腹腔干根部仔细解剖胃胰襞左侧，发现了另一条胃左动脉（LGA-2），并顺利进行了解剖。术后利用术前CT扫描重建的三维CT血管造影重新评估发现，LGA-1直径2.7mm，发自脾动脉；LGA-2直径3.0mm，发自腹腔干。据我们所知，这是第三例报道的在接受腹腔镜胃切除术患者中出现的胃左动脉重复病例。我们的病例是首例报道使用机器人手术的。
尽管胃左动脉重复罕见且临床关注较少，但由于胃切除术中出血风险增加，外科医生在术前评估时应牢记这种血管异常。
