Krishna Pothugunta S, Soori Abhijna, Kalayarasan Raja, Biju Pottakkat
Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND.
Cureus. 2023 Sep 3;15(9):e44605. doi: 10.7759/cureus.44605. eCollection 2023 Sep.
Variations in the hepatic artery's anatomy can significantly impact planning and executing pancreatic and hepatobiliary surgeries. Of these, the commonest are variations of right and left hepatic arteries originating from superior mesenteric and left gastric arteries, respectively. The anomalous origin of the right hepatic artery from the gastroduodenal artery (GDA) is among the rarest and most challenging anatomy, especially in patients undergoing pancreatoduodenectomy (PD) since GDA ligation is a mandatory step, which may threaten the liver blood supply. We present a 62-year-old male with suspected distal cholangiocarcinoma and plan a robot-assisted pancreatoduodenectomy. Preoperative computed tomography evaluation revealed an anomalous segment 6 artery arising from the GDA and coursing posterolaterally to the common bile duct in the hepatoduodenal ligament. Also, the patient had a replacement left hepatic artery originating from the left gastric artery. The described vascular anomaly has not been previously reported in patients undergoing PD. Awareness of vascular anomalies is the key to performing oncologically radical surgery without increasing bleeding and ischemic complications in patients undergoing complex procedures like PD.
肝动脉解剖结构的变异会对胰腺和肝胆手术的规划与实施产生重大影响。其中，最常见的是分别发自肠系膜上动脉和胃左动脉的肝右动脉和肝左动脉的变异。肝右动脉起源于胃十二指肠动脉（GDA）这种异常情况是最罕见且最具挑战性的解剖结构之一，尤其是在接受胰十二指肠切除术（PD）的患者中，因为结扎GDA是一个必要步骤，这可能会威胁肝脏血供。我们报告一名62岁男性，疑似远端胆管癌，计划行机器人辅助胰十二指肠切除术。术前计算机断层扫描评估显示，一条异常的6段动脉发自GDA，并在肝十二指肠韧带内向后外侧走行至胆总管。此外，该患者有一条由胃左动脉发出的替代肝左动脉。这种所描述的血管异常情况此前在接受PD的患者中尚未见报道。了解血管异常是在像PD这样的复杂手术中，在不增加出血和缺血并发症的情况下进行肿瘤根治性手术的关键。
