Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Hepatobiliary Pancreat Sci. 2023 Nov;30(11):1241-1248. doi: 10.1002/jhbp.1381. Epub 2023 Oct 25.
Preoperative comprehension of the anatomical variations of the hepatic artery and bile duct is essential for safe laparoscopic surgery for pancreaticobiliary maljunction (PBM). This study aimed to investigate the impact of anatomical variations of the hepatic artery and bile duct on surgical technique and postoperative complications.
We conducted a retrospective review of patients with PBM who underwent laparoscopic surgery at our institution between January 2014 and December 2022 to investigate anatomical variations in the hepatic artery and bile duct, surgical technique, and postoperative complications.
We included 112 patients with PBM, with a median age of 4 years (interquartile range, 0-55). Overall, 29 of 112 patients had an aberrant right hepatic artery (ARHA) running ventral to the common hepatic duct (CHD), and they underwent hepaticojejunostomy on the ventral side of the ARHA. Additionally, eight of 112 patients had an aberrant posterior hepatic duct (APHD), which was joined to the CHD in all but one case. The presence of APHD was associated with postoperative bile leak occurrence.
Performing hepaticojejunostomy ventral to the ARHA is important to prevent complications. Furthermore, APHD may be a risk factor for postoperative bile leak and requires careful bile duct plasty.
术前了解肝动脉和胆管的解剖变异对于安全施行胰腺胆管合流异常（PBM）的腹腔镜手术至关重要。本研究旨在探讨肝动脉和胆管解剖变异对手术技术和术后并发症的影响。
我们回顾性分析了 2014 年 1 月至 2022 年 12 月在我院行腹腔镜手术的 PBM 患者，以调查肝动脉和胆管的解剖变异、手术技术和术后并发症。
我们纳入了 112 例 PBM 患者，中位年龄为 4 岁（四分位距，0-55）。总体而言，112 例患者中有 29 例存在肝右动脉（ARHA）异常走行于胆总管（CHD）腹侧，这些患者在 ARHA 的腹侧行胆肠吻合术。此外，112 例患者中有 8 例存在异常后肝管（APHD），除 1 例外，其余均与 CHD 相连。APHD 的存在与术后胆漏的发生有关。
在 ARHA 腹侧行胆肠吻合术对于预防并发症很重要。此外，APHD 可能是术后胆漏的危险因素，需要仔细进行胆管整形。
