Volpe C M, Peterson S, Hoover E L, Doerr R J
Department of Surgery, Buffalo VA Medical Center, SUNY at Buffalo School of Medicine and Biomedical Sciences, New York, USA.
Am Surg. 1998 Aug;64(8):758-61.
The hepatic arterial anatomy is aberrant in almost 50 per cent of all individuals. The most common anomalies include the right hepatic artery arising from the superior mesenteric artery (25%) and the left hepatic artery arising from the left gastric artery (25%). Anomalies of the common hepatic artery, usually a branch of the celiac artery, are rare. A replaced common hepatic artery originating from the superior mesenteric artery occurs in 2.5% of the entire population. Injury to hepatic blood supply is more common in the presence of aberrant arterial anatomy. Knowledge of aberrant arterial anatomy in patients about to undergo pancreaticoduodenectomy can lead to measures to preserve the vessels, and avoid fatal hepatic injury. We present a patient with a replaced common hepatic artery originating from the superior mesenteric artery successfully treated with a standard pancreaticoduodenectomy for pancreatic adenocarcinoma. The anomalous vessel was identified on visceral angiography, performed as part of the initial preoperative evaluation. At the time of laparotomy, the artery followed a course atypical for replaced hepatic arteries, lying medial to the common bile duct, and closely mimicking the gastroduodenal artery that would normally be divided during a Whipple procedure. This case emphasizes the importance of preoperative visceral angiography and the margin of safety it can provide when that knowledge is used in the operative strategy. Visceral angiography should be considered routine before pancreaticoduodenectomy, particularly in surgical residency training programs.
几乎50%的人肝动脉解剖结构异常。最常见的异常包括起源于肠系膜上动脉的右肝动脉（25%）和起源于胃左动脉的左肝动脉（25%）。肝总动脉通常是腹腔干的分支，其异常情况较为罕见。起源于肠系膜上动脉的替代肝总动脉在整个人口中的发生率为2.5%。在存在动脉解剖结构异常的情况下，肝血供损伤更为常见。了解即将接受胰十二指肠切除术患者的异常动脉解剖结构，可采取措施保护血管，避免致命的肝损伤。我们报告一例起源于肠系膜上动脉的替代肝总动脉患者，成功接受了标准的胰十二指肠切除术治疗胰腺腺癌。在内脏血管造影时发现了异常血管，这是术前初始评估的一部分。在剖腹手术时，该动脉走行与替代肝动脉的典型走行不同，位于胆总管内侧，与通常在惠普尔手术中会被切断的胃十二指肠动脉非常相似。该病例强调了术前内脏血管造影的重要性以及将该知识应用于手术策略时它所能提供的安全 margin 。在胰十二指肠切除术之前，尤其是在外科住院医师培训项目中，应将内脏血管造影视为常规检查。
