Nakamura S, Suzuki S, Hachiya T, Ochiai H, Konno H, Baba S, Baba S
Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
Surg Today. 1998;28(10):1065-8. doi: 10.1007/BF02483963.
Dissecting aneurysms of the hepatic artery are extremely rare. We report herein the case of a 51-year-old man with massive hepatic metastases from rectal carcinoma, who was found incidentally to have a left hepatic artery aneurysm by a preoperative angiography. After replacing the left hepatic artery with a 2-cm segment of long saphenous vein, an extended right lobectomy with partial resection of the left lateral segment for multiple metastases was successfully performed. To prevent thrombus formation at the anastomosis, the Pringle maneuver was not used during dissection of the hepatic parenchyma. Histological examination of the resected specimen showed a dissecting aneurysm of the left hepatic artery, but there were no findings to suggest the etiology of this disease. The patient is currently alive 13 months after his operation without any evidence of further recurrence of the carcinoma. To the best our knowledge, 12 case reports of this anomaly have been documented, but only one of these describes a successful operation. The clinical features and etiology of the hepatic artery aneurysm that develops independent of other vascular diseases are discussed following this case report.
肝动脉夹层动脉瘤极为罕见。我们在此报告一例51岁男性患者，其患有直肠癌肝转移，术前血管造影偶然发现左肝动脉动脉瘤。用一段2厘米长的大隐静脉替换左肝动脉后，成功实施了扩大右肝叶切除术并部分切除左外叶以治疗多发转移瘤。为防止吻合口处形成血栓，在肝实质解剖过程中未采用Pringle手法。切除标本的组织学检查显示左肝动脉夹层动脉瘤，但未发现提示该病病因的证据。患者术后13个月仍存活，无癌症进一步复发的迹象。据我们所知，已有12例该异常情况的病例报告，但其中仅有1例描述了成功手术。本病例报告之后讨论了独立于其他血管疾病发生的肝动脉动脉瘤的临床特征和病因。
