PREVALENCE OF HEPATIC ARTERIAL VARIATIONS WITH IMPLICATIONS IN PANCREATODUODENECTOMY

ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

摘要：背景：胰十二指肠切除术（pancreaticoduodenectomy）是壶腹周围癌根治性治疗的常规手术方案，但其存在较高的死亡风险。腹腔干动脉变异并不少见，可能导致医源性损伤，或在胰十二指肠切除术中需要进行动脉切除与重建。目的：明确对胰十二指肠切除术具有临床指导意义的动脉变异的患病率。方法：回顾性分析了200例腹部增强计算机断层扫描（computed tomography，CT）病例的腹腔干（celiac trunk）及肝动脉系统（hepatic arterial system）解剖结构。结果：87%的病例肝动脉系统解剖结构正常。13%的病例存在异常右肝动脉，其中12例为肠系膜上动脉（superior mesenteric artery）发出的替代型右肝动脉，2例为同源的副右肝动脉；7例可见肝肠系膜干，另有5例右肝动脉直接起自腹腔干。所有异常右肝动脉均走行于胰头后方，随后在抵达肝脏前，经门静脉（portal vein）后方及外侧走行。结论：肝动脉变异（如绕过门静脉后方的异常右肝动脉）的发生率高达13%。此类患者在接受胰十二指肠切除术时，可能需要调整手术方案以实现充分切除。术前影像学检查可清晰识别此类变异，通过合理的手术规划有助于实现更安全的胰头分离操作。