胰十二指肠切除中合并肝动脉变异患者的诊治

摘要

目的 探讨肝动脉解剖变异在胰十二指肠切除术中的临床特点及处理原则.方法 回顾性研究2000年1月至2007年7月收治的176例胰十二指肠切除术患者的临床及影像学资料,探讨相关肝动脉变异的类型、影像学检查及术中处理原则.结果 经术中证实,176例患者中20例存在与胰十二指肠切除术相关的肝动脉变异,其中副肝右动脉起自肠系膜上动脉9例(5.1%),替代肝右动脉起自肠系膜上动脉5例(2.8%),肝总动脉起自肠系膜上动脉4例(2.3%),替代肝右动脉起自胃十二指肠动脉2例(1.1%).术前增强螺旋CT资料可明确诊断起源于肠系膜上动脉的变异肝动脉.20例患者中18例完整保留变异肝动脉,其中包含1例贯穿胰腺实质的变异肝总动脉;2例变异肝右动脉损伤患者积极处理后无严重不良后果.结论 术前增强螺旋CT多能准确显示肝动脉变异情况,合理的手术操作可妥善处理各种肝动脉变异.%Objective To study the principle and surgical managements for the patients withanatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy(PD).Methods One hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively.Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.Resuits Hepatic arterial variants were found intraoperatively in 20 cases of all 176 patients.Accessory right heptic atery,replaced right heptic atery and common heptic atery arising from the superior mesenteric artery(SMA)were present in 9(5.1%),5(2.8%),4(2.3%)cases respectively,and replaced right heptic atery coming from the gastroduodenal atery was present in 2 cases(2.9%).All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging.Most of the variant ateries were dissected intact introperatively except 2 cases with accessory fight heptic atery arising from SMA.Conclusions Performing CT scan preoperatively,especially CTA,is effective to diagnose these disorders. Skillfulled surgical techniques can manage the anatomic variants safely.