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Challenging arterial pattern of foregut and its potential impact on surgery

机译:具有挑战性的前肠动脉模式及其对手术的潜在影响

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摘要

Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentially devastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimed to revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomical correlations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut with source & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology, different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classical branches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable with missing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%) and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical origin and accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%) as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenal artery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomical variations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgery involving upper abdominal organs with least complications.
机译:预计前肠衍生物动脉解剖结构的形态学变化范围超出经典模式,精确理解与术前诊断、手术程序相关,并避免在各种创伤性和非创伤性前肠血管损伤期间潜在的破坏性术后结果。该研究旨在重新审视前肠动脉的形态学细节并更新不寻常的构型,以建立临床解剖学相关性。这项研究描述了乳糜干(CT)作为前肠主动脉的详细分支模式,其来源和路线是肝、胃、十二指肠和胰腺分支,在58个尸体解剖中。根据形态学,制作了不同的类型和亚型。这些描述使用数字和相关表格进行了解释。在 CT 的经典分支中,发现脾动脉最稳定,而其他两个分支被发现最可变,11 例肝总动脉缺失。除经典三分叉 (65.52%) 外,还观察到不同类型的 CT 分叉 (12.07%) 和四分叉 (22.41%)。关于肝动脉的变化 (27.59%),发现了非经典起源和副肝支。在胃分支的情况下,与左胃动脉 (34.48%) 相比,右胃 (50%) 的变异起源更多。其他形态学变化包括胃十二指肠动脉的非典型起源 (18.96%)以及副胰动脉 (17.13%) 和十二指肠动脉 (6.38%) 的存在。了解前肠循环动力学的解剖学变化是值得了解的,以便于成功规划涉及上腹部器官的手术,并发症最少。

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