摘要目的 探讨胰十二指肠切除术中肝动脉变异及意义.方法 回顾性分析100例胰十二指肠切除术患者的肝动脉变异情况,分析其变异类型以及术中所采取的针对性措施.结果 通过术前腹腔干动脉、肠系膜上动脉(DSA)造影及术中对肝十二指肠韧带骨骼化,100例患者发现16例肝动脉变异.14例(14%)患者出现替肝动脉,其中10例为替肝右动脉(10%),8例发自肠系膜上动脉,2例发自胃十二指肠动脉;4例(4%)为替肝左动脉,3例发自胃左动脉,1例发自肝右动脉.14例变异血管直径0.3～0.6 cm,平均0.47 cm,术中均予以保留.1例(1%)于肝十二指肠韧带后方伴行门静脉出可触及变异动脉进入肝脏,血管直径0.4 cm,术中予以保留.1例(1%)变异动脉发自胰头方向进入右肝,血管直径0.2 cm,动脉夹闭1 h后离断该血管.结论 针对胰十二指肠切除术中发现的肝动脉变异,必须根据血管直径、阻断变异血管时肝脏变化及血管科建议,判断是否保留变异血管.

abstractsObjective To investigate the clinical relevance of hepatic artery variation during the procedure of duodenopancreatectomy. Methods Data of 100 patients who underwent duodenopancreatectomy were retrospectively reviewed, and the anatomy of hepatic artery variation was evaluated, then the types of variation and specific intra-operative managements were recorded. Results Through pre-operative celiac artery and superior mesenteric artery DSA and duodenohepatic ligament skeletonization during operation, 16 cases were found to have hepatic artery variation, and 14 (14%) patients had alternative hepatic artery, among them there were 10 cases of alternative right hepatic artery (10%) , 8 cases originated from superior mesenteric artery, 2 cases originated from gastroduodenal artery. 4(4%) patients had alternative left hepatic artery, 3 of them originated from left gastric artery, 1 originated from right hepatic artery. The diameter of variant artery was 0.3 -0.6 cm with a mean of 0. 47 cm. All the variant arteries were reserved in operation. 1 patient had a variant hepatic artery located in the posterior of hepatoduodenal ligament parallel with portal vein, and the diameter of this variant artery was 0. 4 cm, the variant artery was reserved. 1 patient had a variant hepatic artery towards right hepatic lobe which originated from the direction of pancreatic head, and the diameter of this variant artery was 0.2 cm, the artery was dissected 1 h after artery occlusion. Conclusions Whether variant blood vessel need to be reserved shall be judged according to blood vessel diameter, the changes of liver in the course of variant artery occlusion and suggestions from blood vessel surgeon.