CAJ | 학술논문

目的：探讨肝动脉变异在肝门淋巴结廓清中的识别与预防损伤策略。方法：回顾性分析2013年1月至2014年7月蚌埠医学院第一附属医院肝胆外科62例肝门淋巴结廓清中12例肝动脉变异患者术中处理情况。结果：12例肝动脉变异类型分为：MichelsⅢ型3例（25.0%），MichelsⅥ型2例（16.7%），MichelsⅨ型1例（8.3%），Hiatt 6型1例（8.3%），肝右动脉与肝总管空间位置变异2例（16.7%），肝左右动脉共同起源于肝总动脉2例（16.7%），以及肝右动脉起自胃十二指肠动脉1例（8.3%）。12例患者无肝动脉损伤；2例发生术后并发症，其中1例胰漏，另1例切口感染；无术后出血、胆漏及肝脓肿等并发症发生。整体恢复良好。结论：在熟知各种肝动脉解剖变异类型的前提下，术前完善的影像学检查与评估，加以术中谨慎且精细的操作，将使肝动脉损伤明显减少。
목적：탐토간동맥변이재간문림파결곽청중적식별여예방손상책략。방법：회고성분석2013년1월지2014년7월방부의학원제일부속의원간담외과62례간문림파결곽청중12례간동맥변이환자술중처리정황。결과：12례간동맥변이류형분위：MichelsⅢ형3례（25.0%），MichelsⅥ형2례（16.7%），MichelsⅨ형1례（8.3%），Hiatt 6형1례（8.3%），간우동맥여간총관공간위치변이2례（16.7%），간좌우동맥공동기원우간총동맥2례（16.7%），이급간우동맥기자위십이지장동맥1례（8.3%）。12례환자무간동맥손상；2례발생술후병발증，기중1례이루，령1례절구감염；무술후출혈、담루급간농종등병발증발생。정체회복량호。결론：재숙지각충간동맥해부변이류형적전제하，술전완선적영상학검사여평고，가이술중근신차정세적조작，장사간동맥손상명현감소。
Objective:To investigate the recognition and injury prevention strategies of hepatic artery variations during hepatic portal lymphadenectomy. Methods:A retrospective analysis was performed, and 12 patients of hepatic arterial variation among 62 pa-tients with hepatic portal lymphadenectomy were the subjects. The study was conducted in the First Affiliated Hospital of Bengbu Medi-cal College between January 2013 and July 2014. The intraoperative treatment and postoperative complications were recorded. Results:Among 12 cases of hepatic artery variation, we found the following cases:3 cases (25.0%) of Michels' Type III, 2 cases (16.7%) of Mi-chels' Type VI, 1 case (8.3%) of Michels' Type IX, 1 case (8.3%) of Hiatt's Type 6, 2 cases (16.7%) of spatial location variation between right hepatic artery and hepatic duct, 2 cases (16.7%) of left and right hepatic artery originating from a common hepatic artery, and 1 case (8.3%) of right hepatic artery originating from the gastroduodenal artery. No injury of hepatic artery occurred. Two cases had post-operative complications, including 1 case of pancreatic leakage and 1 case of incision infection;postoperative hemorrhage, bile leakage, hepatic abscess did not occur in these two cases. Patients recovered well in general. Conclusion:Hepatic arterial injury can be signifi-cantly reduced by the following:increased familiarity with the various types of hepatic artery variations;complete imaging examina-tions for inspection and evaluation before surgery;and careful and meticulous operations in surgery.