Abstract:

Pancreaticoduodenectomy with resection and reconstruction of replaced right hepatic artery: two cases report           LU Zi-peng，YIN Jie，WEI Ji-shu，et al. Pancreas Center，the First Affiliated Hospital with Nanjing Medical University，Nanjing 210029，China
Corresponding author：MIAO Yi，E-mail：miaoyi@njmu.edu.cn；JIANG Kui-rong，E-mail：jiangkuirong@163.com
Abstract    Objective    To discuss the feasibility and safety of Whipple’s procedure combined with resection of replaced right hepatic artery (RRHA) for peri-ampullary malignancy with tumor-invaded RRHA and intact gastroduodenal artery (GDA). Methods    Two cases of peri-ampullary malignnacy with tumor-invaded RRHA treated in the Pancreas Center of The First Affiliated Hospital of Nanjing Medical University during March to June in 2015 were respectively analyzed. During Whipple’s procedure for these two cases，the tumor-invaded RRHA was resected，and isolated GDA was anastomosed to the distal abberant artery to reconstruct the right hepatic artery. Results    In both cases，operation time were 405 min，and estimated blood loss were 400 mL. Case 2 required 4U RBC transfusion. Except for a transient increase in hepatic enzyme in the postoperative course in Case 2，no complications including pancreatic fistula，biliary fistula and intra-abdominal abscess happened in both cases. Postoperative CT angiography (CTA) suggested the reconstructed artery was transparent，and blood supply to the liver was good. Two patients were discharged on posteroperative day 14 and 21. Conclusion    With comprehensive preoperative evaluation and proper intraoperative management，Whipple’s procedure with combined resection of RRHA and reconstruction with GDA is feasible and safe.

Key words: pancreaticoduodenectomy, periampullary adenocarcinoma, replaced right hepatic artery, arterial reconstruction

摘要：

目的    探讨联合替代肝右动脉（RRHA）切除及重建的胰十二指肠切除术治疗壶腹周围癌合并RRHA侵犯且胃十二指肠动脉（GDA）正常病例的可行性和安全性。方法    回顾性分析南京医科大学第一附属医院胰腺中心2015年3-6月诊治的2例壶腹周围癌侵犯RRHA病例的临床资料。均行胰十二指肠切除术，同时切除受侵的RRHA，对保留的GDA近端和远端RRHA行重建。结果    两例病人手术时间均约为405 min，失血约400 mL，病例2输血4单位红细胞。除外病例2术后出现一过性肝脏酶增高，两例病人均未发生胰瘘、胆瘘、腹腔感染等并发症。术后CT动脉成像检查提示重建动脉通畅，肝脏血供良好。分别于术后第14天和第21天出院。结论    如术前评估全面，术中处理妥当，则联合RRHA切除及自体GDA重建的胰十二指肠切除术安全可行。

关键词: 胰十二指肠切除术, 壶腹周围癌, 替代肝右动脉, 动脉重建