肠系膜上动脉变异肝动脉在肝癌及胃癌手术中的意义

目的 了解源自肠系膜上动脉的变异肝动脉走行特征,指导肝癌及胃癌手术操作.方法 研究选择广西医科大学第一附属医院2008年6月至2010年6月间400例经数字减影血管造影(digital subtraction angiography,DSA)及多层螺旋CT血管造影(multislice spiral computed tomography angiography,MSCTA)检查的肝癌患者以及86例术前经MSCTA检查的胃癌患者.术前通过影像学资料了解源自肠系膜上动脉的变异肝动脉的走行情况.将胃癌根治术中变异肝动脉周围组织分离后,行重组人细胞角蛋白20(recombinant human cytokeratin 20,CK20)、癌胚抗原(carcino-embryonic antigen,CEA)免疫组化判断淋巴结转移的发生.结果 全组486例患者中存在源自肠系膜上动脉变异者63例(12.96％),肝癌患者49例、胃癌患者14例.变异肝动脉走行于胰腺前方的2例(3.17％)、胰腺后方的61例(96.83％).胃癌患者变异肝动脉周围组织CK20、CEA免疫组化均为阴性,提示无转移发生.结论 源自肠系膜上动脉的变异肝动脉走行可分为胰前型和胰后型,以后者占多数.术前了解变异肝动脉的走行对于需行肝门部淋巴结清扫的肝癌及胃癌患者具有一定临床意义.

Clinical significance of aberrant hepatic artery arising from superior mesenteric artery in liver cancer and gastric cancer operations

Objective To analyze the clinical significance of aberrant hepatic artery which originated from superior mesenteric artery in liver cancer and gastric cancer operations.Method Four hundred liver cancer patients who underwent digital subtraction angiography (DSA) and multislice spiral computed tomography angiography (MSCTA) and 86 gastric cancer patients who underwent MSCTA between June 2008 and June 2010 and operated at the First Affiliated Hospital of Guangxi Medical University were included in this study.Preoperatively,the origins of the aberrant hepatic arteries from superior mesenteric arteries were detected by medical imaging.Postoperatively,immunohistochemistry of lymphoid tissues around the aberrant hepatic arteries of the gastric cancer patients were performed using recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to determine the incidence of lymph node metastases around the aberrant arteries.Results Among 486 patients,49 patients with liver cancer and 14 patients with gastric cancer had an aberrant hepatic artery which originated from the superior mesenteric artery.The rate was 12.96％ (63/486).The hepatic artery ran in front of the pancreas in 2 patients (3.17％) and behind the pancreas in 61 patients (96.83％).Immunohistochemical analyses of CK20 and CEA were negative which revealed no metastases in the lymphoid tissues surrounding the aberrant arteries.Conclusions Aberrant hepatic artery originated from the superior mesenteric artery can be classified into the pre-pancreas type and postpancreas type.The majority of aberrant hepatic artery belonged to the post-pancreas type.The clinical significance of aberrant hepatic artery is that the hepatic hilar lymph nodes should be dissected in liver cancer and gastric cancer operations.