背景:肝动脉(HA)是肝胰胆管(HPB)手术和介入手术期间最受威胁的血管结构之一。它可以受到许多临床图片的影响,尤其是肿瘤,由于其解剖位置和邻域。
目的:根据文献揭示HA创伤管理的演变和最新进展。
方法:在本文中,回顾了100年的MEDLINE(PubMed)文献和文章,包括病例和一系列HA损伤,以及伤害发生的类型,治疗,并对相关并发症及其管理进行了汇编。
结果:胆囊切除术和胰十二指肠切除术中HA损伤的风险增加,在最常见的操作中。HA解剖显示约15%-25%的病例异常,进一步增加这种风险。HA损伤的发生率尚不清楚。近年来在管理HA损伤患者(裂伤,横切,结扎,根据目前的文献,对具有严重发病率和死亡风险的切除)进行了综述。
结论:结论:由于HA损伤引起的并发症和死亡在今天并不常见.血流动力学不稳定患者的并发症风险增加,黄疸,胆管炎,还有败血症.揭示术前放射学评估的变化将降低风险。在检测到HA损伤的情况下,动脉血流连续性应尽量保持与原发性吻合,动脉转位,或移植物。在胆管损伤发展的情况下,患者应前往HPB手术中心,考虑到伴随HA损伤的可能性。需要进行大规模和多中心的研究,以更好地了解HA结扎的早期和长期结果并确定预防程序。
BACKGROUND: The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood.
OBJECTIVE: To reveal the evolution and recent developments in the management of HA traumas in the light of the literature.
METHODS: In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled.
RESULTS: The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature.
CONCLUSIONS: In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.