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1.
Cir. Esp. (Ed. impr.) ; 91(2): 103-110, feb. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-110149

RESUMO

Introducción: El sistema hepático arterial presenta variaciones anatómicas en hasta un 45%. La identificación pre o intraoperatoria de estas anomalías anatómicas evitará morbilidad adicional a la realización de una duodenopancreatectomía. Rutinariamente son identificadas en el preoperatorio mediante tomografía computarizada (TC). En determinadas ocasiones no son informadas y solo se descubren durante la intervención quirúrgica. El acceso inicial retroperitoneal de la arteria mesentérica superior (AMS) evitará una intervención poco útil si existe invasión de arteria mesentérica superior, e identificará las variantes anatómicas con origen en arteria mesentérica superior. Estas anomalías adquieren importancia dado que su lesión inadvertida ocasionaría severo compromiso vascular y/o hemorragias perioperatorias. Objetivos• Analizar anomalías celiaco-mesentéricas de la arteria hepática ante una duodenopancreatectomía, mediante información de tomografía computarizada multicorte (TCMD), en régimen no protocolizado, •protocolizado y con reconstrucción multidimensional, proyección de intensidad máxima (MIP), tras acceso quirúrgico inicial a AMS. Enfermos y método Estudio restrospectivo de variables clínicas, anatomopatológicas y quirúrgicas de enfermos con (..) (AU)


Introduction: Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely (..) (AU)


Assuntos
Humanos , Artéria Celíaca/anormalidades , Artérias Mesentéricas/anormalidades , Artéria Hepática/anormalidades , Pancreaticoduodenectomia/métodos , Malformações Vasculares , Perda Sanguínea Cirúrgica/prevenção & controle
2.
Cir Esp ; 91(2): 103-10, 2013 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-23219204

RESUMO

INTRODUCTION: Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely identified before surgery using CT imaging, but on certain occasions they are not reported and are only discovered during the surgical operation. The initial retroperitoneal access by the superior mesenteric artery (SMA) will avoid a fairly useless intervention if there is superior mesenteric artery invasion, and will identify the anatomical variations originating in the superior mesenteric artery. These anomalies acquire importance in that their unnoticed injury could lead to severe vascular compromise and/or perioperative bleeding. OBJECTIVES: To analyse celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy using the information from multidetector computed tomography (MDCT) using a non-standardised method, a standardised method with multidimensional reconstruction, and maximum intensity projection (MIP), after initial surgical access to the SMA. PATIENTS AND METHODS: A retrospective study of the clinical, histopathological and surgical variables was conducted on patients with an indication for duodenopancreatectomy in our Department from 2008 until April 2010. A study was performed on the reports made after image acquisition by MDCT. A blind, three-dimensional, MIP reconstruction was performed on all the patients to identify arterial anomalies. A description is given of hepatic artery anomalies after initial access to the SMA. RESULTS: A total of 61 patients were included in the study. The mean age was 65 ± 11 years, with 33 (54%) males and 28 (46%) females. Vascular anomalies, right hepatic artery (RHA) (SMA) substitute (subst), 5 (8%); RHA (SMA) accessory (acc), 4 (7%); left hepatic artery (LHA) (left gastric artery) (LGA) acc 3 (5%); common hepatic artery (CHA) (SMA) subst 3 (5%); RHA (SMA) acc+LHA (LGA) acc2 (3%); CHA (aorta) subst, 1 (2%); RHA+RGA+2 LHA (celiac trunk), 1 (2%); and CHA (SMA)+LHA (LGA) acc. CONCLUSION: On being able to identify arterial anomalies with a mixture of preoperative radiological and methodological criteria, with three-dimensional reconstruction, MIP, and initially performing a dissection of the superior mesenteric artery could avoid duodenopancreatectomies that may not benefit the patient and compromise bleeding.


Assuntos
Artéria Celíaca/anormalidades , Artéria Celíaca/diagnóstico por imagem , Artéria Hepática/anormalidades , Artéria Hepática/diagnóstico por imagem , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Pancreaticoduodenectomia , Idoso , Feminino , Humanos , Masculino , Cuidados Pré-Operatórios , Estudos Retrospectivos
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