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中华腔镜外科杂志(电子版) ›› 2025, Vol. 18 ›› Issue (04) : 241 -243. doi: 10.3877/cma.j.issn.1674-6899.2025.04.010

病例报告

伴有Bühler弓合并肝总动脉异位变异的腹腔镜胰十二指肠切除术1例
蒋宗赢, 陈佳浩, 翟敏, 陆轶杰, 吴建武, 蒋新卫()   
  1. 215000 南京医科大学附属苏州医院/苏州市立医院肝胆胰外科
  • 收稿日期:2025-05-08 出版日期:2025-08-30
  • 通信作者: 蒋新卫

A case of laparoscopic pancreaticoduodenectomy with combined anatomical variations: Arc of Bühler and aberrant common hepatic artery

Zongying Jiang, Jiahao Chen, Min Zhai, Yijie Lu, Jianwu Wu, Xinwei Jiang()   

  1. Department of Hepatobiliary Pancreatic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital, Nanjing Medical University, 215000, China
  • Received:2025-05-08 Published:2025-08-30
  • Corresponding author: Xinwei Jiang
引用本文:

蒋宗赢, 陈佳浩, 翟敏, 陆轶杰, 吴建武, 蒋新卫. 伴有Bühler弓合并肝总动脉异位变异的腹腔镜胰十二指肠切除术1例[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(04): 241-243.

Zongying Jiang, Jiahao Chen, Min Zhai, Yijie Lu, Jianwu Wu, Xinwei Jiang. A case of laparoscopic pancreaticoduodenectomy with combined anatomical variations: Arc of Bühler and aberrant common hepatic artery[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(04): 241-243.

Bühler弓(arc of Bühler,AOB)作为一种罕见的解剖变异,可为腹腔干与肠系膜上动脉提供重要侧支循环,在腹腔干/肠系膜上动脉闭塞时可代偿供血。本文报道1例60岁男性胆总管腺癌患者,术前三维重建发现一支直径5.51 mm的AOB,走行于肝总动脉与肠系膜上动脉之间,术中保留该变异血管未结扎离断。术前三维重建技术能精准识别血管变异,优化手术决策,尤其对于需行胰十二指肠切除术等复杂手术的患者,可显著降低医源性损伤风险。

The arc of Bühler(AOB), as a rare anatomical variation, can provide important collateral circulation for the abdominal trunk and superior mesenteric arteries, and can compensate for blood supply when the abdominal trunk/superior mesenteric arteries are occluded. This article reports a 60-year-old male patient with common bile duct adenocarcinoma. Preoperative three-dimensional reconstruction revealed an AOB with a diameter of 5.51 mm running between the common hepatic artery and the superior mesenteric artery. During the operation, this variant vessel was retained without ligation or dissection. Preoperative three-dimensional reconstruction technology can accurately identify vascular variations and optimize surgical decisions. Especially for patients who need complex surgeries such as pancreaticoduodenectomy, it can significantly reduce the risk of iatrogenic injury.

图1 术前影像及术中情况注:A.水平面增强CT与动脉三维重建;B.冠状面增强CT;C.患者腹部三维重建;D.术中截图。CHA:肝总动脉;RGEA:胃网膜右动脉;SMA:肠系膜上动脉;PHA:肝固有动脉;GDA:胃十二指肠动脉
图2 肝总动脉变异类型
表1 既往术前使用三维重建技术发现AOB的报道
1
Dembinski J, Robert B, Sevestre MA, et al. Celiac axis stenosis and digestive disease: diagnosis, consequences and management[J]. J Visc Surg, 2021, 158(2):133-144.
2
Bühler A. über eine anastomose zwischen den stämmen der art. coeliaca und der art. mesenterica superior[J]. Gegenbaurs Morphologisches Jahrbuch, 1904, 32: 185-188.
3
计璐耀,严高武,李宏伟,等. CTA和DSA对Bühler弓检出率的Meta分析[J]. 介入放射学杂志2024, 33(6): 604-609.
4
Kallamadi R, Demoya MA, Kalva SP. Inferior pancreaticoduodenal artery aneurysms in association with celiac stenosis/occlusion[J]. Semin Intervent Radiol, 2009, 26(3):215-223.
5
Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual. 8th ed.[M]. 8 edition.
6
Tandler J. Uber die varietaten der arteria coeliacaund deren entwicklung[J]. Anatomische Hefte, 1904, 25: 472-500.
7
Ochoa JE, Pointer DT Jr, Hamner JB. Vascular anomalies in pancreaticoduodenectomy: a lesson learned[J]. Case Rep Surg, 2016:5792980.
8
Slaba S, Assaf S. Aberrant gastroduodenal artery with splenic origin[J]. Surg Radiol Anat, 2018, 40(12):1437-1440.
9
Manta BA, Rusu IR, Rusu MC. An arc of Bühler variant[J]. Morphologie, 2022, 106(353):136-140.
10
周嘉杰,梁文祥,马宇斐,等. 腹腔镜胰十二指肠切除术后胰瘘的临床防治进展[J]. 肝胆外科杂志2024, 32(6): 476-480.
11
McNulty JG, Hickey N, Khosa F, et al. Surgical and radiological significance of variants of Bühler′s anastomotic artery: a report of three cases[J]. Surg Radiol Anat, 2001, 23(4):277-280.
12
Kageyama Y, Kokudo T, Amikura K, et al. The arc of Buhler: special considerations when performing pancreaticoduodenectomy[J]. Surg Case Rep, 2016, 2(1):21.
13
Shah N, Chen O, Cohen GS. Arc of Buhler catheterization for tumor therapy:case report[J]. J Interv Oncol, 2010, 3: 28-30.
14
Mohapatra S, Moradi D, Broder A. A rare cause of post-sphincterotomy bleeding[J]. Gastroenterology, 2017, 153(5):1193-1194.
15
Jeong SJ, Lim NY, Jang NK, et al. Transcatheter coil embolization of an arc of Buhler aneurysm[J]. Korean J Radiol, 2008, 9(Suppl):S77-S80.
16
Wayne MG, Narang R, Verzosa S, et al. Superior mesenteric artery originating from the celiac axis: a rare vascular anomaly[J]. World J Surg Oncol, 2011, 9:71.
17
Sugihara F, Murata S, Uchiyama F, et al. Successful coil embolization of an aneurysm in the arc of Bühler[J]. J Nippon Med Sch, 2016, 83(5):196-198.
18
Abe K, Iijima M, Tominaga K, et al. Retroperitoneal hematoma: rupture of aneurysm in the arc of Bühler caused by median arcuate ligament syndrome[J]. Clin Med Insights Case Rep, 2019, 12:1179547619828716.
19
Baz RO, Scheau C, Baz RA, et al. Buhler′s arc: an unexpected finding in a case of chronic abdominal pain[J]. J Gastrointestin Liver Dis, 2020, 29(3):304.
20
Templin R, Tabriz N, Hoffmann M, et al. Case report: virtual and interactive 3D vascular reconstruction before planned pancreatic head resection and complex vascular anatomy: a bench-to-bedside transfer of new visualization techniques in pancreatic surgery[J]. Front Surg, 2020, 7:38.
21
Schumacher L, Albrecht HC, Gretschel S. A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler[J]. Surg Case Rep, 2022, 8(1):37.
22
Padar M, Rieseberg A, Ratnayake S. Unexpected finding of arc of Buhler with celiac artery stenosis during workup for a suspected pancreatic lesion[J]. J Surg Case Rep, 2023, 2023(3):rjad178.
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