Anatomia da artéria hepática em doadores e receptores de transplante hepático intervivos

Abstract

RESUMO: Objetivo:O objetivo do presente estudo é avaliar a anatomia da artéria hepática nos doadores e receptores do transplante hepático intervivos realizados no Hospital de Clínicas da Universidade Federal do Paraná e do Hospital Nossa Senhora das Graças de Curitiba. Método: A avaliação foi retrospectiva de março de 1998 até setembro de 2002 (23 transplantes), quando os dados passaram a ser captados de forma prospectiva (17 transplantes), até agosto de 2003. Foram obtidos dados de 80 pacientes consecutivos (40 doadores e 40 receptores), submetidos a transplante hepático intervivos, sendo 32 transplantes com receptor adulto e 8 transplantes pediátricos (receptor com idade inferior a 15 anos). Entre os 80 pacientes incluídos no estudo, 51 eram do sexo masculino (27 receptores e 24 doadores) e 29 eram do sexo feminino (13 receptores e 16 doadores). A idade média dos doadores foi de 32,6 anos e a dos receptores de 36,3 anos. Resultados: No estudo da anatomia da artéria hepática, realizaram-se arteriografias em 43 pacientes, e variações anatômicas foram encontradas em 18 casos (41,86%), sendo a mais comum a artéria hepática direita ramo da artéria mesentérica superior (12,5%; n=5); no estudo da anatomia arterial realizado nas cirurgias, foram verificadas variações em 16 casos (20%) entre os 80 casos estudados, sendo a mais comum a artéria hepática direita como ramo da artéria mesentérica superior (7,5%; n=6). Conclusão: Conclui-se que a prevalência de variações na anatomia da artéria hepática é elevada (Rev. Col. Bras. Cir. 2006; 33(2): 63-67).Descritores: Transplante de fígado; Doadores vivos; Artéria hepática/anatomia e histologia. ABSTRACTBackground: Detailed knowledge of hepatic artery anatomy is essential for the success of living related liver transplantation. and 29 female (13 recipients and 16 donors). The median age of the donors was 32.6 years and of the recipients was 36.3 years. Thirty-two recipients were adults and 8 were under than 15 years of age. Results: Forty-three patients underwent abdominal arteriography and variations of the hepatic artery anatomy were found in 18 of them (41.86%). The most prevalent anomaly was the right hepatic artery arising from the superior mesenteric artery (12.5%; n=5). The anatomy of the hepatic artery was also evaluated at operation and variations were observed in 16 of the 80 patients (20%). The most common variation observed at operation was the right hepatic artery arising from the superior mesenteric artery (7.5%; n=6). Conclusion: It is concluded that the prevalence of hepatic arterial variations is high.

Variações da artéria hepática: estudo anatômico em cadáveres

“…The detailed study of the anatomy of liver structures, both intra-and extra-hepatic, allowed, in recent years, the development of alternate successful techniques of liver transplantation, such as reduced liver transplant, so called "split-liver" or splitting liver and, recently, the livingdonor transplantation 9 . In the particular case of splitting the liver, an organ can originate two grafts (right lobe and left lobe), thus benefiting two receivers, a technique developed by Pilchlmayr et al 18 .…”

“…According to the literature, variations in this arterial system occur approximately between 25 and 42%. Bertevello et al and Soares et al described even rare cases of variations, including: double hepatic artery; right hepatic artery emerging from the inferior mesenteric artery; hepatic artery passing posterior to the portal vein 8,9 .…”

Atypical origin of the common hepatic artery

“…Several studies 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 report different variations. The most representative of them is to Hiatt et al 5 with a sample of 1000 people.…”

“…Anatomical variations of the hepatic artery are commonly found during radiological examinations and abdominal operations 1 , 8 9 It is estimated that the variation index reach 45% of the population 8 . The significant prevalence gives this type of variation major medical importance, and justifies the surgeon know it to avoid iatrogenic injury.…”

“…The usual blood vessel anatomy is the common hepatic artery ascend from the celiac trunk 8 ; however, this arrangement may change due to embryonic variations. These variations, from most to least frequent are: 1) the right hepatic artery ascend from the superior mesenteric artery; 2) the left hepatic artery ascend from the left gastric artery; 3) the two events occur simultaneously; and 4) the common hepatic artery ascend from the superior mesenteric artery.…”