Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy.
Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy.
复制标题
左肝动脉解剖变异对肝门周围胆管癌应用于右侧肝切除术的临床意义。
DOI：
10.1007/s00268-014-2715-8
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发表时间：
2014
影响因子：
2.6
通讯作者：
Miyazaki M
中科院分区：
文献类型：
--
作者：
Shimizu H;Hosokawa I;Ohtsuka M;Kato A;Yoshitomi H;Miyazaki M
背景充分了解肝门解剖结构对于成功手术切除肝门周围胆管癌 (PHC) 至关重要。方法使用多排计算机断层扫描 (CT) 对 58 名因 Bismuth-Corlette IIIa 或 IV 肿瘤接受右侧肝切除术的连续患者评估左肝动脉 (LHA) 和左门静脉 (UP) 脐部之间的三维位置关系。 LHA与UP的位置关系分为以下三种类型： L-UP型，LHA从UP的左侧尾侧延伸到左侧节（LLS）； R-UP型，LHA从UP的右颅侧延伸至LLS； LHA 的一分支从 UP 的右颅侧进入 LLS，另一分支从 UP 的左尾侧进入 LHA。结果 L-UP 型 LHA 53 例（91.4%），R-UP 型 3 例（5.2%），混合型 2 例（3.4%）。在任何 L-UP 型病例中均未发现 LHA 发生癌症。 1例R-UP型（3例中1例，33.3%）和1例混合型（2例中1例，50%），在UP右侧发现癌侵犯LHA，需要联合切除受累LHA。结论仅沿左肝管走行的R-UP型LHA，当延伸到左肝管时，很容易被右侧为主的PHC累及。肝胆外科医生应认识到这种解剖变异，并仔细评估 LHA 的运行过程，以便在 PHC 右侧肝切除术中成功实施 R0 切除。
BackgroundFull understanding of the hilar anatomy is crucial for successful surgical resection of perihilar cholangiocarcinoma (PHC).MethodsThe three-dimensional positional relationship between the left hepatic artery (LHA) and the umbilical portion of the left portal vein (UP) was evaluated using multidetector-row computed tomography (CT) in 58 consecutive patients who underwent right-sided hepatectomy for Bismuth–Corlette IIIa or IV tumors. The positional relationship of the LHA related to UP was classified into the following three types: L-UP type, LHA runs into the left lateral section (LLS) from the left caudal side of the UP; R-UP type, LHA runs into the LLS from the right cranial side of the UP; and combined type, one branch of the LHA runs into the LLS from the right cranial side of the UP, and the other from the left caudal side of the UP.ResultsL-UP-type LHA was observed in 53 cases (91.4 %), R-UP type in three cases (5.2 %), and combined type in two cases (3.4 %). No cancer involvement of the LHA was seen in any cases with L-UP type. In one case with R-UP type (one of three; 33.3 %) and one case with combined type (one of two, 50 %), cancer invasion to the LHA was observed at the right side of the UP, requiring combined resection of the involved LHA.ConclusionsR-UP-type LHA running just along the left hepatic duct may be easily involved by right-side predominant PHC when extending to the left hepatic duct. Hepatobiliary surgeons should recognize this anatomical variant and carefully evaluate the running courses of LHA to successfully perform R0 resection in right-sided hepatectomy for PHC.