Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation
Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation
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DOI：
10.1097/01.sla.0000102934.93029.89
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发表时间：
2004-01-01
影响因子：
9
通讯作者：
Nimura, Y
中科院分区：
文献类型：
--
作者：
Ohkubo, M;Nagino, M;Nimura, Y
目的：评估应用于活体肝移植的胆管树的解剖变异。背景数据摘要：解剖变异是肝脏手术中的规则而不是例外。然而，很少有研究关注活体肝移植中胆管树的解剖变异与胆道重建的关系。方法：1992年11月至2002年6月，165例患者接受了大面积肝切除术并肝外胆管切除术。右半肝切除110例，左半肝切除55例。对手术标本中肝门处肝内胆管汇合模式进行研究。结果：右侧肝内胆管汇合模式分为7种类型。 7 种类型中的 4 种以及 110 个肝脏中的 29 个（26%）右肝管缺失。左肝内胆管的汇合模式分为4种类型。 4 种类型中的 1 种和 55 种肝脏中的 1 种（2%）缺乏左肝管。结论：在从没有右肝管的供体中获取右肝时，根据其与门静脉的关系，在移植物横切平面上将存在 2 个或更多胆管残端，以 3 种模式存在。准确了解肝脏汇合区的变化对于成功的活体肝移植至关重要。
Objective: To evaluate anatomic variations of the biliary tree as applied to living donor liver transplantation.Summary Background Data: Anatomic variability is the rule rather than the exception in liver surgery. However, few studies have focused on the anatomic variations of the biliary tree in living donor liver transplantation in relation to biliary reconstruction.Methods: From November 1992 to June 2002, 165 patients underwent major hepatectomy with extrahepatic bile duct resection; right-sided hepatectomy in 110 patients and left-sided hepatectomy in 55. Confluence patterns of the intrahepatic bile ducts at the hepatic hilum in the surgical specimens were studied.Results: Confluence patterns of the right intrahepatic bile ducts were classified into 7 types. The right hepatic duct was absent in 4 of the 7 types and in 29 (26%) of the 110 livers. Confluence patterns of the left intrahepatic bile ducts were classified into 4 types. The left hepatic duct was absent in 1 of the 4 types and in 1 (2%) of the 55 livers.Conclusions: In harvesting the right liver from a donor without a right hepatic duct, 2 or more bile duct stumps will be present in the plane of transection in the graft in 3 patterns based on their relation to the portal vein. Accurate knowledge of the variations in the hepatic confluence is essential for successful living donor liver transplantation.