Kitamura H, Mori T, Arai M, Tsukada K, Numata M, Kawasaki S
Department of Surgery, NTT Nagano Hospital, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2511-4.
BACKGROUND/AIMS: Intrahepatic ducts from the left lateral segment of the liver are generally considered to run from the cranial to the umbilical portion of the left portal vein. This understanding often limits surgical exploration of the left hepatic ducts during both curative and palliative surgical procedures. The prevalence of ducts from the lateral segment running caudally to the umbilical portion was studied retrospectively on computed tomography (CT) films, and its clinical implications were evaluated.
One hundred and sixty-six DIC (drip infusion cholangiography) CT and 30 post-PTCD (percutaneous transhepatic cholangio-drainage) CT films taken during 4 consecutive years were reviewed giving special consideration to whether the ducts from the left lateral segment of the liver run caudal to the umbilical portion of the left portal vein.
Corresponding variation was found in 3.6% of the DIC-CT examinations and in 3.3% of the CT examination after PTCD, respectively.
The incidence of caudal left hepatic ducts with respect to the umbilical portion of the left portal vein was higher than expected from clinical experience. These results emphasize that more careful planning is necessary prior to hepatobiliary surgery.
背景/目的：肝脏左外叶的肝内胆管通常被认为是从肝门静脉左支的头侧段延伸至脐部段。这种认知常常限制了在根治性和姑息性手术过程中对左肝管的手术探查。我们通过回顾计算机断层扫描（CT）影像，对左外叶胆管向尾侧延伸至脐部段的发生率进行了研究，并评估了其临床意义。
回顾了连续4年期间拍摄的166例滴注法胆管造影CT（DIC）影像以及30例经皮经肝胆道引流（PTCD）术后的CT影像，特别关注肝脏左外叶的胆管是否向尾侧延伸至肝门静脉左支的脐部段。
分别在3.6%的DIC-CT检查和3.3%的PTCD术后CT检查中发现了相应变异。
相对于肝门静脉左支的脐部段而言，左肝管尾侧段的发生率高于临床经验预期。这些结果强调了在肝胆手术前需要更谨慎地规划。
