Vellar I D
Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia.
Aust N Z J Surg. 1999 Nov;69(11):816-20. doi: 10.1046/j.1440-1622.1999.01702.x.
Cholecystectomy remains the only satisfactory treatment for symptomatic gall bladder stones. Unfortunately, in some cases the operation is complicated by vasculobiliary injury. The present study was undertaken to investigate the blood supply of the normal biliary system, to simulate vasculobiliary injuries described after cholecystectomy, and to determine the possible effects of the vascular injury on biliary reconstruction.
The blood supply of the biliary system in nine normal livers was investigated by injection of the coeliac axis and superior mesenteric arteries with coloured gelatin. The specimens were dissected under magnification and drawings prepared. Injection dissection studies were also carried out in eight specimens in which various vasculobiliary injuries encountered after cholecystectomy were simulated.
The bile ducts possess an arterial plexus on their surface which is supplied from below by ascending marginal vessels derived from the postero-superior pancreaticoduodenal artery. These marginal vessels end above in the right hepatic artery or its branches. The right and left hepatic ductal systems are supplied by the right and left hepatic arteries and their sectoral or segmental branches. The right and left hepatic arteries communicate freely via the hilar plate arterial plexus. This collateral system allows the blood supply to the right hepatic duct to be maintained after ligation of the right hepatic artery and interruption of the common hepatic duct or excision of the confluence.
A knowledge of the blood supply of the normal biliary system and the collateral hilar plate arterial plexus forms the anatomical foundation for successful reconstructive surgery, not only in vasculobiliary injuries following cholecystectomy, but also for a wide range of hepatobiliary procedures.
胆囊切除术仍然是治疗有症状胆囊结石的唯一令人满意的方法。不幸的是，在某些情况下，手术会因血管胆管损伤而变得复杂。本研究旨在调查正常胆道系统的血液供应，模拟胆囊切除术后描述的血管胆管损伤，并确定血管损伤对胆道重建的可能影响。
通过向腹腔干和肠系膜上动脉注射彩色明胶，研究了9个正常肝脏中胆道系统的血液供应。在放大条件下解剖标本并绘制图谱。还对8个标本进行了注射解剖研究，模拟了胆囊切除术后遇到的各种血管胆管损伤。
胆管表面有一个动脉丛，由来自胰十二指肠后上动脉的升支边缘血管从下方供血。这些边缘血管在上方汇入右肝动脉或其分支。左右肝管系统分别由左右肝动脉及其扇形或节段性分支供血。左右肝动脉通过肝门板动脉丛自由交通。这个侧支系统使得在结扎右肝动脉、中断肝总管或切除汇合部后，右肝管的血液供应得以维持。
了解正常胆道系统的血液供应和肝门板动脉侧支丛，不仅为胆囊切除术后血管胆管损伤的成功重建手术，也为广泛的肝胆手术奠定了解剖学基础。
