Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman M M, Matsuno S
First Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-8574 Sendai, Miyagi, Japan.
Surg Endosc. 2000 Feb;14(2):141-4. doi: 10.1007/s004649900086.
The extrahepatic biliary tree with the exact anatomic features of the arterial supply observed by laparoscopic means has not been described heretofore. Iatrogenic injuries of the extrahepatic biliary tree and neighboring blood vessels are not rare. Accidents involving vessels or the common bile duct during laparoscopic cholecystectomy, with or without choledocotomy, can be avoided by careful dissection of Calot's triangle and the hepatoduodenal ligament.
We performed 244 laparoscopic cholecystectomies over a 2-year period between January 1, 1995 and January 1, 1997.
In 187 of 244 consecutive cases (76.6%), we found a typical arterial supply anteromedial to the cystic duct, near the sentinel cystic lymph node. In the other cases, there was an atypical arterial supply, and 27 of these cases (11.1%) had no cystic artery in Calot's triangle. A typical blood supply and accessory arteries were observed in 18 cases (7.4%).
Young surgeons who are not yet familiar with the handling of an anatomically abnormal cystic blood supply need to be more aware of the precise anatomy of the extrahepatic biliary tree.
迄今为止，尚未有通过腹腔镜手段观察到的具有确切动脉供应解剖特征的肝外胆管树的相关描述。肝外胆管树及邻近血管的医源性损伤并不罕见。在腹腔镜胆囊切除术中，无论是否进行胆总管切开，通过仔细解剖胆囊三角和肝十二指肠韧带，可避免涉及血管或胆总管的意外情况。
在1995年1月1日至1997年1月1日的两年间，我们共进行了244例腹腔镜胆囊切除术。
在244例连续病例中的187例（76.6%），我们在胆囊管前内侧、靠近哨兵胆囊淋巴结处发现了典型的动脉供应。在其他病例中，存在非典型动脉供应，其中27例（11.1%）在胆囊三角内无胆囊动脉。18例（7.4%）观察到典型的血液供应和副动脉。
尚未熟悉处理解剖结构异常的胆囊血液供应的年轻外科医生，需要更加了解肝外胆管树的确切解剖结构。
