Kawarada Y, Das B C, Onishi H, Taoka H, Gadzijev E M, Ravnik D, Tabata M, Isaji S
First Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
J Hepatobiliary Pancreat Surg. 2000;7(5):480-5. doi: 10.1007/s005340070018.
In some patients, hilar bile duct carcinoma can easily spread to the bile duct branches of the caudate lobe (B1) as well as to the bile duct branches of the medial segment (B4), and resection of the inferior portion of the medial segment (S4a) is then required. It is therefore important to understand the detailed anatomy of the B4, its confluence patterns, and its relation to the B1 in order to be able to identify such patients. The confluence pattern of the B4 was studied in 141 specimens (68 adult cadavers and 73 liver casts) and the distance between the left bile duct branches of the caudate lobe (B11) and the B4 was measured in 56 of the 73 casts in which both B11 and B4 were present. Two main gross types of B4 were recognized: type I, in which B4 joined the left hepatic duct (LHD) close to the hilar confluence (35.5%), and type II, in which B4 joined the LHD far from the hilar confluence (54.6%). Analysis of the relationship between B11 and B4 revealed a mean distance between B11 and B4 of 8 mm in type 1, and 17 mm in type II. When the distance is less than 10 mm, B11 and B4 are considered to be located very close to each other, and in such individuals hilar bile duct carcinoma can infiltrate the B4 easily, thereby necessitating the resection of S4a, together with a caudate lobectomy for curative resection. Also, the confluence pattern of the B4 often creates a problem when the LHD is divided and reconstructed during hepatectomy, because of the numerous anatomical variations of the B4 itself. We therefore concluded that a good anatomical knowledge of the B4 and its relation to the B11 is essential in making the decision to perform S4a resection in selected patients with hilar bile duct carcinoma with the aim of curative resection.
在一些患者中，肝门部胆管癌很容易扩散至尾状叶胆管分支（B1）以及内侧段胆管分支（B4），进而需要切除内侧段（S4a）的下部。因此，了解B4的详细解剖结构、其汇合模式以及与B1的关系，对于识别此类患者至关重要。对141个标本（68具成人尸体和73个肝脏铸型）研究了B4的汇合模式，并在73个同时存在B11和B4的铸型中的56个中测量了尾状叶左胆管分支（B11）与B4之间的距离。识别出B4的两种主要大体类型：I型，B4在靠近肝门汇合处汇入左肝管（LHD）（35.5%）；II型，B4在远离肝门汇合处汇入LHD（54.6%）。对B11与B4之间关系的分析显示，I型中B11与B4之间的平均距离为8mm，II型中为17mm。当距离小于10mm时，B11和B4被认为彼此位置非常靠近，在此类个体中，肝门部胆管癌很容易浸润B4，从而需要切除S4a以及行尾状叶切除术以进行根治性切除。此外，由于B4本身存在众多解剖变异，在肝切除术中对LHD进行离断和重建时，B4的汇合模式常常会引发问题。因此，我们得出结论，对于旨在进行根治性切除的选定肝门部胆管癌患者，要决定是否进行S4a切除，充分了解B4及其与B11的关系至关重要。
