Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.
Am J Surg. 2011 Oct;202(4):441-8. doi: 10.1016/j.amjsurg.2010.06.034. Epub 2011 Aug 20.
A detailed evaluation of portal triad structures, especially the biliary anatomy at the hepatic hilus, is essential to ensure curative resection for hilar cholangiocarcinoma.
Patients underwent 3-dimensional analysis using multidetector row computed tomography cholangioportography preoperatively. The number of bile duct orifices in the cut end of the hilar plate was estimated and compared with the actual number of bile ducts. Furthermore, the estimated length of the surgical margin and its relationship to the pathological margin status was evaluated.
The number of bile duct orifices was correctly estimated in 14 of 19 patients. Of 18 hepatic ducts in which the estimated length of the hepatic side surgical margin was calculated 17 hepatic ducts (94.4%) were diagnosed pathologically as margin negative.
This investigatory technique has the advantages of precise visualization of anatomic structures and multidirectional assessment of biliary branches and vessels, allowing improved operative planning for the treatment of hilar cholangiocarcinoma.
详细评估门脉三联体结构，特别是肝门部胆管解剖，对于确保肝门部胆管癌的根治性切除至关重要。
术前对患者进行多排螺旋 CT 胆胰管成像三维分析。估计肝门板切端胆管口的数量，并与实际胆管数量进行比较。此外，评估估计的手术切缘长度及其与病理切缘状态的关系。
19 例患者中有 14 例正确估计了胆管口的数量。在计算肝侧手术切缘估计长度的 18 个肝管中，17 个肝管（94.4%）病理诊断为切缘阴性。
该研究技术具有精确显示解剖结构和多方位评估胆管分支和血管的优点，可改善肝门部胆管癌的手术治疗计划。
