Kiss Mátyás, Deshpande Rahul R, Nemeskéri Ágnes, Nguyen Tien T, Kürti Zsuzsanna, Kovács Sándor, Pápai Zsolt, Németh Károly, Szuák András, Dudás Ibolyka, Kóbori László
Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
Department of Hepatobiliary Surgery, Manchester Royal Infirmary, Manchester, UK.
Pediatr Transplant. 2015 Aug;19(5):510-6. doi: 10.1111/petr.12468. Epub 2015 Apr 23.
Multiple duct anastomoses during LLS transplantation increase the incidence of biliary complications. The optimal plane of hepatotomy that results in the least number of bile ducts at the surface was investigated according to LHD variations. Ducts of 30 human livers were injected with resin and LHD branching on 3D-CT reconstructions were analyzed. Ducts on the virtual hepatotomy surface were estimated in three splitting lines. Variations with subtypes were described. Ia (66.7%): ducts from segments (S.) II-III form a common trunk and S.IV duct joins it. Ib (10%): common trunk formed by ducts from S.II-S.III while S.IV duct joins the common hepatic duct. IIa (16.67%): S.IV duct drains into S.III duct. IIc (3.33%): S.IV duct drains into both S.II and S.III ducts. III (3.33%): trifurcation of S.II, S.III and S.IV ducts. When the virtual hepatotomy line was on the FL, there was a single duct for the anastomosis in 30% of cases but two, three, or four ducts in 53.3%, 10%, and 3.3%, respectively. Division 1 cm to the right of the FL resulted in one duct (70%), but S.IV duct injury may occur. LLS hepatotomy should not necessarily be performed along the FL. Variations must be taken into consideration to minimize the number of biliary anastomoses during liver implantation.
左外侧段（LLS）移植术中多个胆管吻合会增加胆系并发症的发生率。根据左肝管（LHD）变异情况，研究了能使肝表面胆管数量最少的最佳肝切开平面。对30例人体肝脏的胆管注入树脂，并分析三维CT重建图像上的LHD分支情况。在三条虚拟肝切开面上估计胆管数量，并描述其亚型变异。Ia型（66.7%）：来自Ⅱ-Ⅲ段的胆管形成一个共同主干，Ⅳ段胆管汇入该主干。Ib型（10%）：Ⅱ-Ⅲ段胆管形成共同主干，Ⅳ段胆管汇入肝总管。Ⅱa型（16.67%）：Ⅳ段胆管汇入Ⅲ段胆管。Ⅱc型（3.33%）：Ⅳ段胆管同时汇入Ⅱ段和Ⅲ段胆管。Ⅲ型（3.33%）：Ⅱ、Ⅲ、Ⅳ段胆管呈三叉状分支。当虚拟肝切开线位于镰状韧带（FL）时，30%的病例吻合时只有一根胆管，但分别有53.3%﹑10%和3.3%的病例有两根、三根或四根胆管。在FL右侧1cm处进行分割会有一根胆管（70%），但可能会发生Ⅳ段胆管损伤。LLS肝切开术不一定非要沿着FL进行。在肝移植过程中，必须考虑变异情况以尽量减少胆管吻合的数量。
