Clipet Fabien, Rebibo Lionel, Dembinski Jeanne, Yzet Thierry, Vilgrain Valérie, Regimbeau Jean-Marc
Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, F-80054, Amiens cedex 01, France.
Department of Radiology, Amiens University Medical Center, Avenue René Laennec, F-80054, Amiens cedex 01, France.
Clin Anat. 2019 Apr;32(3):328-336. doi: 10.1002/ca.23315. Epub 2019 Jan 7.
Glissonian approach has been described as a selective vascular clamping procedure during hepatectomy based on external anatomical landmarks. Anatomical variations of the right Glissonian pedicle have been identified with an increased risk of clamping failure during Glissonian approach. The objective of this study was to characterize the anatomical variations of the right Glissonian pedicle at risk of clamping failure during right hepatectomy. This was a retrospective analysis of abdominal multiphasic CT and routine 3D reconstruction (n = 346). Anatomical variations at risk of clamping failure were Types 1 to 3 (Madoff's classification) and an angle of less than 50° between the portal vein and the left portal vein. Primary objective was the risk of right Glissonian pedicle clamping failure. Secondary objectives were the rate of normal anatomy, the rate of variations, and the rate of incomplete or extended clamping. Normal anatomy was found in 245 patients (71%). Anatomical variations were as follows: Type 1: 11%, Type 2: 17%, Type 3: 0.8%, Type 4: 0%. Angle variation less than 50° was observed in 4.5%. The risk of selective clamping failure was 34%. Extension of clamping was observed in 16%, while incomplete clamping was observed in 17.8%. Failure of right Glissonian pedicle clamping was predictable in 34% of cases while 71% of patients presented normal portal vein anatomy. Clin. Anat. 32:328-336, 2019. © 2018 Wiley Periodicals, Inc.
肝蒂入路已被描述为基于外部解剖标志的肝切除术中一种选择性血管钳夹术。右肝蒂的解剖变异已被确认，这增加了肝蒂入路时钳夹失败的风险。本研究的目的是描述右肝切除术中右肝蒂有钳夹失败风险的解剖变异。这是一项对腹部多期CT和常规三维重建（n = 346）的回顾性分析。有钳夹失败风险的解剖变异为1至3型（马多夫分类法）以及门静脉与左门静脉之间夹角小于50°。主要目的是右肝蒂钳夹失败的风险。次要目的是正常解剖结构的比例、变异的比例以及不完全或延长钳夹的比例。245例患者（71%）为正常解剖结构。解剖变异情况如下：1型：11%，2型：17%，3型：0.8%，4型：0%。观察到夹角变异小于50°的占4.5%。选择性钳夹失败的风险为34%。观察到延长钳夹的占16%，而不完全钳夹的占17.8%。34%的病例中右肝蒂钳夹失败是可预测的，而71%的患者门静脉解剖结构正常。《临床解剖学》32:328 - 336，2019年。© 2018威利期刊公司。
