Hosokawa Isamu, Ohtsuka Masayuki, Yoshitomi Hideyuki, Furukawa Katsunori, Miyazaki Masaru, Shimizu Hiroaki
Department of Surgery, Teikyo University Chiba Medical Center, 3246-3, Anesaki, Ichihara, Chiba, 299-0111, Japan.
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Surg Radiol Anat. 2019 May;41(5):589-593. doi: 10.1007/s00276-018-2135-9. Epub 2018 Nov 29.
Left trisectionectomy (LT) extending to the segment I with bile duct resection for perihilar cholangiocarcinoma (PHC) is a technically demanding procedure with high morbidity. Liver transection during LT is generally conducted to expose the right hepatic vein (RHV) on the remnant side. In clinical practice, we have often encountered a discrepancy between the theoretical RHV-oriented plane and the actual right intersectional plane.
To enable anatomical LT safely, the three-dimensional right intersectional transection plane based on portal inflow was investigated using multidetector-row computed tomography, and it was compared to the theoretical RHV-oriented plane in 100 patients with hepatobiliary disease.
The posterior portion of RHV just below the diaphragm was supplied by the dorsal portal branches of segment VIII in 85 cases of 100 (85.0%). The median volume of this portion was 82 mL (25-169 mL). On the other hand, the anterior region of the peripheral RHV was supplied by a few small ventral portal branches of segment VI in 24 of 90 cases (26.7%). The median volume of this portion was 53 mL (20-104 mL). In ten cases with a large inferior RHV, the RHV trunk was relatively short and did not reach the caudal part of the liver.
The portal inflow-oriented right intersectional plane does not coincide with the RHV-oriented plane in most cases. The cranial part of the actual transection plane becomes hollow, whereas the caudal part is protruded in relation to the RHV. Hepatobiliary surgeons should recognize this complicated transection plane to avoid postoperative complications when performing LT for PHC.
对于肝门部胆管癌（PHC）行左半肝切除术（LT）并延伸至Ⅰ段且进行胆管切除是一项技术要求高且并发症发生率高的手术。LT术中肝实质离断通常是为了暴露残肝侧的右肝静脉（RHV）。在临床实践中，我们经常遇到理论上以RHV为导向的平面与实际右交界面之间存在差异。
为了安全地进行解剖性LT，使用多排螺旋计算机断层扫描研究基于门静脉血流的三维右交界面，并将其与100例肝胆疾病患者的理论RHV导向平面进行比较。
100例中有85例（85.0%）膈下RHV后部由Ⅷ段的背侧门静脉分支供血。该部分的中位体积为82 mL（25 - 169 mL）。另一方面，90例中有24例（26.7%）外周RHV前部由Ⅵ段的一些小的腹侧门静脉分支供血。该部分的中位体积为53 mL（20 - 104 mL）。在10例下腔RHV较大的病例中，RHV主干相对较短，未到达肝脏尾状部。
在大多数情况下，基于门静脉血流的右交界面与RHV导向平面不一致。实际离断面的头侧部分呈中空状，而尾侧部分相对于RHV突出。肝胆外科医生在对PHC进行LT时应认识到这种复杂的离断面，以避免术后并发症。
