Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
World J Surg. 2020 Dec;44(12):4231-4235. doi: 10.1007/s00268-020-05753-2. Epub 2020 Aug 28.
In "anatomic" right hepatic trisectionectomy for advanced perihilar cholangiocarcinoma, the left hepatic duct is divided at the left side of the umbilical portion (UP) of the left portal vein (LPV). For this reason, the left hepatic duct is completely detached from the UP after all division of the portal branches arising cranially from the UP. However, little is known about these thin portal branches.
Using 3D imaging processing software, we examined the portal branches arising cranially from the UP of the LPV in 100 patients who underwent multidetector row computed tomography (MDCT). Special attention was paid to the portal branch running to the left lateral sector, designated as the left cranio-lateral branch.
The left cranio-lateral portal branch number was 0 in 57 patients, 1 in 32 patients, and 2 in 11 patients. Thus, 54 left cranio-lateral branches were identified, arising from near the cul-de-sac of the UP, from near the elbow of the LPV, or from the UP trunk. The median volume of the territory supplied by the left cranio-lateral portal branch was 21 mL (range, 5-47 mL), and the median ratio to the left lateral sector was 11.8% (range, 1.7-25.0%).
Approximately 40% of patients had the left cranio-lateral portal branches arising cranially from the UP and running to the left lateral sector. When planning anatomic right hepatic trisectionectomy, the presence or absence of this branch should be checked by using 3D imaging with MDCT.
在针对高位肝门部胆管癌的“解剖性”右三叶切除术，左肝管在左门静脉（LPV）脐部（UP）的左侧被切断。由于这个原因，在所有发自 UP 颅侧的门静脉分支被切断后，左肝管完全与 UP 分离。然而，对于这些细小的门静脉分支，人们知之甚少。
我们使用三维成像处理软件，对 100 例行多排螺旋 CT（MDCT）检查的患者的 LPV UP 发出的门静脉分支进行了检查。特别关注了向左外侧段走行的门静脉分支，将其命名为左颅外侧支。
57 例患者的左颅外侧支为 0 支，32 例患者为 1 支，11 例患者为 2 支。因此，共发现 54 支左颅外侧支，发自 UP 的盲端附近、LPV 的肘状部附近或 UP 主干。左颅外侧支供应区域的体积中位数为 21 毫升（范围 5-47 毫升），中位数占左外侧段的比例为 11.8%（范围 1.7-25.0%）。
约 40%的患者发自 UP 颅侧并向左外侧段走行的左颅外侧支。在计划解剖性右三叶切除时，应通过 MDCT 的三维成像来检查该分支的存在与否。
