Toyosaka A, Okamoto E, Okasora T, Nose K, Tomimoto Y, Seki Y
First Department of Surgery, Hyogo College of Medicine, Japan.
J Pediatr Surg. 1994 Jul;29(7):896-9. doi: 10.1016/0022-3468(94)90011-6.
Dissection at the porta hepatis is the crucial step in surgery for biliary atresia. The authors describe their procedure for extensively dissecting the porta hepatis. The technique is based on an anatomic cast corrosion of the human liver, and the portal vein serves as the landmark for dissection. Lateral dissection at the hepatic hilus is critical to the procedure. On the right side, the anterior portal branches are dissected to the bifurcation of the S5 and S7 segmental portal branches, over the bifurcation of the anterior and posterior portal branches. On the left side, the liver parenchyma, which bridges the umbilical point, is sectioned, and the left portal branch is dissected to the umbilical point over the pars transversalis and taped. The fibrous mass that lies within the confines of the portal branches, including the dorsal aspect, is transected completely. This procedure was performed in 16 infants; the jaundice cleared in 93.7%.
肝门部解剖是胆道闭锁手术的关键步骤。作者描述了他们广泛解剖肝门部的手术方法。该技术基于人体肝脏的铸型腐蚀，门静脉作为解剖的标志。肝门部的外侧解剖对该手术至关重要。在右侧，将前门静脉分支解剖至S5和S7段门静脉分支的分叉处，位于前后门静脉分支的分叉上方。在左侧，切开连接脐点的肝实质，将左门静脉分支解剖至脐点，经过横部并进行结扎。完全横断位于门静脉分支范围内（包括背侧）的纤维组织团块。该手术在16例婴儿中进行；93.7%的患儿黄疸消退。
