La Greca G, Racalbuto A, Puleo S, Licata A
Istituto di I Clinica Chirurgica, Università di Catania, Italia.
Eur J Surg Oncol. 1996 Feb;22(1):97-101. doi: 10.1016/s0748-7983(96)91814-4.
The liver and the biliary tract are rich in anatomical variations, knowledge of which is important for the surgeon. A case of an anatomical variation is reported, which allowed easy and oncologically correct resection of a Klatskin tumour. The variation consisted of abnormally long right and left extrahepatic ducts and an abnormal distal bifurcation, with a cystic duct joining the distal end of the right duct. A favourable modification of surgical strategy could be obtained by an oncologically correct resection of a Klatskin tumour avoiding a liver resection and also allowing easy reconstruction. Complete biliary exposure was necessary to reveal the rare, pre-operatively unrecognized, but favourable situation. In the absence of clear contraindications extended biliary dissection is to be recommended to avoid errors in the evaluation of the resectability of hilar biliary cancers.
肝脏和胆道存在丰富的解剖变异，外科医生了解这些变异非常重要。本文报告了一例解剖变异病例，该变异使得肝门部胆管癌的切除变得容易且符合肿瘤学原则。该变异包括肝外左右胆管异常延长以及远端分支异常，胆囊管连接右肝管远端。通过符合肿瘤学原则的肝门部胆管癌切除，避免肝切除并实现轻松重建，可对手术策略进行有利调整。为了发现这种罕见的、术前未被识别但有利的情况，需要完全暴露胆管。在没有明确禁忌证的情况下，建议进行广泛的胆管解剖，以避免在评估肝门部胆管癌可切除性时出现错误。
