Anatomy of the hepatic hilar area: the plate system |
| |
Authors: | Kawarada Y Das B C Taoka H |
| |
Institution: | (1) First Department of Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan, JP |
| |
Abstract: | To surgically manage hilar bile duct carcinoma successfully, it is important to be familiar with the principal anatomical
variations of the biliary and vascular components of the plate system in the hepatic hilar area, because all the variations
in the bile ducts and vessels occur in the plate system. The plate system consists of bile ducts and blood vessels surrounded
by a sheath. There are three plates in the hilar area: the hilar plate, the cystic plate, and the umbilical plate. The bile
duct and blood vessel branches penetrate the plate system and form Glisson's capsule in all segments of the liver, except
for the medial segment. The right hepatic duct is usually (in 53%–72% of individuals) formed by the union of the anterior
segmental duct and the posterior segmental duct in the hilar area. However, three other variations have been found in which
these segmental ducts do not form the right hepatic duct. Few anatomical variations have been identified in the left hepatic
duct, but confusion arises because of the variations in the medial segment ducts (B4) which join the left hepatic duct at
different sites. In 35.5% of individuals they join the hepatic duct in the vicinity of the hilar confluence (type I B4 anatomy),
and in 64.5% of individuals they join the left hepatic duct some distance away from the confluence (type II B4 anatomy). Because
B4 is very close to the hilar confluence in type I, hilar bile duct carcinoma can easily invade B4 and, for that reason, for
curative resection of hilar bile duct carcinoma, resection of S4a (the inferior part of the medial segment) should be considered
along with the resection of extrahepatic bile duct and caudate lobe. Variations in the portal vein and hepatic artery are
found in 16%–26% and 31%–33% of individuals, respectively. Because a considerable number of anatomical variations in the bile
ducts and vessels persist in the hilar area, and the reported proportions of the different variations vary, it is necessary
to have a good knowledge of the plate system and the variations in the bile ducts and blood vessels in the hilar area to perform
safe and curative surgery for hilar bile duct carcinoma.
Received: June 3, 2000 / Accepted: July 20, 2000 |
| |
Keywords: | Hilar plate Cystic plate Umbilical plate |
本文献已被 PubMed SpringerLink 等数据库收录! |
|