Study On The Hilar Plates Anatomy And Tissue Structure

PartⅠ:The anatomy and clinical application of Hilar plateObjective:To study the anatomy and clinical application of Hilar plate.Methods:To observe the tissue space between hilar plate with the bile duct,portal vein and hepatic artery,firstly we anatomy three normal livers and five livers with cirrhosis,and then measure and record the width and depth of every trunk of hilar plate.24 hemihepatectomy cases were divided in two groups,total hepatic vascular exclusion and selective hepatic vascular exclusion through hilar plate.Finally we record and compare blood loss,surgery time,liver function of two groups after operation and time of stay in hospital.Results:As to hilar plate of three normal cases,the average of left main trunk width is 1.73cm,depth is 1.53cm;the mean value of left inner lobe truck width and depth was 1.3cm and 1.07cm respectively; the average of superior segment width and depth of left external lobe was 1.07cm and 0.83cm;the width and depth of left external lobe is 0.97cm and 0.7cm;the average of right main trunk width is 2.07cm,depth is 1.73cm;the mean value of right posterior trunk width and depth was 1.3cm and 1.3cm respectively;the average of right anterior trunk width and depth was 1.47cm and 1.1cm.In five cirrhosis cases of Hilar plate,the average of left main trunk width is 1.92cm,depth is 1.16cm;the mean value of left inner lobe truck width and depth was 1.08cm and 0.94cm respectively;the average of superior segment width and depth of left external lobe was 1.06cm and 0.78cm;the width and depth of left external lobe is 0.9cm and 0.68cm;the average of right main trunk width is 1.98cm,depth is 1.62cm;the mean value of right posterior trunk width and depth was 1.14cm and 1.12cm respectively;the average of right anterior trunk width and depth was 1.16cm and 1.04cm.Tissue space and location of hilar plate in normal and cirrhosis liver were relatively invariant.The length difference of stay in hospital of selective hepatic vascular exclusion group through hilar plate and total hepatic vascular exclusion group after liver resection was not significant(p＞0.05).In aspect of the operative time,blood loss and liver function,the former was better than the latter(p＜0.05).Conclusions:①Hilar plate is a plate of fibrous tissue.②The Hilar plate in cirrhosis and normal liver is almost same in every anatomical respect.③There is one clear gap and negligible communicating branches between hilar plate and intrahepatic pipes.④Isolating hilar plate can effectively drop the height of the hepatic portal bile duct, particularly in cases of bile duct cancer and calculus of intrahepatic duct.⑤The technology of selectively blocking blood through hilar plate is secure,viable and easy to master.In whole,it deserve clinical study and use.PartⅡ:Study on the tissue structure and Clinical Significance of Hilar plateObjective:To investigate the hilar plate of nerve tissue,blood vessels,lymphatic and the organizational structure and to study the clinical significance of the hilar plate during the cholangiocarcinoma tumor metastasis.Methods:To observe the presence and distribution of blood vessels,nerve and lymphatic of the hilar plate and the distribution and metastasis of tumor,we use HE staining method to study three normal livers and two cases of bile duct cancer.Results:Hilar plate contains lymphatic,blood and nerve tissues.There was negligible small branch of blood vessels between the liver and hilar plate.Fibrous tissue is the main composition of hilar plate.In one case of cholangiocarcinoma,the metastasis to the distant of tumor cells along the lymphatic vessels,blood vessels and nerves is not typical.Conclusion:Nerves,lymph is the main channels of cholangiocarcinoma's metastasis.It is clear that Hilar plate contains nerves, lymphatic vessels and blood vessel.Hilar plate may play some important roles during the metastasis of cholangiocarcinoma.