Applied Anatomy Of The Hepatic Portal Area

The pathological mechanisms of cholangiocarcinoma as well as surgical methodshave made significant progress since Durand Fardel first reported cholangiocarcinomacases in1840. Cholangiocarcinoma often causes more serious complications such as bileduct obstruction, liver failure, sepsis, seriously affecting the quality of life of patients andbringing a heavy financial burden to families and society. In recent years, the incidence ofcholangiocarcinoma tends to rise, even double in some areas.Although bile duct cancer hasa low incidence compared with other abdominal malignancies, cholangiocarcinoma is stilla malignant that is more difficult for surgical treatment, and bile duct cancer surgery is stilla more difficult problem for the surgeon to overcome. As the less cure and secure rate ofbile duct cancer surgery, the applied anatomy of the bile duct cancer-related area, can helpthe surgeon to choose the correct surgical approach and improve the efficacy of bile ductcancer surgery.ObjectiveTo observe and measure the diameter, origin, course, branches, and adjacentrelationship of the bile duct, hepatic artery, hepatic portal vein of the hepatic portal pipelinesystem,and the anatomical structure of the hepatic portal area, the caudate lobe andpancreatic head area were dissected and observed to obtain data on anatomy of thehepatic portal pipeline system, and set a reference for programming surgery, the choosingof surgical approach and solving difficulties during operation of the bile duct cancer.MethodsThirty cases of adult cadavers (male16cases,female14cases, no liver and bile ductlesions) were chosen to measure the diameter and length of common bile duct, cystic duct,common hepatic duct, and the distance from liver parenchyma to the bifurcation of properhepatic artery, the portal vein and the hepatic duct, and the length of the left and righthepatic duct and the angle of them to the common hepatic duct. And all obtained data wereanalysized statistically. ResultMeasurements from30cadavers showed: the length of common bile duct, cystic duct,hepatic duct, left hepatic duct,hepatic duct is72.5±9.2mm,25.4±3.2mm,22.6±3.4mm,11.0±1.2mm; and their diameter is7.4±0.7mm,4.2±0.5mm,5.7±0.6mm,4.7±0.3mm,3.8±0.4mm respectively. The length of hepatic artery, cystic artery, left and right hepaticartery is26.3±1.2mm,22.4±2.1mm,15.2±1.2mm,13.6±2.3mm,28.2±3.5mm; and theirouter diameter is5.1±0.4mm,3.7±0.3mm,1.8±0.3mm,2.5±0.5mm,2.9±0.6mm respec-tively. The angle of right and left hepatic duct to the common hepatic duct is145°±7.3°,109°±6.8°respectively; the distance of the bifurcation of proper hepatic artery, the portalvein, the hepatic duct to liver parenchyma is4.3±0.8mm,6.5±1.1mm,11.2±2.3mm. In3cases from30,left and right hepatic duct are fully exposed outside the liver accounting for10%;in20, partly exposed accounting for66.7%; and in7, fully in the liver accounting for23.3%. Three cases indicated confluence of right and left hepatic duct, counting10%; andthe accessory hepatic duct,middle hepatic artery and the accessory hepatic artery werefound in3,6and7cases, counting for10%,20%and23.3%respectively. One with twocystic artery, and in one case left hepatic artery originating from the gastroduodenal artery,suggesting a higher variations.ConclusionBile duct system from30cadavers showed higher rate of variation, such as lowconfluence of bile duct, middle hepatic artery, accessory hepatic artery. In the bile ductcancer surgery, surgeon should pay more attention to the existence of variation to avoidaccidents.