Abstract
The portal triad around the hepatic hilum, including the caudate lobe, was investigated using 106 adult cadavers. The portal vein showed regular branching at the hepatic hilum. The round ligament was attached mainly to the pars umbilicalis of the left branch of the portal vein (81.3%), especially to its lower portion (64.6%). Typical extrahepatic branching of the hepatic artery was noted in 67% of the cadavers. Intrahepatic branching of the middle and left hepatic arteries showed some variations in 9.4% and 12.5% of the cadavers, respectively. The cystic artery originated from the right hepatic artery in 84.4% of the cadavers, and a dual cystic artery was observed in 30.2%.
An aberrant hepatic duct, previously reported as an accessory hepatic duct, was observed in 9.0% of the cadavers; each entered the common hepatic duct on the right side. With reference to the course of bile duct and hepatic artery, the middle hepatic artery traversed the left main hepatic duct anteriorly in 13.5% of the cadavers, and ran partly in front of the duct in 52.0%. Furthermore, the right hepatic artery or its branches traversed the right main hepatic duct anteriorly in 9.4% of the cadavers and ran partly in front of the duct in 38.5%. The caudate lobe is supplied by both the right and left branches of the portal triad, mainly by the left. The caudate process is mainly supplied by the posterior branches of the portal triad, being continuous with the posterior segment of the liver.
Résumé
L'anatomie du hile du foie et du lobe caudé a été étudiée sur 106 cadavres. La division de la veine porte au niveau du hile est toujours régulière. Le ligament rond se rattache principalement à la pars umbilicalis de la branche gauche de la veine porte (81.3%) et plus particulièrement à sa partie inférieure (64.6%). La division extra-hépatique classique de l'artère hépatique a été observée dans 67% des cas. La division intra-hépatique des artères hépatiques moyenne et gauche a été constatée respectivement dans 9.4% et 12.5% des cas. L'artère cystique prend son origine dans 84.4% des cas au niveau de la branche droite de l'artère hépatique et dans 30.2% des cas l'artère cystique est double.
Un canal bilaire aberrant, considéré auparavant comme un canal biliaire associé, a été observé dans 9% des cas, le canal aboutissant toujours au bord droit du canal hépatique. En ce qui concerne le trajet du canal biliaire et de l'artère hépatique, l'artère hépatique moyenne croise en avant le canal hépatique gauche dans 13.5% des cas, et court partiellement en avant de lui dans 52% des cas. L'artère hépatique droite ou ses branches croisent en avant le canal hépatique droit dans 9.4% des cas et courént partiellement en avant de lui dans 38.5% des cas. Le lobe caudé dépend à la fois des branches droites et des branches gauches de la triade portale mais principalement de ces dernières. Ce sont les branches postérieures de ces éléments qui le concernent ainsi que le segment postérieur du foie.
Resumen
Se realizó una investigación de la triada portal alrededor del hilio hepático, incluyendo el lóbulo caudado, en 106 cadáveres adultos. La vena porta mostró ramificaciones regulares al nivel del hilio hepático. El ligamiento redondo apareció unido principalmente al pars umbilicalis de la rama izquierda de la vena porta (81.3%), especialmente sobre su portión inferior (64.6%). La ramificación extrahepática, típica de la arteria hepática, fué observada en el 67%. La ramificación intrahepática de las arterias hepáticas media e izquierda mostró algunas variaciones en 9.4% y 12.5% respectivamente. La arteria cistica se originó en la arteria hepática derecha en 84.4% de los casos y se observó una arteria cística doble en 30%.
Un canal hepático aberrante, previamente reportado como un canal hepático accesorio, fué observado en 9.0%; cada cual entraba al canal hepático comÚn sobre el lado derecho. En cuanto al curso del conducto biliar y la arteria hepática, la arteria hepática media cruzaba el canal hepático izquierdo por su aspecto anterior en 13.5% y corría parcialmente enfrente del canal en 52%. La arteria hepática derecha o sus ramas cruzaban el canal hepático derecho por su aspecto anterior en 9.4% y corría parcialmente enfrente del canal en 38.5%. El lóbulo caudado es irrigado por las dos ramas, derecha e izquierda, de la triada portai, especialmente por la izquierda. El proceso caudado es irrigado principalmente por las ramas posteriores de la triada portai, siendo anatómicamente continuo con el segmento posterior del hígado.
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Mizumoto, R., Suzuki, H. Surgical anatomy of the hepatic hilum with special reference to the caudate lobe. World J. Surg. 12, 2–10 (1988). https://doi.org/10.1007/BF01658479
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DOI: https://doi.org/10.1007/BF01658479