三维立体腹腔镜下胆囊三角区胆囊动脉解剖结构观察及其临床意义

ANATOMY AND SIGNIFICANCE OF THE CYSTIC ARTERY WITHIN THE HEPATOBILIARY TRIANGLE WITH 3-DIMENSIONAL LAPAROSCOPE DEVICE

目的 了解胆囊三角区有关胆囊动脉的解剖 ,为 L C安全入路提供形态学依据。方法 全麻下 310例 L C患者 ,用三维立体腹腔镜对胆囊动脉在胆囊三角区解剖进行三维形态学观察。记录胆囊动脉数目 ,行经与毗邻结构的关系。结果 胆囊动脉在三角区内型 :1支 2 0 8例 ,2支 5 8例 ,3支 32例。三角区外型 :三角区内看不到明确血管 3例 ,胆囊动脉在胆囊管下方进入胆囊 5例 ,2例胆囊动脉从左至右横跨在胆总管前方进入胆囊 ,1例在胆囊管下粗大血管不能识别。炎症疤痕胆囊三角形态失常不能判断型 :3例。结论 胆囊三角区详实的胆囊动脉解剖特点及定位规律 ,提示后入路手术可行性 ,顺行性切除胆囊的优点在于准确辩认组织层次 ,对肝面潜在的出血危险有重要防治意义。

objective To provide a safe LC approach on a sound laparoscopic visualization anatomic basis.Methods Cystic artery was studied in hepatobiliary triangle under 3 Dimentional video laparoscopic visualization in 310 cases.The number and course of the cystic artery are noted as well as its relations with the adjacent structures.Results Classifications of the anatomic variations of cystic artery are gattered into three main groups.Group I intra hepatobiliary triangle on laparoscopic visua- lization consisted 3 types:(1) 1 branch (208 cases 67%),(2) 2 branches (58 cases 18.7%),(3) 3 branches (32 cases 10.3%).Group Ⅱ extra hepatobiliary triangle also consised 3 types,(1) 5 cases (1.6%) with their cystic artery running ventral and inferior to the cystic duct,(2) 2 cases (0.6%) with their cystic artery running ventral and across the common duct from left to right,(3) 1 case with an unidentified vessel inferior to the cystic duct.Group Ⅲ consisted dense scar tissues in the triangle in 3 cases (0.9%) in which no vessels could be visualized.Conclusion According to our findings we propose a posterior approach which should be the route chosen in LC.The merit of anterograde LC is good exposure of plane of cleavage that has great significance in prevention and treatment of potential hemorrhage from raw surface of the liver about gallbladder.