门静脉尾状叶支解剖及在肝门部胆管癌外科治疗中应用进展

Research progress of caudate branch of portal vein in surgical treatment of hilar cholangiocarcinoma

近年来,门静脉尾状叶支是肝门部胆管癌手术的研究热点之一,术中处理尾状叶支的安全性与有效性尚未明确。门静脉尾状叶支分布、走行于解剖结构复杂的H型横沟区域,涉及肝脏、胆囊、区域淋巴结等组织器官和门静脉、肝动脉、胆管及下腔静脉等脉管系统,是肝胆外科手术的难点区域,合理的手术入路至关重要。肝门部胆管癌根治术中预处理门静脉尾状叶支可以减少术中出血和术后并发症的发生,契合加速康复外科理念。因此,在实施肝门部胆管癌根治术时应强调门静脉尾状叶支预处理的地位。

In recent years,the caudate branches of portal vein(CBPVs)are one of the hotspots of surgical research for hilar cholangiocarcinoma.The safety and effectiveness of intraoperative management of CBPVs remain unclear.The CBPVs are distributed in the H-shaped transverse sulcus region with complex anatomical structure,involving tissues and organs such as liver,gallbladder,regional lymph nodes,and vascular systems including portal vein,hepatic artery,bile duct and inferior vena cava.It is a difficult area for hepatobiliary surgery,thus a reasonable surgical approach is crucial.Pretreatment of CBPVs during radical resection of hilar cholangiocarcinoma can reduce intraoperative bleeding and postoperative complications,which corresponds to the concept of accelerated rehabilitation surgery.Therefore,the preconditioning of CBPVs should be emphasized during radical resection of hilar cholangiocarcinoma.