Yf. Cheng et al., ANATOMIC DISSOCIATION BETWEEN THE INTRAHEPATIC BILE-DUCT AND PORTAL-VEIN - RISK-FACTORS FOR LEFT HEPATECTOMY, World journal of surgery, 21(3), 1997, pp. 297-300
The anatomic variations of the intrahepatic portal vein and bile duct
were analyzed to evaluate the potential risk of left hepatectomy. A to
tal of 210 cholangiograms and hepatic arterioportograms were performed
in which the ramifications of the intrahepatic portal vein and bile d
uct were investigated. The orientation of the intrahepatic duct and po
rtal vein were classified into five types. In 175 patients (83.33%), t
he intrahepatic portal vein and bile duct had the same anatomic classi
fication. In 24 patients (11.43%), the right anterior or posterior int
rahepatic duct drained into the left hepatic duct at the umbilical por
tion (type TV); there were only 15 patients (7.14%) :whose portal vein
s fell into this category. All patients with type IV portal veins had
type IV hepatic ducts, but there were 9/49 patients (18.36%) whose hep
atic duct distribution belonged to type IV but their portal veins belo
nged to type II (6 cases) or III (3 cases). Without complete knowledge
of the intrahepatic portal anti biliary anatomy, insufficient portal
perfusion and bile duct complications may result from the left hepatec
tomy operation. Preoperative portal vein evaluation or left portal vei
n clamping can provide significant information, but there are still 18
.36% of patients where type IV biliary ducts were? not detected in tho
se with type II and III portal veins. Cholangiography is of paramount
importance in these two groups of patients, as it can prevent inadvert
ent injury to the right intrahepatic ducts, which drain into the left
intrahepatic duct. On the other hand, intraoperative ultrasonography i
s recommended to identify or exclude an aberrant portal vein if type V
I biliary anatomy is detected during intraoperative cholangiography.