Chapter 55– Biliary System

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1、CHAPTER55BILIARYSYSTEMPatrickG.JacksonandStevenR.T.Evansmayoverliethecommonhepaticorrighthepaticducts,thusanatomyandphysiologyplacingthesestructuresatriskduringtheperformanceofalapa-generalconsiderationsinbiliarytreepathophysiologyroscopiccholecystectomy.benignbiliarydiseaseAbo

2、vethecysticductliesthecommonhepaticduct,drain-malignantbiliarydiseaseingtheleftandrighthepaticductsystems.Theconfluenceofmetastaticandothertumorsthesestructuresliesatthehilarplate,whichisanextensionofGlisson’scapsule.Theabsenceofanyvascularstructuresoverly-ingthebileductsatthis

3、locationallowsexposureofthebifurca-tionbyincisingthislayeratthebaseofthesegmentIV,liftingANATOMYANDPHYSIOLOGYtheliveroffthesestructures,knownasloweringthehilarplate,Biliaryanatomyisextremelyvariable,andpreciseknowledgeofandisgenerallyusedtoexposetheremainderoftheextrahepaticthe

4、normalandanatomicvariantsiscriticaltosurgicalinterven-biliarytreeforresectionorreconstruction.tioninthebiliarytree.Thedistalcommonbileduct(CBD)insertsintotheduodenumviatheampullaofVater,passingVascularAnatomythroughthesphincterofOddi.Ascendingfromtheduodenum,Thesegmentalanatomy

5、oftheliverparenchymaisbasedonthethecommonbileductmayjoinwiththepancreaticductinthevascularsupplyanddrainage,andthebiliarydrainageisdescribedwalloftheduodenum,withinthepancreaspriortoinsertionbythecorrespondingvascularsegment.Thehepaticparenchymaintotheduodenalwall,ormayenterthe

6、duodenumseparatelyisdividedintolobes,eachofwhichisdividedintolobarseg-fromthepancreaticduct(Fig.55-1).Themostinferiorportionments(Fig.55-4)todefinethebasichepaticanatomicresec-oftheCBDisencompassedbytheheadofthepancreas.Supe-tions.Theleftlobeiscomprisedofmedialandlateralsegment

7、s.riortothisportion,thecommonbileductisdividedintoret-Therightlobeisdividedintoposteriorandanteriorsegments.roduodenalandsupraduodenalsegments.TheinsertionoftheAlternatively,thehepaticparenchymacanbedividedintoseg-cysticductmarksthedifferentiationofthecommonhepaticmentsbasedont

8、hespecifichepaticvenousdrainageandportalductaboveandth