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ID:33353336
大小:6.96 MB
页数:39页
时间:2019-02-25
《Chapter 55– Biliary System》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
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
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