The Applied Anatomical Research Of Choosing OperationPath In High-level Bile Duct Carcinoma

High-level bile duct carcinoma , which is also called portal hepatic bile duct carcinoma (namely the klatskin neoplasia), is the malignant tumor occured in from the left and right hepatic duct to common hepatic duct. Because of its complicated anatomic structure, difficult operation and big trauma, it' s an operation with high risk . If the purpose of permanent control can' t be reached, the 3-year surviv- al rate is only 3. 8%, and the 5-year survival rate after radical operation is only 13.2%. Especially in type Bismuth III-IV bile ductcarcinoma , the operation effect is much worse .Objective:In order to conduct corresponding radical operation or palliative bile duct drainage according to the bile duct carcinoma with different type , the writer detected the anatomic length and circumference of grade I -Illbile duct in portal hepatis , and comprehended the anatomic position in liver,so as to choose better various kinds of operative route to make operation .Methods:The writer collected the liver specimens of 16 cases common adults, which were made into hollowed-out specimens after fixation and were measured with slidegaudand twofoot compasses measuring instrument .Results: the length of common hepatic duct is 2.25 ± 0. 56cm or so and the circumference of initiationpart is 1. 76 ± 0. 94cm; the lengthof the right hepatic duct is 1.15±0. 39cm and the circumference of initiation part is 1. 13± 0. 37cm; the length of the left hepatic duct is 1.53± 0.58cm and the circumference of initiation part is 1.16±0. 33cm. The left hepatic duct is longer than the right, we can adopt various operation path, such as dissection path through mid-hepatic interface, dissection path through legamentum teres of liver, dissection path of quadrath lobe of liver resection or adding tail fluke resection , to expose intrahepatic bile duct and resect the tumor .Conclusions: Although there are many kinds of domestic and international inquiry into surgical resection way at present, the resection scope is tend to extend as a whole. If only we know the dissection of portal hepatis, master reasonable operation path and unite with lobes of liver or tail fluke radical excision or extended radical excision, thepatient' s survival period can be lengthened.