The Applied Anatomic Study On The Perihepatic Hilar Area Of Selective Hemihepatic Vascular Occlusion

Objective To study and observe the form of the perihepatic hilar area, the distribution of the hepatic ducts, portal vein and properhepatic artery. And to explore the possibilities of the safe surgical approach of the selective hemihepatic blood flow occlusion.Methods To dissect and observe the connective tissue of the perihepatic hilar area and the relationships of the hepatic ducts, portal vein and properhepatic artery on the livers of 40 adult corpses. To measure the diameter of the branches of the right and left hepatic ducts, portal vein and properhepatic artery, and the distance between the nearby branches. 22 in-patients of Human Primary Liver Cancer were treated by surgery of selective hemihepatic blood flow occlusion. The studies have been carried out by statistical analysis of the operation duration, surgical blood loss, liver function index (albumin, glutamic-pyruvic transaminase, alanine aminotransferase(ALT), bilirubin).Results From front to back, there are the right and left branches of the hepatic ducts, properhepatic artery and portal vein which were bundled by the hepatoduodenal ligament. There are the hepatic duct triangle and the superior hepatic pedicle space between the porta hepatis and those branches. The triangle and space can be dissected safely. The distance between the porta hepatis and the upper end of the hepatic duct is 3.22±1.10 mm, the bifurcation of the portal vein is 7.32±0.92 mm, the bifurcation of the properhepatic artery is 32.46±2.36 mm. The distance from the last secondary branches of the right hepatic duct to the left, also in the portal vein, the properhepatic artery is 43.76±0.82mm,44.18±0.98mm,45.16±1.12mm, respectivly. There were significant differences in ALT, bilirubin(1-6 days after operation) and albumin(3-6 days after operation) between the postoperatives who were treated by Pringle's complete hepatic vascular occlusion and the selective hemihepatic vascular occlusion.Conclusion The portal vein, hepatic ducts and the properhepatic artery are stayed in the Glisson's sheath and the positions of those tubes are relatively stable.There is a relatively avasculararea on the right of the bifurcation of the hepatic portal vein and it is a safe area for surgical operation. The hepatic duct triangle and the superior hepatic pedicle space are the safe surgical approach for the selective hemihepatic vascular occlusion.