肝鋳型標本とその臨床応用-尾状葉の門脈枝と胆道枝-

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The development of the hepato-biliary surgery and diagnostic imagings have necessitated full appreciation of intra-hapatic topography. In the literature, the caudate lobe seems to be well studied especially by Healey and Shroy and Couinaud. However, since they didn't describe clearly the border between the right lobe and caudate lobe, there is confusion concerning the region of the caudate lobe. Considering this fact, in our study on the bile duct and portal vein of the caudate lobe using 23 cases of corrosion liver casts, we divided the caudate lobe into 3 parts: (1) the so-called Spiegel lobe, (2) the caudate process portion and (3) para-caval portion. the portal branches of the Spiegel lobe ramified mostly from the left and main portal veins, but the biliary branches are more frequently drained to the right ductal system. The portal branches of the process portion ramified from the main and right portal veins except for the early ramifiying type of the right posterior branch. All the bile ducts of the caudate process is drained into the right ductal system, mainly into the posterior branch. The portal branches of the para-caval portion ramified from the left portal branch in 70% of cases and from the right portal branch in 30%. The biliary branches of the para-caval portion drained in to the right and left ductal systems at equal frequency. The branches of the para-caval portion are big enough to pass through between the roots of the right and middle hepatic veins in more than 50% of cases and reached up to the surface of the liver just beneath the diaphragm. From the standpoint of surgery, the para-caval portion is most important because the Spiegel lobe and caudate process are not difficult to resect, but the branches of the para-caval portion can not be resected completely by the conventional right or left lobectomy.
社団法人日本肝臓学会の論文

肝鋳型標本とその臨床応用-尾状葉の門脈枝と胆道枝-

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