Difficulties and countermeasures of diagnosis and treatment of biliary dilatation / 中华消化外科杂志

The pathogenesis of biliary dilatation is unclear and the preoperative evaluation of pancreaticobiliary junction type is still difficult.The indication of minimally invasive surgery is limited.Diagnosis and treatment of gestational biliary dilatation and reoperation of biliary dilatation are two tricky problems.There are two dilemmas in the treatment of biliary dilatation,including the balance between radical resection of pathological bile ducts and organ reservation,as well as balance between radical resection of pathological bile ducts and surgical safety.The most difficult regions of diagnosis and treatment lie in the hilar dilated bile duct and dilated bile duct in the pancreatic segment.Dong's classification simplifies the classification of extrahepatic bile duct dilatation and subdivides the classification of intrahepatic bile duct dilatation on the basis of Todani classification.It highlights the difficulties of treatment and provides more accurate basis for choosing appropriate method according to the classification.The therapeutic goals of biliary dilatation are the radical excision of pathological bile duct,removal of the secondary lesions and reconstruction of excellent cholangiojejunostomy.The principle of surgical procedure choice is choosing appropriate method according to the classification.Perihilar surgery technique and pancreatic door plate descending technique can be used to deal with the dilated bile ducts at hilar and pancreatic segment on the basis of accurate evaluation in order to improve the thoroughness and security of pathological bile duct resection.Not only short-term complications such as postoperative bile leakage and pancreatic leakage require management,but radical resection of lesion and long-term life quality of patients should be paid more attention.

Anatomical development and clinical significance of the concept of porta hepatis / 中华肝胆外科杂志

The liver has complex blood supply and outflow system,mainly is composed of portal vein,hepatic artery,hepatic vein,short hepatic vein and inferior vena cava.At the initial stage of liver anatomy,the concept of "porta hepatis " refers specifically to the portal vein blood flow into the anatomical region of the liver.With the further study of liver anatomy and the need to adapt to the development of clinical practice of liver surgery,the concept of "porta hepatis" gradually extends to the blood inflow and outflow region.This article will review and discuss the anatomical development and clinical significance of "porta hepatis".