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Background: Ligamentum teres is the ligament of the hip joint. It is flat and triangular in shape. The ligamentum teres starts developing in the fetal life during 10-11 weeks. The present work was undertaken chiefly to gain insight into the pattern of sequential development of ligamentum teres and to compare the findings of other authors with the observations made in the present study and to correlate these findings clinically to find out the function of ligamentum teres.Methods: The present study was undertaken on 40 fetuses of varying gestational periods collected from the operation theatre, labour room and obstetrics wards of department of Gynaecology and Obstetrics, Government Medical College, Jammu and other areas of Jammu, 10% Formalin was used as preservative. The hip joints of both the sides were dissected carefully. 5% solution of Gooding and Stewart’s was used for decalcification. Paraffin wax embedding method was used for preparing the tissue for section cutting. Staining was done by Harri’s Hematoxylin and Eosin stain and Masson’s Trichrome stain. The slides were then examined under microscope for important findings.Results: The ligamentum teres is seen by 10½ weeks. Blood vessels appear in 12½ weeks. Ramification of blood vessels in this ligament is seen by 21½ weeks. Through this ligament, the blood vessels are seen limited up to the fovea capitis femoris by about 16½ weeks and by 18½ weeks they penetrate deep into the head of femur. Ligamentum teres is lined by thin synovial membrane at 19th week.Conclusions: The ligamentum teres develops by 10½ weeks. It arises in-situ as it develops in the same position as it occupies in the adult but as age advances, it shows much differentiation and resembles the adult features.
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Objective To investigate the application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation.Methods The retrospective cohort study was conducted.The clinical data of 58 patients with recurrent hepatolithiasis who underwent laparoscopic biliary reoperation in the Chengdu Second People's Hospital were collected.There were 33 males and 25 females,aged from 31 to 85 years,with an average age of 54 years.Thirty-one of 58 patients who underwent laparoscopic biliary reoperation using ligamentum teres hepatis approach were divided into the ligamentum teres hepatis group,and 27 patients who underwent laparoscopic biliary reoperation using regular anatomy and positioning were divided into the regular operation group.Observation indicators:(1) intraoperative situations;(2) postoperative recovery;(3) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recurrence of bile duct stone up to August 2018.Doppler ultrasonography of biliary tract was performed once at 3,6 and 12 months postoperatively and once at every 12 months after 1 year.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed by rank sum test.Count data were analyzed using the four-grid table chi-square test or Fisher exact probability.Results (1) Intraoperative situations:all patients underwent successful laparoscopic biliary reoperation,without conversion to open surgery and perioperative death.During the intraoperative exploration,7,8,16 patients in the ligamentum teres hepatis group and 5,8,14 patients in the regular operation group were respectively found peritoneal omental adhesions,hilar omental adhesions and hilar intestinal adhesions.The operation time and volume of intraoperative blood loss were (125± 24) minutes,40 mL (range,15-100 mL) in the ligamentum teres hepatis group and (150 ± 36) minutes,55 mL (range,20-350 mL) in the regular operation group,respectively,with statistically significant differences between the two groups (t =-3.162,Z =-2.768,P＜0.05).The primary suture of bile duct,T-tube drainage and intraoperative stone removal were detected in 10,21,26 patients of ligamentum teres hepatis group and 9,18,23 patients of regular operation group,respectively,with no statistically significant difference between the two groups (x2 =0.008,0.019,P＞0.05).Postoperative residual biliary calculi were removed by choledochoscope through T-tube sinus in outpatient department after 8-week carrying T-tube.(2) Postoperative recovery:the time to initial anal exsufflation and duration of postoperative hospital stay were respectively (31 ± 7) hours,(7.2± 1.5) days in the ligamentum teres hepatis group and (35±10) hours,(7.1±1.3)days in the regular operation group,with no statistically significant difference between the two groups (t=-l.814,0.036,P＞0.05).(3) Follow-up:5 of 58 patients were lost to follow-up,including 3 in the ligamentum teres hepatis group and 2 in the regular operation group.Fifty-three patients were followed up for 6-40 months,with a median follow-up time of 28 months.No recurrence of bile duct stone was found in the ligamentum teres hepatis group.One patient in the regular operation group had recurrence of common bile duct stones at 36 months postoperatively and underwent endoscopic sphincterotomy stone.Conclusion Laparoscopic biliary reoperation for patients with recurrence of hepatolithiasis is a safe and effective method,and it can also quickly determine the location of common bile duct,with advantages of less blood loss and shorter operation time.
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Resumen: La función del ligamento teres de la cadera ha llamado la atención en los últimos años debido al incremento y a la realización de la artroscopía de cadera, la información en la literatura es escasa, por ello nos propusimos realizar una revisión bibliográfica sobre los conceptos actuales, su anatomía, función, biomecánica, diagnóstico y rupturas del ligamento de teres de la cadera.
Abstract: The role and function of the ligamentum teres has drawn our attention in the last years due to the increasing and performance in hip arthroscopy, few is written in the literature, this is why we proposed to perform and assessed a review on the current literature of the anatomy, function, diagnose and rupture of the ligamentum teres of the hip.
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Humans , Arthroscopy , Hip Injuries , Ligaments, Articular/injuries , Rupture , Hip JointABSTRACT
Objective To investigate the clinical effect of fissure for ligamentum teres hepatic (LTH) approach in hepatectomy.Methods The method of cross-sectional study was adopted.The clinical data of the 85 patients undergoing hepatectomy through fissure for LTH approach who were admitted to the West China Hospital of Sichuan University from February 2009 to December 2013 were collected.Among all the 85 cases, there were 61 of hepatocellular carcinoma, 12 of intrahepatic bile duct stones, 6 of bile duct cellular carcinoma and 6 of metastatic hepatic carcinoma.The operations involved dissecting fissure for LTH, dealing with portal vein, hepatic artery and bile duct inside the fissure, lowering the hepatic portal, mutilating hepatic parenchyma, and undergoing the hepatic left lateral lobectomy, left hemihepatectomy, mesohepatectomy, hepatic left and/or right trisegmentectomy.Operation method, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative drainage-tube removal time and complications were recorded.The follow-up including recurrence and metastasis of tumor and survival of patients was conducted by outpatient examination and telephone interview up to August 2015.Measurement data with normal distribution were presented as (x) ± s.Measurement data with skewed distribution were presented as M (range).The survival rate was caculated by Kaplan-Meier method.Results The 85 cases of hepatectomy were successfully completed through fissure for LTH approach, including 19 cases of hepatic left lateral lobectomy (9 with hepatocellular carcinoma, 6 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 20 cases of left hemihepatectomy (8 with hepatocellular carcinoma, 5 with intrahepatic bile duet stones, 4 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 5 cases of left hemihepatectomy + caudate lobectomy (3 with hepatocellular carcinoma, 1 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma), 14 cases of meso-hepatectomy (14 with hepatocellular carcinoma) and 27 cases of hepatic left and/or right trisegmentectomy due to hepatocellular carcinoma (15 of hepatic left trisegmentectomy and 12 of hepatic right trisegmentectomy).No perioperative death occurred.The median operation time was 280 minutes (range, 95-430 minutes).The median volume of intraoperative blood loss was 450 mL (range, 200-3 200 mL).There were 18 cases of intraoperative blood infusion.The postoperative peritoneal drainage-tube removal time was 3 days (range, 2-5 days).Eleven patients with postoperative complications recovered after symptomatic conservative treatment, including 6 with lung infection, 4 with peritoneal effusion and 1 with abdominal infection.There was no case of intra-abdominal bleeding, bile leakage or hepatic failure.No patient died within 1 month after operation.Seventy-nine patients were followed up for a median time of 38 months (range, 18-53 months) with a follow-up rate of 92.9％ (79/85).The 1-year overall survival rate and l-year disease-free survival rate were 79.0％ and 65.0％, and the 3-year overall survival rate and 3-year disease-free survival rate were 56.0％ and 34.0％, respectively.Conclusion Hepatectomy through fissure for LTH approach is safe, effective and easily operable, with a good short-term outcome.
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A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.
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Adult , Humans , Male , Cadaver , Cystic Duct , Diagnostic Errors , Hepatic Duct, Common , Liver , Students, Medical , Urinary BladderABSTRACT
Retrospective study was conducted to analyze the efficacies of using round hepatic and falciform ligaments in acute abdominal repair for 22 cases between December 2010 to March 2013.There was no occurrence of perioperative mortality.Twenty patients (90％) were followed up for 3 to 24 months.All cases recovered favorably and no complications of common bile duct stricture,bile leakage,postoperative hemorrhage or pancreatic fistula occurred.The anatomic and morphological advantages of pedicled ligamentum teres hepatic and falciform ligaments have made it a high-quality autologous biological repair material applicable for a variety of acute abdominal repairs.
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PURPOSE: The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures. MATERIALS AND METHODS: The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope. RESULTS: One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing. CONCLUSION: These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Autopsy , Hernia, Umbilical/pathology , Ligaments/anatomy & histology , Umbilicus/anatomy & histologyABSTRACT
[Objective] This study examined the distribution and the expression of platelet-derived growth factor-A (PDGF-A) in the ligamentum teres of children with developmental dislocation of the hip (DDH) and normal persons in order to investigate the roles of PDGF-A in hip joint laxity. [Methods]There were six pairs of joint laxity of children with DDH and normal children (control group) matched to gender and age. Immunohistochemistry (SP method) method was used to detect the location and distribution of the PDGF-A in the ligamentum teres,and to semi-quantify their content.Semiquantitative RT-PCR method was used to detect the PDGF-A in the ligamentum teres at mRNA level. The quantitative analysis of the PDGF-A was performed by professional image software and the results were analyzed with standard statistical methods.[Results]High density expression was observed in the synovial layer with fibroblast regularly arranged parallel to the joint surface in the ligamentum teres. PDGF-A distribution was decreased in the fibrous layer of the ligamentum teres. There were significant differences in the percentage of positive fibroblast and gray-scale density in the fibrous layer between DDH group and control group (P
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[Objective]To investigate the expression of collagen type I and III at mRNA and protein level in the ligamentum teres of developmental dislocation of the hip(DDH) and the normal hip. [Method]There were 6 pairs joint laxity of patients of DDH group and normal control group with paired control of same sex and age.Semiquantity RT-PCR method was used to detect the COLlal and COL3al in the ligamentum teres at mRNA level. Western-Blot method was used to detect the COLlal and COL3al in the ligamentum teres at protein level. The quantitative analysis of the COLlal and COL3al were performed by professional image software and the results were analyzed with standard statistical methods.[Result]At both mRNA and protein level COLlal expression were decreased in the DDH group compared to the control group(P0.05).[Conclusion]The decreased collagen I expression at mRNA and protein level in the ligamentum teres of the children with DDH may lead to hip joint laxity.Hip joint laxity in DDH may be independent to the content of collagen III.
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0.05). The open time of the modified groups was significantly shorter than that of the routine group (P