ABSTRACT
Perihilar area is a clinically specific anatomical area centered on the confluence of the main portal vein with the left and right branches and bounded by the "H-shaped transverse sulcus" of the liver. Its anatomical structure is complex, involving the liver, gallbladder, regional lymph nodes and luminal systems such as portal vein, hepatic artery, bile duct and inferior vena cava. It is a difficult area in hepatobiliary surgery. Therefore, a reasonable surgical approach is of great importance. The anatomical approach strategy of "Glisson intrathecal dissociation" can clearly show the anatomical structure of various luminal systems in the perihilar area, reduce the risk of surgical error injury, and contribute to the rational individualized surgical plan decision and implementation. The short hepatic portal vein is a small branch of the main, right and left branches of the portal vein and their confluence, which distributes and travels in the transverse sulcus of the liver. The anatomical characteristics of the short hepatic portal vein should not be ignored in the implementation of "Glisson intrathecal dissociation" in the perihilar area.
ABSTRACT
The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.
ABSTRACT
The anatomic relationship between bile duct and portal vein/hepatic artery is complicated in perihilar region. As perihilar surgery is technically demanding, both surgical safety and long-term outcome are not satisfactory. Under the guidance of precision surgery, three kinds of technique,including visualization, quantitation and controlization, are focused. Meanwhile, three principles including vessel priority,bleeding control and limit point control are introduced to improve the development of perihilar surgery. In addition,some new types of operation are potentially important and warranted in the near future.