La vía biliar intrahepática: clasificación anátomo-quirúrgica con base colangiográfica / Intrahepatic biliary ducts: anatomic and surgical classification after cholangiographic findings

Las variaciones en la constitución de la vía biliar son muy frecuentes. Su conocimiento adquiere importancia en distintos procedimientos quirúrgicos, como la colocación de un drenaje en la vía biliar o una colecistectomía. Sin embargo, el cirujano a menudo la visualiza por primera vez durante el acto quirúrgico, y debe lidiar con clasificaciones complejas para poder comprenderlas. El objetivo de este trabajo es presentar una clasificación sencilla y de rápida interpretación. Se analizaron 100 estudios colangiográficos y se realizaron 10 disecciones cadavéricas, como apoyo al estudio colangiográfico. A partir de los resultados obtenidos, se propuso la siguiente clasificación: Conducto hepático derecho "típico", cuando éste reúne la bilis de toda la porción hepática derecha, o "dividido", cuando sus ramas desembocan separadamente en la vía biliar principal. Conducto hepático izquierdo "típico" o "dividido", siguiendo el mismo criterio. Conducto hepático "central", cuando las secciones parasagitales de ambas porciones hepáticas, derecha e izquierda, se reúnen en un solo conducto. Respecto a la confluencia de los conductos biliares, puede clasificarse en "típica" precisamente cuando ambos conductos hepáticos también lo son, "triple confluencia" cuando uno o ambos conductos hepáticos se encuentran divididos y todos ellos confluyen en un punto, o "escalonada" cuando uno de ellos se encuentra dividido y la confluencia se realiza a distinta altura, en ocasiones con algún conducto segmentario. Creemos que esta clasificación resulta de fácil aplicación por su sencillez, permitiendo identificar todas las estructuras de la vía biliar rápidamente aún sin contar con estudios previos, colaborando de esta manera en una cirugía más segura.

Variations in intrahepatic biliary ducts are frequent. Its knowledge is of great importance when facing certain procedures such as drainage or a simple cholecystectomy to avoid iatrogenic lesion or incomplete drainage of the biliary tract. Nevertheless, it is during surgery that the surgeon attempts to see it for the first time, and must deal with complex classifications in order to recognize the ducts. This paper aims to suggest an easy and quick way to interpret and simple classification. 100 cholangiograms were studied and 10 cadaveric specimens were analyzed to support radiologic findings. As a result, we propose the following classification: Right "typical" biliary duct, when all the bile produced in the right hemiliver is drained by a single duct, or "divided" when sectional ducts reach separately the main bile duct. The same applies to the left hepatic ducts, "typical" or "divided". When both paramedian sections are drained by the same duct, there is a "Central" hepatic duct The biliary confluence may be "typical", when both hepatic ducts are also typical, "triple confluence" when one or both hepatic duct are divided and reach the main bile duct in the same place, or "staggered (selved) confluence" (etagée) when one of the ducts is divided and reaches the main bile duct separately from the others. This name is even proper if a segmentary duct reaches the main bile duct. We think this classification is easy to use due to its simplicity, allowing the surgeon to quickly identify each biliary duct and get through the surgery safely.

Histological study of extrahepatic part of human biliary tree with emphasis on peribiliary glands

Extrahepatic part of human biliary tree was lined with simple tall columnar epithelium. Supranuclear cytoplasm of the cell was darkly stained. Histochemistry of the epithelium revealed that it was mucus secreting. Below the epithelium there was a thick compact layer of connective tissue. Outside the compact layer there was a loose layer of areolar tissue in which smooth muscle, blood vessels and nerves were found. Glandular acini were present within and outside the compact layer of intrapancreatic bile duct [IPBD] and common bile duct [CBD] whereas these were present only within the compact layer of bile duct of ampulla of Vater [BDAV]. Statistical significance of quantitative difference between glandular acini of BDAV with other regions revealed that the difference was significant [P < 0.01] with IPBD and non significant [P > 0.05] with CBD. Statistical significance of quantitative difference between glandular acini of IPBD with other regions revealed that the difference was significant [P < 0.01 and P < 0.05] with BDAV and CBD respectively. Statistical significance of quantitative difference between glandular acini of CBD with other regions also revealed that difference was significant [P<0.05] with IPBD whereas it was not significant with BDAV [P>0.05]. Intramural and extramural glandular acini were present in IPBD and CBD whereas BDAV contained only intramural glands. The difference between intramural and extramural glandular acini was statistically significant [P < 0.02] in IPBD. The difference between intramural and extramural glandular acini of CBD was also statistically highly significant [P<0.001]. Glandular acini as demonstrated by different stains were 100% mucous type in BDAV and IPBD whereas it was mixed type in CBD. The acini of CBD were serous, mucous and mixed type. The difference between serous and mucous, mucous and mixed glandular acini was statistically highly significant [P<0.001]. The difference between serous and mixed glandular acini was statistically not significant [P>0.05]. Ratio of serous, mucous and mixed glandular acini was 1:22:1 respectively

Estudo anatômico das vias bilíferas em búfalos (Bubalus bubalis, L. 1758). Sistematizaçäo do Ramus principalis sinister / Anatomical study of the biliary ducts in buffaloes (Bubalus bubalis, L. 1758). Intra-hepatic distribution of the Ramus principalis sinister

Estabeleceu-se a sistematizaçäo do ramus principalis sinister, um dos componentes das vias bilíferas intra-hepáticas em 40 búfalos fêmeas da raça Jaffarabadi adultas. Através do ductus choledocus, as vias bilíferas de cada animal foram injetadas com látex Neoprene 650 e Celobar, radiografadas e dissecadas após fixaçäo em soluçäo aquosa de formol a 10 por cento. O ramus principalis sinister é formado de maneira geral pelos seus componentes: ramus medialis lobi sinestri, truncus intermedialis, truncus intermediolateralis, ramus lateralis lobi sinistri e ramus lobi quadrati, além de afluentes inominados oriundos do lobus caudatus (pars supraportalis), lobus sinister (territórios medial, intermédio e lateral), lobus quadratus e lobus dexter. Foram observados em alguns órgäos determinados componentes do sistema do ramus principalis sinister relacionando-se entre si ou com a vesica fellea