Special concerning of the anatomy of hepatic hilum

Abstract

We have proposed the new liver anatomy that right liver should be divided into the ventral, middle and posterior segments as an alternative to Couinaud's anatomy. We recognized important new findings that posterior hepatic duct joins with middle hepatic duct in 28% of cases. Among of them, posterior inferior hepatic duct joins middle hepatic duct while posterior superior hepatic duct joins with left hepatic duct. These new findings are very important to perform rational surgery for hilar bile duct cancer. We have performed ventral segmental resection combined with total caudate lobe resection in several cases with hilar bile duct cancer.
The hepatic hilum is overlapped by plate system. The variance of the running of bile duct and hepatic artery is occurred inside the plate system. The artery connecting with left and right hepatic artery (CA) runs inside the plate system. The CA is the very important vessels to supply the caudate lobe and bile duct. Furthermore investigating regarding plate system is required.
The understanding of caudate lobe anatomy including Spiegel lobe, paracaval portion and caudate processis is very important. The all portal vein to caudate lobe arises from bilateral portal vein and root of posterior portal vein. The right and left caudate lobes are supplied by common trunk of portal vein in 43% of cases, so that the caudate lobe should be considered one segment.