Die chirurgische Anatomie des intrahepatischen Portaltrakts

Zusammenfassung

Das Ziel dieser Studie war die Identifizierung von charakteristischen anatomischen Beziehungen zwischen dem lymphatischen und dem biliären System der Leber, insbesondere der zwischen diesen Systemen vermuteten Verbindungen in den intrahepatischen Anteilen des Portaltrakts. An 75 Lebern von Erwachsenen wurden morphologische Untersuchungen der vaskulär-fibrösen Strukturen der intrahepatischen Anteile des Portaltrakts durchgeführt. Es wurde festgestellt, dass die einzelnen Segmente der intrahepatischen Strukturen und ihre fibrösen Schichten aus drei vaskulär-fibrösen Blättern oder Scheiden bestehen, die sich zirkulär einhüllen. Die extramuralen biliären Schleimdrüsen bilden die Verbindungen zwischen dem lymphatischen und dem intrahepatischen biliären System.

Abstract

The aim of the study was the identification of anatomical characteristics of lymphobiliary interactions and their presumed connections in the intrahepatic portal tracts. Morphological investigation of vascular-fibrous structures in the intrahepatic portal tracts of 75 adults liver samples was performed. It was described that the single segments of the intrahepatic structures and their fibrous tunics constitute of three vascular-fibrous sheathes orbiculary surrounding each other. The extramural biliary mucous glands provide the connections between the lymphatic and intrahepatic biliary systems.

Schlüsselwörter

Lymphobiliäre Verbindungen - hepatische vaskulär-fibröse Strukturen

Key words

Lymphobiliary connections - hepatic vascular-fibrous structures

Literatur

• 1 Alekseev B V. Surgery of thoracic duct. 4th ed. 1983; 92-113
• 2 Bartos V, Brzek V. Significance of thoracic duct drainage in clinical medicine.  Chirurg. 1973;  44 110-114
• 3 Bettezzati M. La Decompression del Sistema Lymphatic in Corso di Hipertensione Portal.  Minerva Chir. 1975;  30 383-384
• 4 Briskin B S. et al . Errors and complications in lymphosorption.  Khirurgiia. 1986;  12 104-109
• 5 Chanukvadze I M. Structure and connections of paravasal connective tissue in liver. Dissertation for M. D. Tbilisi Medical Institute 1979
• 6 Chanukvadze I M. Structure and connections of fibrous sheathes of portal complexes and hepatic veins. Surgical anatomy and experimental morphology of liver. Collection of Scientific Works of Tbilisi State Medical Institute. Tbilisi, T. S. M. I. 1989; 13-33
• 7 Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. Masson, Paris 1957
• 8 Dedo D D. A cannula for maintaining long-term thoracic duct fistulas.  Surgery. 1973;  73 791-794
• 9 Dumpe E P, Krilov L B, Shurkalin B K. Thoracic duct drainage and lymphosorption in complex management of obstructive jaundice and pancreonecrosis. Managed Lymphodrainage in clinical practice and experiments. Moscow 1983; 35-39
• 10 Fegereshanu I, Ionesku-Budjor K, Aloman D, Albu A. Surgery of liver and intrahepatic biliary tracts. Bucharest 1976; 537
• 11 Gugushvili L L. Hepatic retrograde blood circulation and portal hypertension. Meditsina, Moscow 1972; 196
• 12 Konstantinov B A, Gotie S V, Tsiruklnikova O M, Filin A V. Living related liver transplantation. The first clinical experience.  Khirurgiia. 2000;  3 4-9
• 13 Kornev O S, Davlatkindev F A, Kim B K. Thoracic duct measuring drainage in urgent surgery. Khirurgiia 3: 90-93
• 14 Kovanov V V, Anikina T I. Surgical anatomy of human fasciae and tissue spaces. 2nd ed. Meditsina, Moscow 1967; 428
• 15 Kovanov V V, Anikina T I, Razumnaia T A. Surgical significance of the connective tissue structures of the posterior part of human liver. Scientific methodological problems of soft tissue studying. Gorkyi, Kirov Medical Institute 1973; 137-146
• 16 Nakanuma Y, Sasaki M, Terada T, Kenichi H. Intrahepatic peribiliary glands of human. II. pathological spectrum.  J Gastroenterol Hepatol. 1994;  9 80-86
• 17 Ostroverchov G S, Zabrodskaiya V F. Surgical anatomy of liver and biliary tract. Abdominal surgical anatomy. Meditsina, Leningrad 1972; 297-384
• 18 Ostroverchov G S, Zabrodskaiya V F, Aliev A Z. Compensatory role of lymphatic system in choledochal and cystic duct obstruction in experiment.  The works of M. M. I. 1st ed. 1973;  18 112-117
• 19 Pavlinov B G. Structure and development of fibrous tissue around hepatic blood vessels and bile ducts. Dissertation for M. D., Omsk Medical State Institute 1969; 148
• 20 Razumnaiya T A. Development and structure of soft tissue of human liver and its significance in surgery. Dissertation for M. D., Moscow Sechenov Medical Institute 1976; 36
• 21 Razumnaiya T A. Morphological and topographical peculiarities of fixative system of human liver. Clinical aspects of surgical anatomy in experimental surgery. Moscow Sechenov Medical Institute 1979; 102-105
• 22 Shapkin V S, Thoidze S S, Izraelishvili M S. Surgical procedures on liver in the conditions of extracorporeal blood circulation. Sabchota Sakartvelo, Tbilisi 1983; 108
• 23 Sherlock S, Dooli G. Diseases of liver and biliary tracts. Meditsina, Moscow 1999; 859
• 24 Snegirevskaiya E S, Veselov V S. Changes in plasmogenic hepatocytes and their specific sites of intercellular junctions in complicated forms of cholelithiasis.  Arkhiv Anatomii Gistologii Embriologii. 1986;  1 12-15
• 25 Tanaka K, Uemato S, Tokunoga Y. et al . Surgical techniques and innovation on living related liver transplantation.  Ann Surg. 1997;  217 82-91
• 26 Terasaki S, Nakanuma Y, Unoura M. et al . Involvement of peribiliary glands in primary sclerosing cholangitis: histopathologic study.  Internal Medicine. 1997;  36 766-770
• 27 Thoidze S S, Chanukvadze I M. Interactions among liver paravascular fibrouse structures. Materials of Transcaucasian Conference of Morphologists. Baku 1978; 268-369
• 28 Virenkov Y A, Kataev S M. Hepatic microcirculatory flow according to the evidences of electronic microscopy.  Arkhiv Anatomii Gistologii Embriologii. 1983;  4 21-24
• 29 Virenkov Y A, Makarenko E P, Martirosova M T. Hepatic lymphocirculation in biliary hypertension.  Khirurgiia. 1971;  2 35-40
• 30 Zatolokin V D. Anatomical resections of hepatic lobe. Abstract of dissertation for M. D., Moscow 1974