Abstract
During any surgery, in addition to pathology-related factors, it is necessary to evaluate the individual features of the anatomy of a particular area or complex of organs. The relevance of such data is confirmed by the results of numerous studies that show that half of patients are characterized by certain anatomical variants, including the location of the arteries and biliary tract. The purpose of the work is to establish the peculiarities of the morphometric parameters of the components of the hepatic-duodenal ligament. The study was based on 50 preparations of fetus corpses (4 to 10 months) and 10 newborns without external signs of anatomical abnormalities or congenital malformations. Adequate anatomical methods were used during the study: macropreparation, injection of blood vessels, making topographic anatomical sections, morphometry. Statistical analysis of the obtained data was performed using the licensed program RStudio. During the perinatal period, the length of the hepatic-duodenal ligament was found to increase from 5.224±0.572 mm in fetuses for 4 months to 32.12±1.77 mm in newborns. The chart of change of the average values of its length by months of prenatal development indicates uneven increase of organometric parameters. From 4 to 5 months observed a significant increase in the length of the hepatic-duodenal ligament, while from 5 to 7 months of development observed a period of relative slowdown of its length, and from 5 to 6 months of development even a relative decrease in length. The period from 7 to 10 months determines the period of accelerated growth of ligament. The indices of the width of the hepatic-duodenal ligament in the perinatal period increased from 3.292±0.227 mm in fetus of 4 months to 21.25±0.938 mm in newborns. The width increases are not uniform. The periods of accelerated development (4-5 months and 9 months – newborns) and the period of slow development (5-8 months) were observed. It was proved that there are periods of accelerated and slow development, in which during periods of intensive development, organometric indicators always differed significantly, were smaller than the previous ones and outweighed the following ones respectively (4-5 months and 7-9 months, р˂0.05). Regarding the periods of slow development, the organometric indicators in these periods did not differ significantly (р˃0.05). Therefore, analyzing the dynamics of changes in the morphometric parameters of the components of the hepatic-duodenal ligament, revealed periods of their accelerated and slow growth.
Highlights
Hepatic-duodenal ligament, portal hepatic vein and gallbladder are target structures during laparoscopic cholecystectomy - one of the most common surgical interventions
Considering the importance of the communication structures: biliary tract, portal hepatic vein, hepatic arteries, etc., any damage to them is dangerous to the life of the patient [21,22,23]
Analyzing the organometric parameters of the hepaticduodenal ligament by constructing a box diagram (Fig. 1), it can be seen that the difference between the medians of the samples is statistically significant
Summary
Hepatic-duodenal ligament, portal hepatic vein and gallbladder are target structures during laparoscopic cholecystectomy - one of the most common surgical interventions. This manipulation is for the purpose of treating gallstone disease, which, a benign disease, is potentially dangerous to the patient. Considering the importance of the communication structures: biliary tract, portal hepatic vein, hepatic arteries, etc., any damage to them is dangerous to the life of the patient [21,22,23]. Along with surgical skills, knowledge of variants and features of the topography of structures of the hepatic-duodenal ligament is important for the favorable course of surgery. Further growth and rotation of the duodenum lead to displacement of the rudiments of the pancreas and extrahepatic bile ducts more dorsally than the duodenum [1,2,3,4,5,6]
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