THE ANATOMICAL GROUNDING OF ISOLATED LOBAR PORTOCAVAL PERFUSION OF THE LIVER

Abstract

With the development of perfusion technologies in oncology, the problem of finding the optimal ways to perfusates injections has become fundamental, and in this regard, the study of the features of liver angioarchitectonics in normal and pathological conditions does not lose its relevance. The aim of our study was to study the features of the portal architectonics of the liver in relation to the possibility of its isolated lobar perfusion. Using the methods of color perfusion (n=50), separate injections of a hardening mass and the preparation of corrosive preparations (n=3), microfocus angiography (n=8), transparenchymal sections and light microscopy (n=5), 53 liver preparations explanted from non-embalmed corpses of people who died from diseases not directly related to the liver pathology. As a result of the study, it was found that the border of the zones of blood supply by the lobar branches of the portal vein after the introduction of dyes passes along the lateral border of the fourth segment of the liver in the projection of the main trunk of the middle hepatic vein, and not along the falciform ligament. According to the distribution criterion of the portal vein branches, the anatomical and surgical concepts of the interlobar boundaries of the liver do not coincide. Macro- and microscopically visible interlobar intraorgan portal anastomoses are normally absent, which indicates the relative isolation of the lobar portal blood flow of the liver. The intrahepatic bed of the proper hepatic artery has a rich architectonics in the surface layers of the parenchyma and abundantly supplies the liver capsule with blood. When performing transparenchymal sections, the boundaries of the blood supply zones of the lobar branches of the portal vein coincided with the interlobar boundaries in all cases of observation. It was also noted that the topography of the border of the blood supply zones with the lobar branches of the portal vein to match the diaphragmatic surface of the liver and in its parenchyma. Thus, it seems possible to reliably determine the indicated boundary by the pattern on the surface of the liver preparation. The relative autonomy of the channels of the lobar portal vein branches can be used to develop techniques for vascular isolation of the lobar portal blood flow in the liver to assess its selective isolated perfusion.