pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.34215/1609-1175-2024-1-24-28pmj-2684Research ArticleОБЗОРЫREVIEWSВариантная анатомия структур треугольника КалоVariant anatomy of structures in Calot’s triangleШиловаА. Н.ShilovaA. N.

Moscow

ЖариковаТ. С.ZharikovaT. S.

Москва

Moscow

КойчуевК. Р.KoychuevK. R.

Москва

Moscow

https://orcid.org/0000-0001-9636-3807ЖариковЮ. О.ZharikovYu. O.

Жариков Юрий Олегович – кандидат медицинских наук, доцент кафедры анатомии и гистологии человека Института клинической медицины имени Н.В. Склифосовского

125009, г. Москва, Моховая улица, 11с10   тел.: +7 (999) 912-11-45 

Yury O. Zharikov, Cand. Sci. (Med.), Associate Professor, Department of Human Anatomy and Histology, Institute of clinical medicine

11 Mokhovaya str., p. 10, Moscow, 125009 

dr_zharikov@mail.ruНиколенкоВ. Н.NikolenkoV. N.

Москва

Moscow 

Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский университет)РоссияSechenov First Moscow State Medical UniversityRussian FederationПервый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский университет) ; Московский государственный университет им. М.В. ЛомоносоваРоссияSechenov First Moscow State Medical University ; Lomonosov Moscow State UniversityRussian Federation202418052024012428Copyright © Шилова А.Н., Жарикова Т.С., Койчуев К.Р., Жариков Ю.О., Николенко В.Н., 20242024Шилова А.Н., Жарикова Т.С., Койчуев К.Р., Жариков Ю.О., Николенко В.Н.Shilova A.N., Zharikova T.S., Koychuev K.R., Zharikov Y.O., Nikolenko V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/2684

Вариантная анатомия желчевыводящих путей и источников их кровоснабжения создает технические сложности и повышает риск повреждения этих магистральных структур в области ворот печени и печеночно-двенадцатиперстной связки во время операций в гепатобилиарной области, особенно лапароскопической холецистэктомии. Магистральные структуры формируют единое топографическое образование – треугольник Кало, в пределах которого возможны множественные анатомические вариации, которые были рассмотрены в проведенном обзоре литературы.

The variant anatomy of the biliary tract and its sources of blood supply causes technical difficulties and increases the risk of damage to these main structures in the area of the porta hepatis and hepatoduodenal ligament during hepatobiliary operations, especially laparoscopic cholecystectomy. The main structures form a single topographic formation – the Calot’s triangle, with possible multiple anatomical variations, considered in the literature review.

треугольник Калоанатомияхолецистэктомияпузырный протокпузырная артерияправая печеночная артерияCalot’s triangleanatomycholecystectomycystic ductcystic arteryright hepatic arteryReferencesБелоус П.В. Вариантная анатомия артериального русла печени и ее протоковой системы. Журнал Гродненского государственного медицинского университета. 2014;3(47):117–22.Belous PV. Variant anatomy of the artery of the liver and its ductal system. Journal of the Grodno State Medical University. 2014;3(47):117–22 (In Russ.)Alvarez FA, de Santibañes M, Palavecino M, Sánchez Clariá R, Mazza O, Arbues G, de Santibañes E, Pekolj J. Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014;101(6):677–84. DOI: 10.1002/bjs.9486Alvarez FA, de Santibañes M, Palavecino M, Sánchez Clariá R, Mazza O, Arbues G, de Santibañes E, Pekolj J. Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014;101(6):677–84. DOI: 10.1002/bjs.9486Фомов Г.В., Мухин А.С., Подолинный Г.И., Горпинюк В.П., Звягинцев В.В. Фенотипические маркеры аномалий треугольника Кало. Медицинский альманах. 2011;2(15):58– 61.Fomov GV, Muhin AS, Podolinnyj GI, Gorpinyuk VP, Zvyagincev VV. Markers of anomalies of Calot’s triangle anatomy. Medicinskij Almanah. 2011;(2):58–61 (In Russ.)Köckerling F, Schneider C, Reymond MA, Hohenberger W. Laparoskopische Cholezystektomie in anterograder (prograder) Technik [Laparoscopic cholecystectomy in antegrade (prograde) technique]. Zentralbl Chir. 1997;122(6):498–500.Köckerling F, Schneider C, Reymond MA, Hohenberger W. Laparoskopische Cholezystektomie in anterograder (prograder) Technik [Laparoscopic cholecystectomy in antegrade (prograde) technique]. Zentralbl Chir. 1997;122(6):498–500.Баталова Ю.С., Ефремов С.С. Вариантная анатомия структур треугольника Кало. Альманах молодой науки. 2015;3:20–3Batalova YuS, Efremov SS. Variant anatomy of the structures of Calot’s triangle. Almanah Molodoj Nauki. 2015;3:20–3 (In Russ.)Белоус ПВ. Вариантная анатомия кровоснабжения правой доли печени. Журнал Гродненского государственного медицинского университета. 2013;3(43):58–61Belous PV. Variant anatomy of the blood supply of the right lobe of the liver. Journal of the Grodno State Medical University. 2013;3(43):58–61 (In Russ.)Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surg Endos. 2000;14(2):141–4. doi: 10.1007/s004649900086Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surg Endos. 2000;14(2):141–4. doi: 10.1007/s004649900086Abdalla S, Pierre S, Ellis H. Calot’s triangle. Clin Anat. 2013;26(4):493–501. doi: 10.1002/ca.22170Abdalla S, Pierre S, Ellis H. Calot’s triangle. Clin Anat. 2013;26(4):493–501. doi: 10.1002/ca.22170Теремов С.А., Мухин А.С., Градусов В.П. Редкая аномалия треугольника Кало при лапароскопической холецистэктомии. Эндоскопическая хирургия. 2011;17(2):12–3.Teremov SA, Mukhin AS, Gradusov VP. Calot’s triangle rare anomaly during laparoscopic cholecystectomy. Endoscopic Surgery. 2011;17(2):12–3 (In Russ.)Жариков Ю.О., Коваленко Ю.А., Жарикова Т.С., Шкердина М.И., Николенко В.Н. Хирургическая анатомия IV сегмента печени и ее значение в гепатобилиарной хирургии. Хирургия. Журнал им. Н.И. Пирогова. 2019;(11):93–9. doi: 10.17116/hirurgia201911193Zharikov YuO, Kovalenko YuA, Zharikova TS, Shkerdina MI, Nikolenko VN. Surgical anatomy of liver segment IV and its importance in hepatobiliary surgery. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal im. N.I. Pirogova. 2019;(11):93–9 (In Russ.) doi: 10.17116/hirurgia201911193Белоус П.В. Вариантная анатомия пузырной артерии и пузырного протока человека. Проблемы здоровья и экологии. 2014;2(40):70–6Belous PV. Variant anatomy of the cystic artery and cystic duct. Health and Ecology Issues. 2014;2(40):70–6 (In Russ.)D’Angelo T, Racchiusa S, Mazziotti S, Cicero G. Magnetic Resonance (MR) Cholangiopancreatography Demonstration of the Cystic Duct Entering the Right Hepatic Duct. Am J Case Rep. 2017;18:242–5. doi: 10.12659/ajcr.902620D’Angelo T, Racchiusa S, Mazziotti S, Cicero G. Magnetic Resonance (MR) Cholangiopancreatography Demonstration of the Cystic Duct Entering the Right Hepatic Duct. Am J Case Rep. 2017;18:242–5. doi: 10.12659/ajcr.902620Nomura T, Shirai Y, Sasagawa M, Wakai T, Hatakeyama K. Anomalous insertion of the right hepatic duct into the cystic duct: report of a case diagnosed before laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 1999;9(3):211212.Nomura T, Shirai Y, Sasagawa M, Wakai T, Hatakeyama K. Anomalous insertion of the right hepatic duct into the cystic duct: report of a case diagnosed before laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 1999;9(3):211212.Abe T, Ito S, Kaneda Y, Suto R, Noshima S. Main right hepatic duct entering the cystic duct: a case report. Surg Case Rep. 2019;5(1):46. doi: 10.1186/s40792-019-0604-y.Abe T, Ito S, Kaneda Y, Suto R, Noshima S. Main right hepatic duct entering the cystic duct: a case report. Surg Case Rep. 2019;5(1):46. doi: 10.1186/s40792-019-0604-y.Tsutsumi S, Hosouchi Y, Shimura T, Asao T, Kojima T, Takenoshita S, Kuwano H. Double cystic duct detected by endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy: a case report. Hepatogastroenterology. 2000;47(35):1266–8.Tsutsumi S, Hosouchi Y, Shimura T, Asao T, Kojima T, Takenoshita S, Kuwano H. Double cystic duct detected by endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy: a case report. Hepatogastroenterology. 2000;47(35):1266–8.Munie S, Nasser H, Go PH, Rosso K, Woodward A. Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon. Int J Surg Case Rep. 2019;56:78–81. doi: 10.1016/j.ijscr.2019.02.030Munie S, Nasser H, Go PH, Rosso K, Woodward A. Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon. Int J Surg Case Rep. 2019;56:78–81. doi: 10.1016/j.ijscr.2019.02.030Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoskopska kolecistektomija-akcesorni zucni vodovi [Laparoscopiccholecystectomy-accessory bile ducts]. Acta Med Croatica. 2003;57(2):105–9.Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoskopska kolecistektomija-akcesorni zucni vodovi [Laparoscopiccholecystectomy-accessory bile ducts]. Acta Med Croatica. 2003;57(2):105–9.Itoh T, Fuji N, Taniguchi H, Yasukawa S, Yasuda H, Wakabayashi N, Watanabe T, Kosuga T, Kashimoto K, Yanagisawa A, Naito K. Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. J Hepatobiliary Pancreat Surg. 2008; 15(3):338–343. doi: 10.1007/s00534-007-1245-2Itoh T, Fuji N, Taniguchi H, Yasukawa S, Yasuda H, Wakabayashi N, Watanabe T, Kosuga T, Kashimoto K, Yanagisawa A, Naito K. Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. J Hepatobiliary Pancreat Surg. 2008; 15(3):338–343. doi: 10.1007/s00534-007-1245-2Mugunthan N, Kannan R, Jebakani CF, Anbalagan J. Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance. J Clin Diagn Res. 2016;10(9):AC01–AC04. doi: 10.7860/JCDR/2016/22126.8428Mugunthan N, Kannan R, Jebakani CF, Anbalagan J. Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance. J Clin Diagn Res. 2016;10(9):AC01–AC04. doi: 10.7860/JCDR/2016/22126.8428Asghar A, Priya A, Patra A, Gupta P, Kumar A. Moynihan’s hump of the right hepatic artery in Calot’s triangle: a systematic review and meta-analysis of its incidence and surgical importance. Surg Radiol Anat. 2023;45(5):643–651. doi: 10.1007/s00276-023-03125-8Asghar A, Priya A, Patra A, Gupta P, Kumar A. Moynihan’s hump of the right hepatic artery in Calot’s triangle: a systematic review and meta-analysis of its incidence and surgical importance. Surg Radiol Anat. 2023;45(5):643–651. doi: 10.1007/s00276-023-03125-8Raghuwanshi DS, Ram M, Khan S, Anand K. Moynihan’s Hump: Our Eyes See What Our Mind Knows. Indian J Surg. 2021; 83, 1077–1078. doi: 10.1007/s12262-020-02535-xRaghuwanshi DS, Ram M, Khan S, Anand K. Moynihan’s Hump: Our Eyes See What Our Mind Knows. Indian J Surg. 2021; 83, 1077–1078. doi: 10.1007/s12262-020-02535-xMarano L, Bartoli A, Polom K, Bellochi R, Spaziani A, Castagnoli G. The unwanted third wheel in the Calot’s triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature. J Minim Access Surg. 2019;15(3):185–91. doi: 10.4103/jmas.JMAS_75_18.Marano L, Bartoli A, Polom K, Bellochi R, Spaziani A, Castagnoli G. The unwanted third wheel in the Calot’s triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature. J Minim Access Surg. 2019;15(3):185–91. doi: 10.4103/jmas.JMAS_75_18.Kavitha Kamath B. An anatomical study of Moynihan’s hump of right hepatic artery and its surgical importance. Journal of the Anatomical Society of India. 2016;65(Supp.1):65–7. doi: 10.1016/j.jasi.2016.04.004.Kavitha Kamath B. An anatomical study of Moynihan’s hump of right hepatic artery and its surgical importance. Journal of the Anatomical Society of India. 2016;65(Supp.1):65–7. doi: 10.1016/j.jasi.2016.04.004.Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg. 1999;23(7):703–7. doi: 10.1007/pl00012372Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg. 1999;23(7):703–7. doi: 10.1007/pl00012372Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg. 1992;163(6):593–5. doi: 10.1016/0002-9610(92)90564-8Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg. 1992;163(6):593–5. doi: 10.1016/0002-9610(92)90564-8Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13(42):56295634. doi: 10.3748/wjg.v13.i42.5629Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13(42):56295634. doi: 10.3748/wjg.v13.i42.5629Chetan S, R ajesh K. Cholec ysto-colic Ligament – Anatomical, Physiological and Clinical Prospect. Journal of Morphological Sciences. 2022;39:494–7. doi: 10.51929/jms.39.494.2022Chetan S, R ajesh K. Cholec ysto-colic Ligament – Anatomical, Physiological and Clinical Prospect. Journal of Morphological Sciences. 2022;39:494–7. doi: 10.51929/jms.39.494.2022Andall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016;38(5):529–39. doi: 10.1007/s00276-015-1600-yAndall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016;38(5):529–39. doi: 10.1007/s00276-015-1600-yFlisiński P, Szpinda M, Flisiński M. The cystic artery in human foetuses. Folia Morphol (Warsz). 2004;63(1):47–50.Flisiński P, Szpinda M, Flisiński M. The cystic artery in human foetuses. Folia Morphol (Warsz). 2004;63(1):47–50.Tantia O, Jain M, Khanna S, Sen B. Post cholecystectomy syndrome: Role of cystic duct stump and re-intervention by laparoscopic surgery. J Minim Access Surg. 2008;4(3):71–5. doi: 10.4103/0972-9941.43090Tantia O, Jain M, Khanna S, Sen B. Post cholecystectomy syndrome: Role of cystic duct stump and re-intervention by laparoscopic surgery. J Minim Access Surg. 2008;4(3):71–5. doi: 10.4103/0972-9941.43090Yamashita K, Hashimoto D, Itoyama R, Okabe H, Chikamoto A, Beppu T, Baba H. Accessory right hepatic artery branched from gastroduodenal artery. Surg Case Rep. 2015;1:90. doi: 10.1186/s40792-015-0092-7Yamashita K, Hashimoto D, Itoyama R, Okabe H, Chikamoto A, Beppu T, Baba H. Accessory right hepatic artery branched from gastroduodenal artery. Surg Case Rep. 2015;1:90. doi: 10.1186/s40792-015-0092-7

The authors declare that there are no conflicts of interest present.