肝脏脉管立体构筑解剖研究及其在肝脏海绵状血管瘤剥离切除术中的应用

A study on the topography of liver vessel and the stripping resection of giant hepatic cavernous hemangioma

目的 通过对肝内脉管灌铸解剖和外科手术实践 ,奠定对肝脏巨大海绵状血管瘤施行剥离切除的科学基础。方法 对 10例成年新鲜软尸体行肝脏脉管系统不同构架灌注铸型 ,观察肝内脉管系统的立体解剖。结果 在 10例灌注模型中模拟构筑出肝脏脉管立体构架的少血管区肝段。36例肝血管瘤患者中有 2 7例瘤体超过 15cm ,均按设计的手术入路与方式完成剥离切除手术。结论 第一肝门结构将肝尾状叶和方叶分隔在两个少血管的构架空间内。选择合理的解剖学手术入路可以做到将不同肝段的巨大瘤体单纯剥离切除而不伤及主要的脉管构筑关系。

Objective To determine the existance of oligovessel area in the intrahepatic blood vessel cast for the rationale of stripping resection of cavernous hemangioma of the liver (CHL). Methods Different distribution of the liver vessel were observed by casting 10 fresh adult liver specimens. The various operation route and mode were established by observing and contrasting 36 CHL radiologic data with the cast model. Results Stripping resections of huge CHL with diameter exceeding 15 cm in 27 patients were successfully performed according to the designed operation route and mode. Conclusion According to what we know from the intrahepatic blood vessel casting, the first hilus hepatis divides caudal lobe and square lobe of the liver by oligovessel framework, stripping resection is possible for giant CHL.