肝尾状叶应用解剖的研究与手术原则

Applied anatomy and surgical principle for resection of human caudate lobe

目的为肝脏尾状叶合理化切除提供应用解剖学理论依据。方法通过24具尸体的肝尾状叶标本的解剖观察,揭示尾状叶的形状、边界、毗邻和血管、胆管分布规律。结果①尾状叶左侧的形态、大小、边界变异不大,其血液及胆管引流有一个相对固定的“蒂”,手术切除比较容易;②尾状叶的血管供应、胆管引流繁杂,但均连接于Glisson’s管的一、二级分支的前上缘;③肝短静脉数量、注入部位变异大,其走行多与腔静脉壁垂直。结论尾状叶切除的手术入路有四条可供选择:左入路、右入路、前入路和后入路。

Objective To provide morphological data for caudate lobectomy of human liver. Methods The shapes, border, adjacencies and distributions of the vessels and ducts of the caudate lobe were investigated on liver specimens of 24 corpses with different approaches of caudate loboctomy. Results The left side of caudate lobes varied little in the shape and border, having a constant pedicle of vessels and bile ducts, which could be easily resected in surgery. Most of the blood vessle branches and bile duct of caudate lobe arose from the anterosuperior edge of Glisson＇ s capsule. The hepatic short veins varied significantly in number, but all veritcal to inferior vena cave. Conclusion There are four approaches for caudate lobectomy： left, right, anterior, and posterior approach, and the posterior approach is the most difficult one.