肝尾状叶及其血管的断层解剖学研究

SECTIONAL ANATOMY OF HEPATIC CAUDATE LOBE AND ITS BLOOD VESSELS

目的 :为肝尾状叶疾病的影像诊断和外科手术提供形态学依据。方法 :利用成人腹部连续横断层标本 2 2例、矢状断层标本 14例和冠状断层标本 5例研究了肝尾状叶及其血管的断层解剖。结果 :肝尾状叶有 5面 ,在外形上可分为固有肝尾状叶 (Spigelian叶 )、腔静脉旁部和尾状突三部分。固有肝尾状叶 ,在横断面上 ,14例 ( 63.6% )伸出腔静脉后突 ,11例 ( 50 % )出现孤立乳头突现象 ;在矢状断面上 ,4例 ( 2 8.6% )下端出现分叉。在 15例 ( 68.2 % )横断层和 12例 ( 85.7% )矢状断层标本上 ,可见肝尾状叶鞘系 ,主要出现于肝门静脉左支横部层面。在断层标本上 ,可见 1～ 3支尾状叶静脉 ,大部分汇入下腔静脉肝后段的中、下份。粗大的肝右后下静脉分别见于 10例 ( 4 5.5% )横断层、4例 ( 2 8.6% )矢状断层和 1例冠状断层标本上。结论 :肝尾状叶依内部脉管构筑 ,应视为为一个独立肝段 (段 1) ,但在外形上又可分其为 3部 ;肝尾状叶切除术前 ,应用MRI或增强CT检查 。

Objective:To provide morphologial basis for imaging diagnosis and operation of diseased hepatic caudate.Methods:The sectional anatomy of the hepatic caudate lobe and its blood vessels was investigated in 41 adult cadavers (horizontally,22 cases sagittally 14, frontally 5).Results:The caudate lobe has 5 surfaces and is divided into 3 parts :the caudate lobe proper (Spigelian lobe),paracaval portion,and caudate process.On the horizontal sections in 14(63.6%)cases,the caudate lobe extends with the retrocaval process.The isolated papillary process stretches out from the rest of the liver on the horizontal sections in 11(50%) cases.In 15 cases( 68.2% ) on the horizontal sections and 12 cases(85.7%)on sagittal section,the Glissan pedicles of the caudate lobe were visualized,the structure mainly appearing on the sections through the transverse portion of the left portal vein.1～3 caudate lobe veins could be seen on the sections in all cases,mostly draining into the middle and lower portions of the retrohepatic inferior vena cava.Thicker inferior right hepatic veins appeared in 10 cases (45.5%)on the horizontal sections ,in 4 cases(28.6%)on sagittal sections,and in 1 case on frontal section.Conclusion:Hepatic caudate lobe should be considered as one single segment according to its internal vascular structure and divided into 3 parts.Prior to hepatectomy of caudate lobe,vein draining of right posterior hepatic lobe must be fully known with the aid of MRI or enhanced CT examination.