尾状叶切除术的应用解剖

Applied anatomy of caudate lobectomy of human liver

目的 :通过肝尾状叶的应用解剖学研究 ,为肝脏尾状叶切除术的入路和发展提供解剖学基础。方法 :通过 40具尸肝尾状叶标本的解剖观察和 8具肝脏铸型标本的观察研究 ,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 ,其血液供应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 ,沿肝门板后方向上解剖找出尾状叶“蒂” ,从中再解剖动脉、门静脉、胆管易行 ,甚至一起结扎、切断也可 ;③肝短静脉数量、注入部位变异大 ,然而其走行多与腔静脉壁垂直 ,顺着方向解剖比较安全。结论 :尾状叶切除的手术入路有四条 :左入路、右入路、前入路和后入路。

Objective:To provide morphological data for caudate lobectomy of liver.Methods:The shapes,border,adjacencies and the distributions of the vessels and ducts of the caudate lobe were investigated on 40 cadaver specimens of human liver with different approaches of caudate lobectomy,and were also observed on 8 casting specimens and 2 section specimens of human livers.Results:The left sides of caudate lobe varied little in the shape and border,having a constant pedicle of vessels and bile ducts,which could be resected in surgery.Most of the pedicle of caudate lobe arose from the anterosuperior of the first or second order of Glisson's pedicle.The pedicle of caudate lobe could be found along superior of the posterior hilar plate,which should be resected following ligature of the whole pedicle.The hepatic short vein varied significantly in number and entering location,but it was veritcal to IVC.Separating along the direction of hepatic short vein was safe. Conclusions: There are four approaches of caudate lobectomy,they are left,right,anterior,and posterior approach,and the posterior approach is the most difficult among them.The present study indicats that the caudate lobectomy is feasible and safe if the morphology of the caudate lobe is considered.