肝脏的血管解剖及血供在解剖性肝切除术中的应用

Application of hepatic vascular anatomy and blood supply in anatomic hepatectomy

目的总结肝脏的血管解剖及供血在解剖性肝切除中的应用,为临床开展肝切除术提供参考.方法在中国知网、万方数据库、PubMed、Web of Science等数据库以"肝脏血管""肝切除""肝移植""肝脏血供"以及"liver vascular anatomy""hepatectomy""liver transplantation""the liver blood supply"为中英文关键词,检索2000年1月—2018年12月国内外相关文献资料,对肝脏血管解剖及其在肝切除中的应用进行汇总分析.结果共检索到文献786篇,最终纳入26篇文献,其中中文文献9篇和英文文献17篇.术前了解肝血管的走行及解剖变异,对活体相关肝移植和肝部分切除术均有帮助.掌握肝血管解剖及供血范围,能够在术中确定恰当的肝切除平面,可以减少切肝过程遭遇的血管数量,在一定程度上减少术中出血.实现解剖性肝切除主要依赖于肝血管系统的影像学定位技术、出入肝血管解剖显露及选择性阻断技术、肝切除平面的判定及肝内血管显露技术.结论充分掌握肝血管解剖及供血范围,选择最佳的手术方式,辅以擅长的外科解剖技术,是保证解剖性肝切除术顺利、提高切除精准度的关键所在.

Objective To summarize the application of hepatic and blood supply in anatomic hepatectomy so as to provide reference for performing hepatectomy.Methods In China Knowledge Network,Wanfang Data and other databases,PubMed,Web of Science,the"肝脏血管","肝切除","肝移植","肝脏血供"and"liver vascular anatomy""hepatectomy""liver transplantation","the liver blood supply"were used as key words to search for relevant literatures on liver vascular anatomy from January 2000 to December 2018.The results were summarized and analyzed.Results A total of 786 literatures were retrieved,and 26 literatures were included according to inclusion criteria and exclusion criteria,including 9 Chinese literatures and 17 English literatures.Preoperative understanding of the changes in hepatic blood vessels was helpful for both living-related liver transplantation and partial hepatectomy.A good grasp of the anatomy and blood supply of hepatic blood vessels could determine a good hepatectomy plane during the operation,which could reduce the number of blood vessels encountered in the process of liver resection and reduce intraoperative bleeding to a certain extent.The realization of accurate hepatectomy mainly depended on the imaging positioning technology of the hepatic vascular system,the anatomical exposure and selective occlusion technology of the access and exit hepatic vessels,the determination of the hepatectomy plane and the intrahepatic vascular exposure technology.Conclusions Mastering fully the anatomy and blood supply of hepatic vessels,selecting the best surgical method,and complementing with good surgical anatomic techniques are the keys to ensure the success of hepatectomy and improve the accuracy of resection.