腹腔镜时代的肝尾状叶切除再认识

Re-recognition of caudal lobectomy in the laparoscopic era

肝尾状叶一直被视为肝脏最为深在、解剖最为复杂的肝段。外科医师对肝尾状叶及其亚段的认识经历了复杂、曲折的过程。近年来,在肝脏大体标本、铸型标本、三维重建的传统解剖认识基础上,腹腔镜肝尾状叶切除术中肝尾状叶的特殊视角、精细解剖不断得到验证或者挑战。正是这些验证和挑战使外科医师不断修正、还原着肝尾状叶解剖的真实原貌。本文将对这些最新的观点,以一个腔镜外科医师的角度进行探讨,并对腔镜下全尾状叶切除要点进行详细描述。

The caudate lobe of the liver has always been regarded as the deepest segment,with most complicated anatomy.The surgeon’s understanding of the caudate lobe and its subsegments has undergone a complex and tortuous process.In recent years,the special view and fine anatomy of the caudate lobe in laparoscopic resection of caudate lobe of liver have been proved or challenged based on the traditional anatomical knowledge of the liver gross specimen,cast specimen and three-dimensional reconstruction.It is these validations and challenges that keep surgeons revising and restoring the caudate anatomy to its true form.This article will discuss these new ideas and describe the laparoscopic total caudate lobectomy in detail from the point of view of a laparoscopic surgeon.