基于Laennec膜理论的规范化腹腔镜肝段切除术的研究进展

Research progress of standardized laparoscopic segmentectomy based on Laennec's capsule theory

随着腹腔镜肝脏外科的迅速发展,腹腔镜肝切除术逐渐成为肝脏外科的主流术式,肝脏膜解剖在其中扮演着重要作用。肝Laennec膜包裹整个肝脏,并随着Glisson蒂和肝静脉进入肝实质,将肝实质与Glisson鞘膜、“六扇门”及肝门板系统、肝静脉和肝后下腔静脉隔开,是肝切除术中安全游离并寻找肝蒂的标准膜间隙。通过Laennec膜分离入肝的Glisson蒂和出肝的肝静脉,可以准确切除肝组织。目前严格按照标准腹腔镜肝段切除术的文献不多,结合Laennec膜解剖进行腹腔镜肝段切除的研究报告更少。组织学已证实Laennec膜的存在,其与肝门部的Glisson鞘是互相独立,不延续,二者之间存在间隙,并随着Glisson蒂深入肝实质。利用肝门部Glisson鞘与Laennec包膜之间的间隙,分离各肝段的Glisson蒂,并结扎阻断,是规范化肝段切除的解剖学基础。本文总结肝Laennec膜理论的相关研究,结合临床上腹腔镜肝段切除术的探索报告,为基于Laennec膜的规范化腹腔镜肝段切除术提供参考。

With the rapid development of laparoscopic liver surgery,laparoscopic hepatectomy has gradually become a mainstream procedure in liver surgery,and the anatomical understanding of the liver membrane plays a crucial role in this.The Laennec's capsule encapsulates the entire liver.It enters the liver parenchyma along with the Glisson's capsule and hepatic veins,separating the liver parenchyma from the Glisson's capsule,"six portal triads"system,hepatic veins,and the retrohepatic inferior vena cava.It is the standard intermembrane space for safe dissection and location of the hepatic pedicle during hepatectomy.Accurate liver tissue resection can be achieved by separating the Glisson's capsule that enters the liver and the hepatic veins that exit the liver through the Laennec's capsule.Currently,there is a scarcity of literature strictly adhering to the standard laparoscopic liver segmentectomy,and even fewer studies report on laparoscopic liver segmentectomy combined with Laennec's membrane anatomy.Histology has confirmed the existence of the Laennec's membrane,which is independent and not continuous with the Glisson's capsule at the hepatic hilum;there is a space between them that deepens into the liver parenchyma along with the Glisson's capsule.Utilizing the space between the Glisson's capsule at the hepatic hilum and the Laennec's capsule to separate and ligate the Glisson's capsule of each liver segment provides the anatomical basis for standardized liver segmentectomy.This paper summarizes relevant research on the theory of Laennec's capsule,combined with clinical exploration reports on laparoscopic segmental hepatectomy,to provide a reference for standardized laparoscopic liver segmentectomy based on Laennec's capsule.