左外叶活体肝移植的解剖学研究

Applied anatomy of the left lateral lobe in living-related liver transplantation

目的:模拟左外叶活体肝移植门静脉、肝动脉和胆管的切取方法。方法:解剖正常人肝脏标本30具,观察肝脏铸型标本30具,测量门静脉、肝动脉及胆管长度、管径及属支或分支分布情况。结果:左外叶门静脉的血供来自门静脉左支,主要为左外叶上段门静脉支、左外叶下段门静脉支;动脉主要来源于肝固有动脉、肝左动脉、肝中动脉,偶有迷走动脉支;胆道引流属支有左外叶上段胆管支、左外叶下段胆管支。结论:左外叶解剖变异较多,活体取肝前应仔细研究其结构特点,设计合理的切取模式;对门静脉、肝动脉和胆管支需行必要的整形,以便与受体相应的管道进行吻合。

Objective: To imitate the method to cut and obtain the vessels and bile ducts in left lateral lobe living-related liver transplantation. Methods: Thirty normal adult liver specimens were anatomized and 30 cast liver specimens were observed. The lengths, diameters of the portal veins, hepatic arteries and bile ducts of all livers were measured,and of which subsegmental vessels and ducts were described. Results:The portal vein of the left lateral lobe which came from the angle part; sagittal part and cystic part of the left portal vein formed two groups of branches which were to the supper segment and the inferior segment respectively; The hepatic arteries of the left lateral lobe came from the proper hepatic artery,left hepatic arter-y and middle hepatic artery. The aberrant arteries were left inferior phrenic artery, left gastric artery and right gastric artery, and form two groups of branches, which were to the supper segment and the inferior segment;The branches were the bile duct of the upper segment of the left lateral and the inferior segment of the left lateral lobe. Conclusions:The portal vein,hepatic arteries and bile ducts of the left half liver consisted of 4,5 and 6 types respectively. So there were many anatomic variations. The anatomic structure should be researched and designed well to gain a partial liver graft from a living donor before performing living-related liver transplantation. The portal veins, hepatic arteries and bile ducts should be reconstructed if necessary so as to anastomose with recipient vessels or ducts.