肝尾状叶手术的应用解剖研究

Research on the applied anatomy of the hepatic caudate lode

目的 :为肝尾状叶手术提供形态学理论基础。方法 :选取 4 2具成人离体尸肝标本 ,采用雕琢法观测肝尾状叶形态、毗邻及管道。制作 6具肝静脉铸型标本 ,观测尾状叶静脉系统属支及走行。制作 1具肝尾状叶生物塑化薄层连续断面标本 ,并行计算机三维重建 ,显示尾状叶空间关系。利用 3具整尸行单独全尾状叶切除。结果 :大体解剖发现尾状叶门脉三管来源分散 ,行程短 ,不集中 ;铸型标本发现尾状叶门静脉有集中分布的优势 ;成功重建尾状叶及毗邻主要管道空间关系 ;在整尸上 ,顺利完成单独全尾状叶切除。结论 :肝尾状叶位置特殊 ,毗邻关系复杂。肝尾状叶切除手术方式应依据病变部位及大小、性质、肝功状况而定 。

Objective:To provide the morphological basis for the operation of the diseased hepatic caudate lobe.Methods:The morphology,adjacency and ducts of the hepatic caudate lobe were observed with corrosion cast in 42 isolated liver specimens of adult cadavers. The cast specimens of the hepatic vein in 6 cadavers were prepared to investigate the tributaries and courses of the vein system of the caudate lobe. SGI specimens were prepared and the space relationship of the adjacent major vascular structure of the caudate lobe was reconstructed in three dimensions with computer. Total caudate lobectomy was imitatively performed using 3 whole cadavers.Results:It was found in dissection that the origin of three vessels(artery,portalvein and bile duct) of the caudate lobe was decentralized,did not concentrate,and the courses of them were short. The portal vein in the caudate lobe was found to have superiority of concentrated distribution in the cast specimen. The space relationship of the caudate lobe and its adjacent major vascular structures has been reconstructed successfully on 1 adult cadaver. Total caudate lobectomy was successfully performed on the whole cadaver.Conclusion:The position and adjacency of the caudate lobe of the liver is special and the anatomicosurgical relation is complicated. The pattern of the operation of the hepatic caudate lobe depends on the position,size,nature of the lesion and the function of the liver. The postero inferior approach dissociationg the caudate lobe is a pathway worthy to try.