肝脏右后叶脉管解剖分型及其变异

Anatomical Typing of the Right Posterior Lobe Vein of the Liver and Its Variations

Couinaud’s分段法将肝脏划分为“五叶八段”。其中,由于右后叶在肝脏所占的体积较大,可达整个肝脏体积的24.7%,同时因为其解剖变异较复杂,因此在肝胆外科手术中具有重要价值。根据Fisher和Couinaud提出的门静脉解剖分型,分为三种不同的分支模式:I型、II型和III型。I型分支模式被认为是门静脉的标准分支模式。约有65.0%至89.1%发生率。II型和III型被分为变异分型,分别有4.5%至11.1%和2.6%至23.5%的发生率。门静脉右后支被分为“弓形”(arch-like)、“二分叉型”、“三分叉型”,分别有32%至63%、27.9%至37.6%、2%至6%的发生率。右后肝动脉(RPHA)的走行路径在解剖学上主要有三种类型,“南绕型”(门静脉下型)、“北绕型”(门静脉上型)、“混合型”,其发生率分别为75.8%~79.7%,7.3%~11.7%,以及8.7%~12.1%。右后肝内胆管同样分为“南绕型”(门静脉下型)、“北绕型”(门静脉上型)、“混合型”,其发生率分别为82.7%~92.9%,7.1%~12.7%,3.2%~5.5%。对于肝脏右后叶的血管和胆管结构的深入理解,以及对其解剖变异的准确识别,对于提高手术效果,减少术中并发症,提高患者的生存质量和生存期具有重要的临床意义。

Couinaud’s segmentation method divides the liver into “five lobes and eight segments”. Among them, the right posterior lobe is of great value in hepatobiliary surgery because of its large volume in the liver, which can be up to 24.7% of the whole liver volume, and because of its complex ana-tomical variations. According to the anatomical typing of the portal vein proposed by Fisher and Couinaud, it is categorized into three different branching patterns: type I, type II, and type III. Type I branching pattern is considered the standard branching pattern of the portal vein. It has an inci-dence of approximately 65.0% to 89.1%. Type II and type III are categorized as variant branching patterns with an incidence of 4.5% to 11.1% and 2.6% to 23.5%, respectively. The right posterior branch of the portal vein was categorized as “arch-like”, “bifurcation”, and “trifurcation”, occurring in 32% to 63%, 27.9% to 37.6%, and 2% to 23.5%, respectively. 37.6%, and 2% to 6%, respective-ly. The right posterior hepatic artery (RPHA) has three main anatomical types of travel paths, “southern bypass” (subportal type), “northern bypass” (supraportal type), and “mixed type”, with incidence rates of 75.8%~79.7%, 7.3%~11.7%, and 8.7%~12.1%, respectively. Right posterior in-trahepatic bile ducts were also categorized as “southern bypass type” (subportal type), “northern bypass type” (supraportal type), and “mixed type”, with incidences of 82.7%~92.9%, 7.1%~12.7%, 3.2%~5.7%, 3.2%~12.7%, and 3.2%~5.7%, respectively, and 3.2%~5.5%, respectively. An in-depth understanding of the vascular and biliary structure of the right posterior lobe of the liver and accurate identification of its anatomical variants are of great clinical significance in improving surgical outcomes, reducing intraoperative complications, and improving the quality and survival of patients.