胆囊后三角应用解剖及其在腹腔镜胆囊切除术中的临床意义

目的探索胆囊后三角的解剖结构，为腹腔镜胆囊切除术提供胆囊后三角解剖学基础。方法2005年9月至2008年1月山东省泰安卫生学校、山东省立医院、泰山医学院附属医院、荣成市人民医院选用81例成人尸体标本，模拟腹腔镜胆囊切除术胆囊后三角入路，观察胆囊后三角的组成边界、穿行结构及毗邻关系。结果胆囊后三角由胆囊颈部后壁、胆囊管、胆总管上段和肝右叶脏面组成；胆囊管的长度(3018±219)mm，直径为(302±036)mm，其形状有直线型和弯曲型；胆囊动脉的直径为(168±035)mm；胆囊管较胆囊动脉粗，二者差异有统计学意义（P＜005）；6例（74%）于胆囊后三角后下方见异常胆囊动脉，自胆囊颈及胆囊体后方入胆囊，胆囊动脉自胆囊管后方走行进入胆囊8例（99%），胆囊动脉走行于胆囊管前方5例（61%）；5例（61%）发自肝右叶脏面的副肝管通过胆囊后三角经胆囊管和肝总管汇合处后下方入胆总管。结论熟悉胆囊后三角的组成结构及毗邻关系，是避免手术时损伤血管和胆管的关键，对腹腔镜胆囊切除术的开展具有指导意义。

Applied anatomy of posterior Calot's triangle and its clinical significance in laparoscopic cholecystectomy

Applied anatomy of posterior Calot’s triangle and its clinical significance in laparoscopic cholecystectomyYOU Xiao gong*,SHI Bao min,JING Li yan,et al.*Taian Health School of Shandong Province，Taian 271000,China Corresponding author：SHI Bao min，E mail:tawxyxg@163.com AbstractObjectiveTo investigate the structure of the posterior Calot's triangle sector and provide anatomic data of posterior Calot's triangle for laparoscopic cholecystectomy.MethodsFrom September 2005 to January 2008,the structure of posterior Calot’s triangle was observed by simulating the posterior Calot’s triangle approach of laparoscopic cholecystectomy in 81 samples of adult liver and gallbladder.ResultsPosterior Calot’s triangle was composed of the back wall of gallbladder neck,cystic duct,the upper section of common bile duct, and the facies visceralis of lobus hepatis dexter.The length of the ductus cysticus was (3018±219)mm and (302±036)mm in diameter(range from 232 to 398mm).It had either linear type or arcuate type.The mean diameter of the cystic artery was (168±035) mm (range from 080 to 378mm). Abnormality of cystic artery was observed posterosuperior to the posterior Calot’s triangle in 6 sample (74%) entering gallbladder from the back of neck and body of gallbladder.Cystic artery pass through the back of the cystic duct occurred in 8 samples (99%).Cystic artery pass through the front of the cystic duct occurred in 5 samples(6.1%).Accessory hepatic duct originated in the facies visceralis of lobus hepatis dexter was observed in 5 samples（61%）through the posterior Calot’s triangle entering common hepatic duct through the joint of cystic duct and common hepatic duct.ConclusionIdentification of posterior Calot's triangle and its bordering structures is beneficial to avoiding injuries of surrounding blood vessels and bile ducts during laparoscopic cholecystectomy