肝胃韧带的断层和CT解剖

目的 :阐明肝胃韧带分隔网膜囊上隐窝 (SRLS)的意义及内侧胃膈韧带的存在。方法 :①观察肝的韧带的附着和相互移行情况及肝胃韧带、SRLS与左肝上后间隙、左肝上前间隙的通连关系。②观察腹部连续断层标本 (横断层和矢状断层 )。③腹部螺旋CT扫描。结果 :①通常教科书和文献所述的肝胃韧带实际上由肝膈韧带、肝食管韧带和肝胃韧带构成。②肝胃韧带位于静脉韧带裂内 ,后层在近胃小弯处反折至膈形成内侧胃膈韧带 ,并与内侧胃膈韧带分别作成SRLS的前界和左侧界。③肝胃隐窝与SRLS之间因隔以肝胃韧带而不相通。结论 :肝胃韧带和内侧胃膈韧带分别构成SRLS的前界和左侧界分隔SRLS ;一些教材所用的图 ,表达SRLS与左肝上后间隙相通的概念值得商榷。

Secticnal and CT of the hepatogastric Iigament

Objective:To describe and explain the importance of the hepatogastric ligament in dividing the superior recess of the lesser sac (SRLS) and the exist of gastrodiaphragmatic ligament.Methods:Fifty liver specimens away from cadavers,specimens of abdomen,serial sections of abdomen specimens and CT images were made and observed.Results:In the prevailing view,the hepatogastric ligament consists of hepatoesophageal ligament and hepatogastric ligament.However,on the transverse section between the second porta hepatis and the porta hepatis,the posterior layer of the hepatogastric ligament can be observed turning back to diaphragm and form the medial gastrodiaphragmatic ligament.The hepatogastric ligament formed the anterior boundary of SRLS while the medial gastrodiaphragmatic ligament formed the left boundary of SRLS.On the sagittal section,the hepatogastric ligament situated in the fissure of ligamentum venosum and formed the anterior boundary of SRLS.The hepatogastric recess communicated with the anterior superior space of left liver and the posterior superior space of left liver;but SRLS did not.Conclusions:The hepatogastric ligament forms the anterior boundary of SRLS and the medial gastrodiaphragmatic ligament forms the left;the matter that SRLS communicates with the posterior superior space of left liver described in some textbook is an open question.