尾状叶切除术应用解剖学研究

目的：为肝尾状叶切除术提供形态学理论基础。方法：选取37具成人离体尸肝标本，采用雕琢法和断层解剖观测肝尾状叶形态、毗邻，血管系统的来源、走行，肝后腔静脉前间隙。结果：尾状叶三管系统的来源，Spiegel叶多以左肝三管系统为主，而腔静脉旁叶多以右肝或分权处为主，三管系统中，以门静脉分支分布最为稳定，尾状叶静脉变异较大；三管系统在进入尾状叶时形成簇；尾状叶有前平面及肝后腔静脉前间隙；尾状叶Spiegel叶与腔静脉旁部存在较为明显的界线，其外部标志大致与其外切迹相当，腔静脉旁部与尾状突无明显的界线。结论：肝尾状叶位置特殊，毗邻关系复杂，三管系统进入尾状叶的位置比较恒定。尾状叶的手术切除术应首先确定边界，根据相应的解剖标志来选择手术方式及入路。

Applied anatomy of the hepatic caudate lobectomy

Objective: To provide anatomic foundation for the operation of the hepatic caudate lobectomy. Methods: 37 cases of adult liver specimens were dissected and investigated the shape, adjacent structures and the vessel system of the caudate lobe, as well the anterior space of inferior vena cava behind the liver using carving technique and sectional anatomy. Results: It was the left portal triads that reached the Spiegel's lobe. The branches of the paracaval portion almost originated from the right portal triads and hilar bifurcation. The branches of portal vein in the portal triads were the most stable structure. The veins of caudate lobe always variated during its course. There was a space between caudate lobe and inferior vena cava. A obvious border line existed between the Spiegel's lobe and the paracaval portion, which corresponded to the external notch of caudate lobe. However no anatomic mark could be found between the paracaval portion and the caudate process. Conclusions: The position and anatomical relationship of the caudate lobe is complicated. The pattern of the operation for hepatic caudate lobe depends on the lesion type and the anatomic landmarks.