数控气压式肝血流阻断术的肝脏解剖学基础

目的　探讨非直视下钝性分离肝裸区 ,临床应用数控气压式肝血流阻断术做肝切除的可能性。方法　观测 15例经福尔马林灌注的成人尸体肝脏标本的形体特点。结果　 (1)全部标本右肝膈面前部、后部的凸出部位明显 ,后部的最凸出点位于肝裸区 ,其至下腔静脉右缘最小距离约 (4 7± 1 1) (7 2～ 3 0 )cm ,前部的最凸出点到第二肝门右缘的最小距离为 (6 7± 1 6 ) (9 0～ 5 0 )cm。两凸出点之间联线左侧缘至镰状韧带的中间部位肝膈面形成凸圆形 ,中间部位脏面右侧较平整 ,左侧有尾状叶 ,故外形轮廓呈钝圆形 ,较规则 ;(2 )肝裸区的左右最大径线为 (8 4± 9 8) (10 5～ 7 3)cm ,肝裸区的前后最大径线为(7 1± 1 1) (8 9～ 4 9)cm。肝裸区有纤维结缔组织与膈相连 ,无较大血管。结论　 (1)肝脏中间部位的形态结构特征适合肝气压止血带的固定、加压 ,为临床上应用数控气压式肝血流阻断术提供了可能性 ;(2 )不游离肝周韧带 ,非直视下钝性分离肝裸区不会引起大出血 ,临床上操作简单、安全、可行。

Hepatic anatomy of hepatectomy using the technique of liver hemostasis with pneumatic tourniquet by digital controlled gas pressure

Objective To provide amatomic basis for the appliance of the technique of the liver hemostasis with pneumatic touroniquet by digital controlled controlled gas pressure.Methods The observation and measurement of liver morphology were made on 15 adult liver specimens.Results (1)It was evident that the salient points situated in both the poseterior and the anterior diaphragmatic surface of the right lobe of the liver.The salient point of the posterior diaphragmatic surface,which situated in the area nuda hepatic,to the inferior vena cava was a range of (4 7±1 1)(7 2～3 0)cm.The length of the anterior salient point to the second porta hepatic was a range of (6 7±1 6)(9 0～5 0)cm.It was round in shape between the salient points of the right lobe and the falciform ligament,because the diaphragmatic suriace was convex,and the right part of the visceral surface was flatten,the left lodges the caudate lobe.(2)The area nuda hepatic was attached to the diaphragm by connective tissue and has relative avascular plane,its minimum length was (8 4±9 8)(10 5～7 3)cm from anterior to posterior coronary ligament and (7 1±1 1)(8 9～4 9)cm from the left edge to the inferior vena cava.Conclusions (1)The technique of the liver hemostasis with pneumatic tourniquet by digital controlled gas pressure could be designed and used for the hepatic resection because the regularity of the liver in shape.(2)It is safe to separate the area nuda hepatic non visually without separating the parahepatic ligaments.