国人肝段的再认识

目的:对肝内门静脉和肝静脉重新认识,提出一种新的国人肝段划分方法,为影像学和肝外科提供断层解剖学资料。方法:使用50例上腹部连续断层标本和20例多层螺旋CT图像及三维重建图像,研究了肝内门静脉的走行和分布以及肝静脉及其属支的回流范围及其两者之间的相互关系。结果:国人肝段新的划分方法:门静脉右支主干存在时,依肝中静脉所在的正中裂将肝分为左、右半肝。右半肝被一弯曲的右叶间裂分成右前上叶和右后下叶。右前上叶依垂直段间裂分为腹侧和背侧段。右前上叶的腹侧段被水平亚段间裂分为上、下两个亚段。右后下叶依水平段间裂分为上、下两段。肝左静脉主干存在时,依肝左静脉主干所在的左叶间裂将左半肝分成左后上叶和左前下叶。左前下叶依左段间裂分为内侧和外侧段。水平亚段间裂将左前下叶的内侧段分为上、下两个亚段。依弧形背裂分尾状叶和右前上叶及左前下叶内侧段。结论:国人肝段新的划分法不仅有利于肝内微小病变的精确定位,而且便于肝外科探索新的和更加安全的术式来施行各种肝切除和肝移植。

Re-recognition of the hepatic segment in Chinese

Objective:To re-recognize the intrahepatic portal veins and hepatic veins,to propose a new views of the classification of Chinese hepatic segment and to provide sectional anatomic data for the imaging and liver surgery.Methods: Using 50 successive sections of the upper abdomen of adult cadavers and MSCT enhanced images and three-dimensional images of 20 patients,we investigated the course and division pattern of the intrahepatic portal vein,and the return area of the hepatic veins and their tributaries and the relationships between them.Results: The new classification of Chinese hepatic segments: the liver was divided into left and right hemiliver by the median fissure when the trunk of the right hepatic portal vein was present.The right hemiliver was divided into the right anterosuperior lobe and right posteroinferior lobe by the curved right interlobular fissure.The right anterosuperior lobe was divided into the ventral and dorsal segments by the vertical intersegmental fissure.The ventral segment of right anterosuperior lobe was divided into the upper and lower subsegment.The right posteroinferior lobe was divided into the upper and lower segment by the horizontal intersegmental fissure.When the trunk of the left hepatic vein was present,the left hemiliver was divided into the left posterosuperior lobe and left anteroinferior lobe by the left interlobular fissure where the trunk of the left hepatic vein was located.The left anteroinferior lobe was divided into the medial and lateral segment by the left intersegmental fissure,and the medial segment was divided into the upper and lower subsegment by the horizontal subsegmental fissure.The caudate lobe was separated from the right anterosuperior lobe and medial segment of left anteroinferior lobe by the arcuate dorsal fissure.Conclusion: This new method of Chinese hepatic segment division will be helpful not only to the precise allocation of minimal lesion in the liver,but also to the development of new and safer surgical procedures,which include various kinds of hepatectomy and liver transplantation.