肝内胆管的应用解剖与肝内胆管结石手术入路的研究

目的 探讨肝内叶、段胆管的解剖结构及肝内胆管结石的手术入路。方法 通过研究12例成人肝脏标本的肝内胆管与血管的位置、毗邻关系,设计出经肝的脏面显露左右肝管,经肝的膈面显露肝内叶、段胆管相对合的手术入路,并结合治疗56例复杂性肝内胆管结石患者。结果 左右肝管均位于肝脏脏面门静脉左右干的前上缘;左内叶、右前叶胆管位于相应门静脉的前内侧。右后叶胆管位于门静脉右前支或右前叶下段支脏面测侧者占66.7％(8/12);位于门静脉右后支脏面深侧或后上缘者占83.3％(10/12)。左外叶胆管位于门静脉矢状部脏面深侧者占91.7％(11/12)。选择经肝的脏面显露左右肝管,经肝的膈面显露肝内叶、段胆管相结合的手术入路,治疗复杂性肝内胆管结石患者56例,临床疗效满意。结论 选择经肝的脏面与膈面相结合的手术方式,较易取出结石。

Study on anatomical structure intrahepatic segmental bile ducts and operation approach of cholelithiasia

Objective To explore the anatomical structure and operation means of intrahepatic segmental bile ducts. Method Surgical anatomic relationships between intrahepatic bile ducts and blood vessels in 50 adults liver specimens were studied, new combined operational routes getting to segmental ducts from both visceral and diaphragmatic faces were designed to treat 56 patients. Results Left and right hepatic bile duct lie to the superior anterior board of the left and right trunk of the portal vein; left medial and right anterior segmental duct lie to the anterior medial edge of corresponding portal vein branches. Right posterior segmental duct lies on the visceral side of right anterior portal branches in 66.7% (8/12)and on the visceral side of posterior right branches in 83.3% (10/12). Left lateral segmental duct lies in the deep visceral side of sagittal portion of left portal vein in 91.7% (11/12) . A new combined operative routes getting to segmental ducts from both visceral and diaphragmatic faces were designed to treat 56 patients with multiple intra-hepatic calculis. Conclusion Combined operative routes from both visceral and diaphragmatic facies can easily removing calculi.