肝胆管外科入路的应用解剖

目的探讨在不同肝门解剖结构条件下，肝内及肝门胆管的暴露途径。方法选用成人肝脏标本３０例，沿肝十二指肠韧带向肝门及肝内解剖，观察肝内外胆管的行径特点及其毗邻关系。结果肝管汇合的常见方式有３型，本组左右肝管正常汇合型１８例、二级肝管直接汇合型和右侧胆管变异支异常汇合型分别为６例。肝管行出肝门的水平有较大差异。肝门区管道结构的相互毗邻关系及Ｇｌｉｓｏｎ束在肝内的行径相对恒定。结论在正常的肝门解剖结构条件下，通过解剖肝门的方法可以暴露肝总管及左右肝管，在解剖变异或需要暴露更高位胆管时，可以借助肝正中裂切开法或肝方叶切开法达到暴露目的。

Applied anatomy on surgical access of hepatic bile ducts

Objective To investigate the surgical approaches to biliary tracts from the hepatic hilus to intrahepatic region. Methods Thirty specimens of adult cadaveric liver were dissected and observed from hepatoduodenal ligament to hepatic and segmental hilus. Results From observation, the conjugation of bile ducts is classified into three patterns: normal conjugation of hepatic ducts, direct conjugation of secondary hepatic ducts and aberrant conjugation of bile ducts from right robe. The depth of biliary ducts at hepatic hilus varies from extrahepatic hepatic duct to intrahepatic common hepatic ducts, however, the adjoining relationship and intrahepatic passage of Glisson system varies less. Conclusions Common hepatic ducts and primary hepatic ducts could be visualized from surgical dissection at hilus under normal anatomical condition, and middle fissure separation or partial resection of quadrate segment could facilitate the visualization of intrahepatic ducts.