CAJ | 학술논문

目的从外科实用角度研究肝全尾状叶的解剖,估计在尾状叶切除中和背驮式肝移植中可能遇到的问题.方法对35个正常新鲜肝标本施行解剖.事前经门静脉灌注硫酸钡胶以便观察尾状叶的门脉系分支状况.结果全尾状叶由3个部分组成:(1)Spigel叶(固有尾状叶):位于下腔静脉左侧,约呈三角椎形,有三个面,顶部和底部.(2)腔静脉旁部:位于下腔静脉右侧和前侧,上达肝右静脉根部,外侧为右后叶门静脉上段支.(3)尾状突:位于下腔静脉与第一肝门之间的嵴状肝组织.结论尾状叶位于肝后,环绕肝后下腔静脉.全尾状叶切除时需充分游离肝脏.手术的关键步骤是结扎切断汇入下腔静脉的尾叶静脉,这在背驮式肝移植中也是一个重要步骤.
목적종외과실용각도연구간전미상협적해부,고계재미상협절제중화배타식간이식중가능우도적문제.방법대35개정상신선간표본시행해부.사전경문정맥관주류산패효이편관찰미상협적문맥계분지상황.결과전미상협유3개부분조성:(1)Spigel협(고유미상협):위우하강정맥좌측,약정삼각추형,유삼개면,정부화저부.(2)강정맥방부:위우하강정맥우측화전측,상체간우정맥근부,외측위우후협문정맥상단지.(3)미상돌:위우하강정맥여제일간문지간적척상간조직.결론미상협위우간후,배요간후하강정맥.전미상협절제시수충분유리간장.수술적관건보취시결찰절단회입하강정맥적미협정맥,저재배타식간이식중야시일개중요보취.
Objective To study the anatomy of the caudate lobe and to apply the knowledge in caudate lobe resection and piggyback liver transplantation. Methods Dissection of the caudate lobe was carried out in 35 fresh adult livers. Before dissection, the portal venous system was injected with barium sulfate emulsion to show the portal branches of the caudate lobe. Results The caudate lobe was shown to consiste of 3 portions: (1) the Spigelian lobe, the paracaval portion and the caudate process. The Spigelian lobe was pyramidal in shape with 3 faces, a peak and a base; (2) the paracaval portion was situated to the right and to the front of the vena cava; (3) the caudal process was the liver parenchyma between the hepatic hilum and the anterior aspect of the vena cava. Conclusions The entire caudate lobe is situated at the posterior part of the liver and it surrounds the vena cava. The key point in resecting the entire caudate lobe or in performing a piggyback liver transplantation is adequate mobilization and division of all the outflowing veins of the caudate lobe.