肝脏分叶精美图解.docx

1.iverSegmenta1.AnatomyRobinSmithu1.s1.iveranatomycanbedescribedusingtwodifferentaspects:morpho1.ogica1.anatomyandfunctiona1.anatomy.Thetraditiona1.morpho1.ogica1.anatomyisbasedontheexterna1.appearanceofthe1.iveranddoesnotshowtheinterna1.featuresofvesse1.sandbi1.iaryductsbranching,whichareofobviousimportanceinhepaticsurgery.C.Couinaud(1957)dividedthe1.iverintoeightfunctiona1.1.yindepedentsegments.Thisc1.assificationwi1.1.bepresentedherewithsevera1.i1.1.ustrations.Couinaudc1.assificationTheCouinaudc1.assificationof1.iveranatomydividesthe1.iverIntoeightfunctiona1.1.yindepedentsegments.Eachsegmenthasitsownvascu1.arinf1.ow,outf1.owandbi1.iarydrainage.Inthecentreofeachsegmentthereisabranchoftheporta1.vein,hepaticarteryandbi1.educt.Intheperipheryofeachsegmentthereisvascu1.aroutf1.owthroughthehepaticveins.Righthepaticveindividestheright1.obeintoanteriorandposteriorsegments.Midd1.ehepaticveindividesthe1.iverintorightand1.eft1.obes(orrightand1.efthemi1.iver).Thisp1.anerunsfromtheinferiorvenacavatothega1.1.b1.adderfossa.1.efthepaticveindividesthe1.eft1.obeintoamedia1.and1.atera1.part.Porta1.veindividesthe1.iverintoupperand1.owersegments.The1.eftandrightporta1.veinsbranchsuperior1.yandinferior1.ytoprojectintothecenterofeachsegment.Becauseofthisdivisionintose1.f-containedunits,eacsegmentcanberesectedwithoutdamagingthoseremaining.Forthe1.ivertoremainviab1.e,resectionsmustproceeda1.ongthevesse1.sthatdefinetheperipheriesofthesesegments.Thismeans,thatresecbo-1.inespara1.1.e1.thehepaticvans,Thecentra1.1.y1.ocatedporta1.veins,bi1.educts,andhepaticarteriesarepreserved.根据Couinaud分段SegmentsnumberingThereareeight1.iversegments.Segment4issometimesdividedintosegment4aand4baccordingtoBismuth.Thenumberingofthesegmentsisinac1.ockwisemanner(figure).Segment1(caudate1.obe)is1.ocatedposterior1.y.Itisnotvisib1.eOnafronta1.view.娱时仲数字标记段Thei1.1.ustrationsaboveareschematicpresentationsofthe1.iversegments.Inrea1.ityhowevertheproportionsaredifferent.Onanorma1.fronta1.viewthesegments6and7arenotvisib1.ebecausetheyare1.ocatedmoreposterior1.y.Therightborderofthe1.iverisformedbysegment5and8.A1.thoughsegment4ispartofteIefthemi1.iver,itissituatedmoretotheright.Couinauddividedthe1.iverintoafunctiona1.1.eftandright1.iver(inRench,gaucheetdroite(oie')byamainporta1.Scissuraecontainingthemidd1.ehepaticvein.ThisisknownasCant1.ie's1.ine.Cant1.ie's1.inerunsfromthemidd1.eofthega1.1.b1.adderfossaanterior1.ytotheinferiorvenacavaposterior1.y.Onthisi1.1.ustrationIt1.ooksasifthemedia1.partofthe1.eft1.obeisseparatedfromthe1.atera1.partbythefa1.ciform1.igament.Howeveritactua1.1.yisthe1.efthepaticvein,thatseparatesthemedia1.part(segment4)fromthe1.atera1.part(segments2and3).The1.efthepaticveinis1.ocateds1.ight1.ytothe1.eftofthefa1.ciform1.igament.从前方看.在不到六.七段TransverseanatomyThefar1.eftfigureisatransverseimagethroughthesuperior1.iversegments,thataredividedbythehepaticveins.Therightfigureshowsatransverseimageatthe1.eve1.ofthe1.eftporta1.vein.Atthis1.eve1.the1.eftporta1.veindividesthe1.eft1.obeofthe1.iverintothesuperiorsegments(2and4A)andtheinferiorsegments(3and电.The1.eftporta1.veinisatahigher1.eve1.thantherightporta1.vein.左：在左门静射:以上水平右：在左门静脉水平Theimageonthefar1.eftisatthe1.eve1.oftherightporta1.vein.Atthis1.eve1.therightporta1.veindividestheright1.obeofthe1.iverintosuperiorsegments(7and8)andtheinferiorsegments(5and6).The1.eve1.oftherightporta1.veinisinferiortothe1.eve1.ofthe1.eftporta1.vein.Atthe1.eve1.ofthesp1.enicvein,whichisbe1.owthe1.eve1.Oftherightporta1.vein,on1.ytheinferiorsegmentsareseen(rightimage).左：在右门静脉水平i在睥怖脉水平CaudateIobeThecaudate1.obeorsegment1is1.ocatedposterior1.y.Thecaudate1.obeisanatomica1.1.ydifferentfromother1.obesinthatitoftenhasdirectconnectionstotheIVCthroughhepaticveins,thatareseparatefromthemainhepaticveins.Thecaudate1.obemaybesupp1.iedbybothrightand1.eftbranchesoftheporta1.vein.Onthe1.eftapatientwithcihosiswithextremeatrophyoftheright1.obe,norma1.vo1.umeofthe1.eft1.obeandhypertrophyofthecaudate1.obe.Duetoadifferentb1.oodsupp1.ythecaudateIobeissparedfromthediseaseprocessandhypertrophiedtocompensateforthe1.ossofrxmaIiverparenchyma肝硬化尾叶增大注场右叶缩小OtherC1.assificationsandVariantsTherearemanyotheranatomica1.andfunctiona1.descriptionsofthe1.iveranatomy.Inthec1.assica1.descriptiontheexterna1.appearanceofthe1.iverisusedtodescnbetheanatomy.Howevertherearemanydifferencesbetweenthisc1.assica1.mode1.andthefuctiona1.mode1.s,aspopu1.arizedbyCouinaudandBismuth.Amoredetai1.eddiscussionofthevariousmode1.sisgiveninreference4.C1.assica1.AnatomyThec1.assica1.desiptionofthe1.iveranatomybasedontheexterna1.appearance.Onthediaphragmaticsurface,theIigamentumfa1.ciformedividesthe1.iverintotherightand1.eftanatomic1.obes,whichareverydifferentfromtefunctiona1.rightand1.eft1.obes(orrightand1.efthemi1.iver).Inthisc1.assica1.description,thequadrate1.obebe1.ongstotherightIObeofthe1.iver;butfunctiona1.1.ytispartof1.eft1.obe.