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腹腔镜肝尾状叶切除术的应用解剖学研究
Applied Anatomic Study on Laparoscopic Hepatic Caudate Lobectomy
【作者】 侯东生；
【导师】 钟世镇；
【作者基本信息】 第一军医大学 ， 人体解剖学， 2006， 博士
【摘要】 由于腹腔镜肝尾状叶切除术是技术复杂、难度极大的一种手术，目前仍处于探索、研究阶段，还未有腹腔镜下肝尾状叶切除术的临床报道。本研究试图通过应用解剖学、影像学、动物实验及临床肝切除的研究来探讨腹腔镜下肝尾状叶切除术的可能性。 第一章 肝尾状叶的应用解剖学研究 目的：为肝尾状叶切除术提供形态学理论基础。 方法：选取37具成人离体尸肝标本，采用雕琢法观测肝尾状叶形态、毗邻及管道、尾状叶静脉系统属支、走行，肝后腔静脉前间隙。根据三管系统分界尾状叶边界。 结果： 1．位置及形态毗邻：肝尾状叶位于第一、二、三肝门之间，可分为三部分，Spiegel叶、腔静脉旁部及尾状突；尾状叶的Spiegel叶与腔静脉旁部存在较为明显的界线，其外部标志大致与其外切迹相当，腔静脉旁部与尾状突无明显的界线。肝尾状叶有三个游离面和二个肝内界面，即尾状叶左侧平面，其正对第二肝段：背侧平面，正对后腹壁及右侧肾上腺；肝门平面，与肝蒂相邻；腹侧平面与第四肝段及／或第八肝段相邻；右侧界面邻近下腔静脉、第七肝段和第八肝段。后两个界面不能在外部看到，且形状不规则，存在较大的解剖学变异。
【Abstract】 Laparoscopic liver resection is still on the stage of research due to its high difficulty and complexity on operation.now,no one paper reports a case laparoscopic caudate lobectomy.our research try to explain the possibility by applied anatomic study,multislice computed tomography,animal experiment and the clinic study.Chapter 1 Applied anatomic study on the caudate lobe of liverObjective: To provide anatomic foundation for the operation of the hepatic caudate lobe process.Methods: To choose 37 cases livers of adult ,using the way of carving to anatomy these livers and investigating the shape of the caudate lobe、 adjacency and ducts、 vein branches of the caudate lobe and the space before IVC. Confirming the margin according to the portal triads.Results:1 .The location of the caudate lobe is between the first,second and third hilar of liver and have three portions,Spiegel lobe,the paracaval portion and caudate process. The borderline exist between the Spiegel’s lobe and the paracaval portion and the exterior sign corresponding to the external notch of caudate lobe.However no anatomic sign could found between the paracaval portion and the caudate process. The caudate lobe has three free surfaces and two intraparenchymal border planes, that is, the left surface (flat) opposite S2, the dorsal surface (almost flat) facing the dorsal abdominal wall and right suprarenal gland, the hilar surface (curved and irregularly shaped) adjacent to the porta hepatis, the ventral border plane adjacent to S4 and/or S8 and the right border plane adjacent to the IVC, S7 and S8.The latter two border