肝全尾状叶的解剖学研究及切除体会  

Applied anatomy and surgical resection of the hepatic caudate lobe

作　　者：姚和祥[1] 邹忠东[1] 王瑜[1] 王烈[1] 

机构地区：[1]南京军区福州总医院普通外科,530025

出　　处：《中华肝胆外科杂志》2011年第8期624-626,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：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。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.

关 键 词：局部解剖学 肝 全尾状叶 

分 类 号：R735.7[医药卫生—肿瘤]