肝内胆管手术入路的解剖及临床应用  

Surgical approach to intrahepatic bile ducts: anatomical study and clinical application

作　　者：王炳煌[1] 张小文[1] 李立春[1] 李晓[1] 朱红[1] 莫小华[1] 张天玉[1] 

机构地区：[1]昆明医学院附属第二医院外科,650101

出　　处：《中华普通外科杂志》2001年第6期325-327,共3页Chinese Journal of General Surgery

基　　金：云南省自然科学基金!资助项目 ( 94C0 73M)

摘　　要：目的　探讨显露肝内叶、段胆管的手术入路。方法　研究 30例成人肝脏标本的肝内叶、段胆管与血管的毗邻关系。结果　左右肝管均位于肝脏脏面门静脉左右干的前上缘 ,左内叶、右前叶胆管位于相应门静脉的前内侧。右后叶胆管位于门静脉右前支或右前叶下段支脏面深侧者占73% (2 2 / 30 ) ;位于门静脉右后支脏面深侧或后上缘者占 80 % (2 4/ 30 )。左外叶胆管位于门静脉矢状部脏面深侧者占 93% (2 8/ 30 )。选择经肝的脏面显露肝门、左右肝管 ,经肝的膈面显露肝内叶、段胆管相结合的手术入路 ,治疗复杂性肝内胆管结石并狭窄患者 38例 ,均获成功。结论　经肝的脏面与膈面相结合的手术入路 ,比较容易显露和切开肝内胆管及其狭窄段、便于取出结石。Objective To explore a new surgical approach to intrahepatic segmental bile ducts.MethodSurgical anatomic relationships between intrahepatic bile ducts and blood vessels in 30 adult liver specimens were studied.Results Left and right hepatic bile duct lie to the superior anterior board of the left and right trunk of the portal vein; left medial and right anterior segmental duct lie to the anterior medial edge of corresponding portal vein branches. Right posterior segmental duct lies on the visceral side of right anterior portal branches in 73%(22/30). and on the visceral side of posterior right branches in 80%(24/30). Left lateral segmental duct lies in the deep visceral side of sagittal portion of left portal vein in 93%(28/30).A new combined operational routes getting to segmental ducts from both visceral and diaphragmatic faces were designed to treat 38 patients with multiple intrahepatic calculis.Conclusion Combined operational routes from both visceral and diaphragmatic facies can easily expose and cut open intra and extra hepatic ducts and the strictures, removing calculi.

关 键 词：肝内胆管 胆结石 局部解剖学 临床应用 

分 类 号：R657.3[医药卫生—外科学]