肝右前叶Glisson系统的解剖结构特点及其临床意义  

The characteristic of anatomical structures and clinical significance about the Glisson pedicle of right anterior section

作　　者：刘巧云[1] 马心逸 喻智勇[1] 高则海[1] 蔡强[1] 侯丽莉[1] 

机构地区：[1]昆明医科大学第四附属医院普通外科三科,昆明650021

出　　处：《中国临床解剖学杂志》2015年第2期121-125,共5页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金(81060041)

摘　　要：目的观察右前叶Glisson系统的解剖结构特点,为实施右前叶病灶的精准肝切除术提供解剖学基础。方法剥离解剖20例成人无病变尸体肝脏标本,对肝右前叶Glisson系统进行形态学观察,采集相关数据并进行统计学分析。结果 G右总分出G右后与G右前的两支型占95%,G右总分出G右前与G6、G7的3支型占5%。G右总长（2.36±0.56）cm,G右前长（2.61±0.72）cm。G右前根部距肝脏面的深度（1.99±0.43）cm,G右前末端距膈面的深度（4.84±1.95）cm,G右前主干与MHV主干的最短距离（1.61±0.90）cm,G右前主干与RHV主干的最短距离（1.89±0.80）cm,G右前主干与MHV主干的夹角（74.4±16.8）°,G右前主干与RHV主干的夹角（73.1±19.6）°。右前叶Glisson系统的主干末端呈Couinaud型占20%,竜崇正型占65%,复合型占15%;3级分支数目呈2-6支不等。结论右前叶Glisson系统走形存在着明显的个体差异,分布情况不完全符合Couinaud 8段所描述,在实施右前叶精准肝切除术之前应掌握右前叶Glisson系统的解剖特点,有助于设计合理的手术方式。Objective To observe the anatomical structures and distributions of the Glissonean pedicle of the Right anterior section, and providing anatomical basis for the precise hepatectomy of the Right anterior section lesions. Method Making morphological observation of the Glissonean pedicle of the right posterior section through peeling and dissecting 20 cases of adult corpses without liver pathological changes,then collecting the relevant data and making statistical analysis. Result 95% of the Glissonean pedicle of the right liver divided into the right anterior and posterior branches, and 5% into the right anterior,G6 and G7branches. The length of the Glisson pedicle of the stem of right liver is（2.36±0.56） cm. The length of the the Glisson pedicle of right anterior is（2.61±0.72）cm. The depth between the Glisson pedicle of the root of right anterior lobe and the visceral surface of liver is（1.99 ± 0.43） cm;The depth between the Glisson pedicle of terminal segment of the right anterior lobe to the diaphragmatic surface of liver is（4.84 ± 1.95） cm;The shortest distance between the Glisson pedicle of the stem of right anterior lobe to MHV＇s stem is（1.61±0.90）cm;The shortest distance between the Glisson pedicle of the stem of the right anterior lobe to RHV＇s stem is（1.89±0.80） cm. Angle between GRA/MHV is（74.4±16.8）°;angle between GRA/MHV is（73.1±19.6）°;The shapes of 20% of the Glissonean pedicle of the Right anterior section presented as Couinaud＇s type,65% Cho A＇s type, 15% mixed type;the number of third order branches is between 2 to 6. Conclusion The distribution of the Glissonean pedicle of the right anterior section does not entirely fit the description of Couinaud＇s segment; obvious individual differences do exist. Therefore, it is vital to understand the anatomy of the Glissonean pedicle of the right anterior section before precise hepatectomy is carried out.

关 键 词：肝右前叶 Glisson系统 临床解剖 精准肝切除术 

分 类 号：R322.47[医药卫生—人体解剖和组织胚胎学]