切开肝内胆管治疗复杂肝内胆管结石的手术入路和方法  

OPERATIONAL ROUTES AND PROCEDURRE ON INCISING INTRAHEPATIC BILE DUCTS TO TREAT COMPLICATED CALCULUS

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]昆明医学院第二附属医院肝胆外科,云南昆明650101

出　　处：《中国现代普通外科进展》2000年第1期48-51,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 探讨显露和剖开肝内各叶、段胆管的手术方法,提高复杂性肝内胆管结石病的治疗效果.方法 从肝内胆管手术显露的角度,研究了30个成人肝脏标本肝内各叶、段胆管与血管走行位置的解剖关系,设计了新的手术方法、用于治疗复杂性肝内胆管结石46例.结果 肝内胆管与血管走行的位置关系.从肝脏的脏面观:左右肝管均位于门静脉左右干的前上缘.左内叶胆管、右前叶胆管位于相应门静脉支的前内侧(近肝门侧).右后叶胆管有73.3%(22/30)位于门静脉右前支(18/30)或门静脉右前下段支(4/30)脏面深侧;80%(24/30)走行于门静脉右后叶支脏面深侧(20/3O)或后上缘(4/30).左外叶胆管基本上都走行于门静脉矢状部脏面深侧,只有2个标本的左外叶下段支胆管在其浅侧.肝动脉在肝内各叶段的分支基本上走行与Glisson鞘内胆管与门静脉之间或侧旁.从肝脏膈面观:肝内各叶、段胆管与血管的解剖位置关系大致与脏面观相反或接近相反.据此,从肝脏脏面显露肝门、可以连续切开左右肝管和多数左内叶及右前叶胆管,但难以显露右后叶及右叶各段胆管和左外叶胆管;而从肝脏膈面进路切开肝方叶或肝中裂.再沿右后叶胆管投影方向切开肝实质,则可避开右肝内的门静脉主要分支,比较容易显露和切开右肝内各叶、段胆管汇合部及狭窄段.从肝左叶膈面切开左外叶胆?Objective:To find a new operational route, which can be employed to in-cise and expose every segmental bile ducts,and improve the curative effect of complicated intrahepatic calculus. Methods: Surgical anatomic relationships between intrahepat-ic bile ducts and blood vessels in 30 human liver specimens of adult were studied; and a new operational procedure were designed to treat 46 patients with complicated intrahep-atic calculus. Results: In the liver specimens anatomic study, we got the following results: From visceral face we can see that both left and right hepatic ducts locate superior anterior edge of the left and right trunk of the portal vein. Left medial segmental duct and right anterior segmental duct locate anteriormedially(near the hilus)with the corresponding portal vein.73.3%(22/30) of right posterior segmental duct locates in the visceral deep of portal vein of right anterior segment (18/30) or inferior-anterior segment of right lobe(4/30). And 80%(24/30) of this duct locates in the visceral deep(20/30) or the posterior-superior edge of portal vein of right posterior lobe(4/30). Most left lateral segmental duct locates in the visceral deep of sagittal portion of left portal vein. Hepatic artery locates between intrahepatic portal vein or bile ducts in the Glisson sheath. Observation from diaphragmatic face,anatomic relationships between intrahepatic bile duct and blood vessels is exactly or nearly contrary to those from visceral face. Therefore, we can continually incise left and right hepatic bile duct,and most left medial segmental duct and right anterior segmental duct from visceral face. But exposing and cutting open right posterior segmental duct, left lateral segmental duct and some right segmental ducts through visceral operational route are still difficult. Diaphragmatic operational route including incising middle fissure,resecting quadrate lobe and then incising parenchymal through imaginary projecting lines of right posterior segmental duct may avoid damaging the main branches of right po

关 键 词：肝内胆管结石 手术入路 方法 

分 类 号：R657.42[医药卫生—外科学]