肝门板结构在肝胆外科手术中的应用进展  

Research progress in the Hepatobiliary Surgery operation of hepatic hilar plate system

作　　者：董小锋[1] 钟敬涛 陈元元[1] 刘天奇[1] 杨建荣[1] Dong Xiaofeng;Zhong Jingtao;Chen Yuanyuan;Liu Tianqi;Yang Jianrong(Department of Hepatobiliary and Pancreatic Surgery Breast and Thyroid Surgery,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Hepatobiliary Surgery,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China)

机构地区：[1]广西壮族自治区人民医院肝胆胰腺乳腺甲状腺外科,南宁530021 [2]山东省肿瘤防治研究院(山东省肿瘤医院),山东第一医科大学(山东省医学科学院)肝胆外科,济南250117

出　　处：《中华外科杂志》2020年第7期555-557,共3页Chinese Journal of Surgery

基　　金：国家自然科学基金(81560406);广西自然科学基金(2016GXNSFBA380198、2018GXNSFAA050118);广西区域性高发肿瘤早期防治研究重点实验室开放课题(GXK201604)。

摘　　要：中国每年新发肝癌病例约占全球50%,手术切除是实现肝癌患者长期生存的主要手段。肝胆外科手术中阻断入肝血流,减少术中出血是保证手术成功的关键,而肝门区的解剖分离是实现入肝血流阻断的前提。肝门板系统是覆盖在肝门部入肝管道上的一层厚结缔组织,肝门板下降可协助降低肝门区的解剖难度。肝门板系统内隐藏的第四肝门是门短静脉的集中区域,系统内的交通血管是引起吲哚菁绿荧光染色效果降低的解剖基础。相对固定的肝门板位置可为精准肝切除提供定位标志。肝内Glisson鞘与肝门板系统的厚结缔组织相连,是限制肝细胞增生及肥大的物理屏障,是肝门板系统在肝内的延续。本文将对肝门板系统的结构及其术中的应用进行初步总结。An estimate of about 50%of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma.Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation.Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion.The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region.The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region.The"forth porta hepatis"that is hidden in the hepatic hilar plate system involves the accumulation area of"short hepatic portal veins".The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection.The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system,and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.

关 键 词：肝肿瘤 肝切除术 肝门板 肝脏解剖 

分 类 号：R735.7[医药卫生—肿瘤]