动态流域理论——肝脏结构功能学的概念与实践  

Dynamic watershed theory:concept and practice of liver structure and function

作　　者：刘荣[1] 刘渠[1,2] 汪洋[1] 张修平 李梦阳 张卓超 王斐[1] 张恭 LIU Rong;LIU Qu;WANG Yang;ZHANG XiuPing;LI MengYang;ZHANG ZhuoChao;WANG Fei;ZHANG Gong(Faculty of Hepatopancreatobiliary Surgery,the First Medical Center of Chinese People’s Liberation Army(PLA)General Hospital,Beijing 100853,China;Organ Transplantation Department,the Three Medical Center of Chinese People’s Liberation Army(PLA)General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部,北京100853 [2]解放军总医院第三医学中心器官移植科,北京100039

出　　处：《中国科学:生命科学》2025年第1期90-97,共8页Scientia Sinica(Vitae)

摘　　要：目前临床上普遍采用的肝脏解剖方法是“Couinaud八段法”,但是在临床中经常会遇到传统肝段解剖法无法解释的现象.研究者在临床实践的基础上,提出肝脏的动态流域理论,即:(ⅰ)肝脏内管道呈相互交通的网络状分布结构;(ⅱ)在正常情况下,肝叶或段血流供应和回流呈相对独立又相互联系的平衡状态;(ⅲ)病理条件下,网络交通或新生血管可以替代受损血管来维持肝脏功能.动态流域理论能够解释肝动脉、肝静脉和门静脉的交通支代偿性再通,以及缺血肝脏恢复血供这些临床现象.通过大鼠部分入肝及出肝血流阻断模型,研究者进一步证实肝脏缺血和淤血能够通过血管交通支的开放来缓解.在动态流域理论的指导下,研究者提出适时分合控血技术、肿瘤靶域切除技术、门静脉的分流补偿技术以及入肝血流的限流技术.动态流域理论是对传统肝脏解剖学的发展和补充,在该理论指导下衍生出的多种手术技术,有望提高肝脏手术的安全性和彻底性,使患者获得最优的治疗结果.Currently,the Couinaud method is widely used in liver resection;however,certain clinical phenomena that cannot be explained by the traditional Couinaud method often occur.Based on clinical practice,the authors propose the dynamic watershed theory,which states the following:(i) The distribution structure of the intrahepatic ducts is a network.(ii) Normally,the blood supply and reflux of the liver lobe or segment are relatively independent and interrelated.(iii) Under pathological conditions,network traffic or new blood vessels can replace damaged blood vessels to maintain liver function.The dynamic watershed theory can explain clinical phenomena such as compensatory recanalization of hepatic arteries,hepatic and portal veins,and restoration of blood supply to the ischemic liver.Furthermore,hepatic ischemia and congestion can be alleviated by opening vessel communication branches in a model of partial occlusion of blood flow in and out of the liver in rats.Under the guidance of the dynamic watershed theory,the authors propose techniques for the timely control of blood flow,tumor-target resection,shunt compensation of the portal vein,and liver flow limitation.The dynamic watershed theory was developed to complement the traditional liver anatomy,and various surgical techniques developed following this theory are expected to improve the safety and thoroughness of liver surgery and achieve the best treatment results.

关 键 词：肝脏解剖 解剖性肝切除 动态流域 结构功能 靶域切除 

分 类 号：R322.47[医药卫生—人体解剖和组织胚胎学]