中国实用外科杂志

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循肝静脉路径肝切除解剖学基础和临床价值

郑树国   

  1. 陆军军医大学第一附属医院(重庆西南医院)  全军肝胆外科研究所,重庆  400038
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要:

循肝静脉路径肝切除是解剖性肝切除的基本要求,已逐渐被认可并广泛应用于开腹和腹腔镜解剖性肝切除手术中。其解剖学基础是肝静脉走行于肝段之间的解剖界面内,是肝段之间的确切分界平面,且肝静脉走行与目标肝段缺血后形成的分界平面几乎重叠。临床价值主要是引导正确的肝实质离断平面,彻底切除缺少流入道和(或)流出道的无效肝组织,减少术中出血,降低术后并发症的发生率。在临床上,循肝静脉路径肝切除主要应用于肝细胞癌的外科治疗,能同时清除肿瘤及经门静脉播散的肝内微转移病灶,减少术后复发,提高术后存活率;也可应用于肝胆管结石和肝内胆管扩张症这类以肝段分布为主要特征的肝胆管疾病的外科治疗,以达到彻底去除目标病灶的病理学要求与最大化保留剩余功能性肝脏的生理学原则之间的统一。

关键词: 肝静脉, 肝切除术, 解剖学

Abstract:

Anatomical basis and clinical value of liver parenchyma transection guided by the hepatic vein        ZHENG Shu-guo. Institute of Hepatobiliary Surgery,the First Hospital Affiliated to Army Medical University(Southwest Hospital),Chongqing 400038,China
Abstract    Liver parenchyma transection guided by the hepatic vein is the basic requirement of anatomical hepatectomy. The technique has been gradually accepted and widely used in open and laparoscopic anatomical hepatectomy. As the exact dividing plane between the hepatic segments,the hepatic vein is almost overlapping with the ischemia demarcation formed by occluding the inflow of the target hepatic segment,and these are the anatomical bases of this technique. The clinical value of the technique is mainly to guide the accurate transaction plane of the liver parenchyma,and eliminate the ineffective liver tissue lacking of inflow and / or outflow,reduce intraoperative bleeding and the incidence of postoperative complications. In clinical,the technique is mainly applied to liver resection for hepatocellular carcinoma,in which it can remove the tumor and intrahepatic micrometastases disseminating through portal vein simultaneously,reduce postoperative recurrence and improve survival rate. It can also be used in the surgical treatment of hepatolithiasis and intrahepatic bile duct dilatation which were characterized by introhepatic segment distribution of the lesions ,and to achieve a complete removal of the target lesion and maximizes the remaining functional liver.

Key words: hepatic vein, hepatectomy, anatomy