中国实用外科杂志

中国实用外科杂志

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右肝段区域划分新认识的解剖学依据研究（附110例人右肝三维数字解剖学研究结果）

李    斌1，邱智泉1，缪应鸟2，姜小清1   

  1. 1海军军医大学东方肝胆外科医院胆道一科 海军军医大学胆道恶性肿瘤诊疗中心，上海200438；2旭东数字医学影像，广东深圳518019
  • 出版日期:2020-12-01 发布日期:2020-12-21

  • Online:2020-12-01 Published:2020-12-21

摘要： 目的    根据人右肝数字解剖学研究结果，总结右肝解剖性区域划分合理方案的解剖学依据。方法    归纳海军军医大学东方肝胆外科医院胆道一科2016年12月至2019年5月收治的110例肝外胆管系统肿瘤病人右肝Ⅰ~Ⅲ级脉管分支数字解剖学特点，并结合门静脉和肝静脉流域分析技术，明确右肝叶不同区域空间解剖学特征。结果    右肝Ⅰ、Ⅱ级脉管支汇合结构及其分布或引流区域的解剖学模式较为清晰、固定，而Ⅲ级脉管分支及肝静脉分支分布或引流区域的解剖学模式呈现出复杂化、多样化的特点。结论    依据各种经典肝脏分段法获得的右肝段解剖性区域划分方案均非合理、准确。三维可视化能够多维度展现肝右叶各区域脉管分布的空间解剖学特点，有助于实现更为精准的个体化右肝段解剖性区域划分方案。

关键词: 三维可视化, 数字解剖学, 右肝段, 解剖性肝区域划分

Abstract: Anatomic basis for new understanding of anatomical division of right hepatic segment(With three-dimensional digital anatomical study of 110 cases of human right hepatic lobe)        LI Bin*, QIU Zhi-quan, MIAO Ying-niao, et al. *Department of Biliary Tract Surgery I，Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University；Biliary Malignant Tumor Diagnosis and Treatment Center，Shanghai 200438，China
Corresponding author：JIANG Xiao- qing，E-mail：jxq1225@sina.com
Abstract    Objective    To summarize the anatomical basis for a rational scheme of right hepatic anatomical segmentation based on the results of the digital anatomical study of the human right liver. Methods    The digital anatomical characteristics of the right hepatic vessels branches grade Ⅰ to Ⅲ in 110 patients with extrahepatic bile duct system tumors who were treated in the Department of Biliary Tract Surgery I，Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University from December 2016 to May 2019 were summarized, and the spatial anatomical characteristics of different regions of the right hepatic lobe were clarified by combining portal vein and hepatic vein basin analysis techniques. Results    The anatomical pattern of right hepatic vessels branch grade Ⅰ and Ⅱ confluence structures and their distribution or drainage areas were clear and fixed, while the anatomical pattern of vessels branch grade Ⅲ and hepatic venous branch distribution or drainage areas showed complex and diverse characteristics. Conclusion    The anatomical segmentation scheme of the right hepatic lobe based on various classical liver segmentation methods is not reasonable and accurate. Three-dimensional visualization can show the spatial anatomical characteristics of the vessels distribution in each region of the right hepatic lobe in multiple dimensions, which helps to achieve a more accurate individualized anatomical segmentation scheme of the right hepatic segment.

Key words: 3D visualization, digital anatomy, right hepatic segment, anatomical hepatic segmentation