【摘要】 目的探讨腹腔镜下肝门血流阻断在肝切除术(LH)的解剖基础及手术路径。方法解剖尸体肝脏,分离血流阻断所涉及各肝门结构,观察在二维平面中毗邻,测量在肝外长度及夹角;观察LH视频中肝门结构,总结镜下的位置及特征。结果肝动脉平面低于肝管(90%),肝门静脉分叉位置固定于后方;肝左和肝中静脉在肝外大多共干(90%),肝右静脉与共干间存在间隙,与肝后下腔静脉(IVC)前方相通;肝短静脉位于IVC两侧,有(7±3)支;IVC韧带在尸体中易忽略,活体中较明显,为包绕IVC的膜性结构,厚度个体差异大;各结构在肝外长度及夹角为肝门血流阻断提供足够空间;镜下各结构位置及特征与实体比较有特殊性。结论 LH中应用肝门血流阻断有解剖依据及路径遵循。更多还原

【Abstract】 Objective To provide anatomic basis of hepatic vascular control in laparoscopic hepatectomy(LH) and design safe and convenient operative approach for vascular control.Methods Antiseptic adult liver specimens were used in this study.Hepatic pedicle,hepatic artery,portal vein and hepatic vein were dissected.The length and angle of these vessels were recorded.Additionally,videos of LH were observed for identifying those structures.Results The plane of hepatic artery was lower than bile duct for 90% specimens.The site of portal bifurcation was always behind hepatic artery and bile duct.The left hepatic veins had common trunk with middle hepatic veins for most of specimens.A gap existed between the right hepatic vein and common trunk of left and middle hepatic vein,which filled by connective tissue and communicated with anterior surface of the retrohepatic inferior vena cava(IVC).The short hepatic veins located in the left and right borders of IVC.The number of the short hepatic veins was about 7±3.IVC ligament was a broad membranous connective tissue bridging the left and right side edges of the caval groove in which the IVC was embedded.This ligament was more easy to be identify in fresh specimens.The length and angles of each vessel was enough to be separated to keep space for hepatic vascular blocking during LH procedure.Conclusions Anatomic features of hepatic hilum area are helpful for vascular control performed in LH surgery.更多还原