右半肝肝段解剖研究进展

对肝内血管解剖结构及肝段的准确认识是肝切除术前评估和活体肝移植肝段选择的基础。特别是活体肝移植供体肝段的选择,需要考虑到肝段的体积、门脉及动脉血供和静脉回流,更需要对肝内各管道的解剖结构有精确的把握。右半肝管道立体交叉关系复杂,门静脉及肝静脉变异均多见。国际上通用的Couinaud肝段划分法,将右半肝分为4段,段Ⅷ、段Ⅴ为上下关系,段Ⅶ,段Ⅵ为上下关系。但随着肝脏手术的进展,影像学技术的提高,人们对右半肝肝段解剖划分提出质疑并有了新的观点。大部分学者倾向于以肝内门静脉3级分支分布形式作为划分右半肝肝段的主要依据,同时肝静脉引流情况也是重要的辅助依据,但分段方式并未形成统一。

Anatomical progress of hepatic segment of human right liver

Accurate understanding of hepatic vessels and hepatic segment is the basis of preoperative evaluation of surgical resection and donor liver selected.Especially during living donor liver transplantation,hepatic vessels should be understood more accurately,because the hepatic volume,the hepatic portal vein,the hepatic artery and hepatic vein are all taken into account during the surgery.The location relationships between vessels of right liver are complex,and variations of portal hepatic vein and hepatic vein are very common.In the widely used Couinaud’s segmentation,the right liver is divided into 4 segments.The location relationship between segment Ⅷ and segmentⅤis upper and down.The location relationship between segment Ⅵ and segment Ⅶ is upper and down.With the development of hepatic surgery and radiology,an increasing amount of researchers have reported discrepancies of Couinaud’s segmentation,especially for further division of the right anterior segment.Some new opinions were put forward.The distribution of the third-order branches of portal vein was regarded as main basis by most researchers,and meanwhile the drainage of hepatic vein was regarded as another important auxiliary basis.But until now,the division of hepatic segment has still remained unclear completely.