肝蒂内结构肝内分支的形态观测及临床意义
发布时间：2018-11-04 10:18
【摘要】： 肝脏是人体最大的实质性腺体,其重量约为体重的1/40,通常为1200-1500克。在肝的脏面,有“H”形沟其中部呈横行的沟称为第一肝门。其内有由肝管、门静脉、肝固有动脉左右支、淋巴管及神经组成的肝蒂出入肝实质内,其中肝门静脉及其分支、肝固有动脉及其分支、肝管及其分支被包于一结缔组织鞘内称Glisson系统。它们不论在肝内或肝门附近都走在一起。门静脉与肝固有动脉进入肝脏后反复分支,在肝小叶周围形成小叶间静脉和动脉,进入肝血窦再经中央静脉注入肝静脉,肝内血管及胆管的复杂分布,为该部位手术带来很大难度。外科治疗的关键在于详细了解肝内血管及胆管的解剖结构,选择合适的手术方式。为求手术达到良好效果,应详细了解肝脏及肝门部的解剖,可以减少术后并发症和死亡率。自19世纪末起国外许多学者对肝脏解剖结构进行了研究,我国学者于20世纪50年代开始对肝脏解剖进行了深入研究。但肝脏手术的出血及胆汁瘘仍是一个外科手术难以克服的障碍。外科医生需要对肝脏的内部解剖有进一步了解。本文利用20具成人尸体肝脏标本。以及6具肝脏铸形标本,解剖观测了Glisson系统的肝内分支形态结构及走行方向,对重要结构进行量化分析,并对肝脏的分叶及分段、手术显露、重要结构的术中保护等问题做了阐述。以期为在手术中合理选择术式提供解剖学依据。
[Abstract]:The liver is the largest solid gland in the body, weighing about a quarter of the body weight, usually 1200- 1500 grams. On the visceral surface of the liver, there is an H-shaped sulcus whose middle part is called the first hilum of the liver. The hepatic pedicle composed of hepatic duct, portal vein, left and right branches of the hepatic proper artery, lymphatic vessel and nerve enter and exit the hepatic parenchyma, in which the hepatic portal vein and its branches, the hepatic proper artery and its branches, The hepatic duct and its branches are encapsulated in a connective tissue sheath called Glisson system. They walk together both in the liver and near the hilum. The portal vein and the proper hepatic artery branch repeatedly after entering the liver, and the interlobular vein and artery are formed around the hepatic lobule. The hepatic vein is injected into the sinusoidal of the liver through the central vein, and the complicated distribution of the intrahepatic blood vessels and bile ducts is obtained. It is very difficult for the operation of this site. The key of surgical treatment is to understand the anatomical structure of intrahepatic blood vessels and bile ducts in detail and to select appropriate surgical methods. In order to achieve good results, we should understand the anatomy of liver and hepatic hilum in detail and reduce postoperative complications and mortality. Since the end of the 19th century, many foreign scholars have studied the anatomical structure of the liver, and Chinese scholars began to study the anatomy of the liver in the 1950s. But the bleeding of liver operation and bile fistula are still an insurmountable obstacle. Surgeons need to know more about the internal anatomy of the liver. The liver specimens of 20 adult cadavers were used. And 6 liver cast specimens were dissected to observe the morphological structure and direction of intrahepatic branches of the Glisson system, and the important structures were analyzed quantitatively, and the lobes and segments of the liver were exposed. Some problems such as intraoperative protection of important structures are discussed. In order to provide anatomical basis for the reasonable selection of surgical methods in the operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322
本文编号：2309529
[Abstract]:The liver is the largest solid gland in the body, weighing about a quarter of the body weight, usually 1200- 1500 grams. On the visceral surface of the liver, there is an H-shaped sulcus whose middle part is called the first hilum of the liver. The hepatic pedicle composed of hepatic duct, portal vein, left and right branches of the hepatic proper artery, lymphatic vessel and nerve enter and exit the hepatic parenchyma, in which the hepatic portal vein and its branches, the hepatic proper artery and its branches, The hepatic duct and its branches are encapsulated in a connective tissue sheath called Glisson system. They walk together both in the liver and near the hilum. The portal vein and the proper hepatic artery branch repeatedly after entering the liver, and the interlobular vein and artery are formed around the hepatic lobule. The hepatic vein is injected into the sinusoidal of the liver through the central vein, and the complicated distribution of the intrahepatic blood vessels and bile ducts is obtained. It is very difficult for the operation of this site. The key of surgical treatment is to understand the anatomical structure of intrahepatic blood vessels and bile ducts in detail and to select appropriate surgical methods. In order to achieve good results, we should understand the anatomy of liver and hepatic hilum in detail and reduce postoperative complications and mortality. Since the end of the 19th century, many foreign scholars have studied the anatomical structure of the liver, and Chinese scholars began to study the anatomy of the liver in the 1950s. But the bleeding of liver operation and bile fistula are still an insurmountable obstacle. Surgeons need to know more about the internal anatomy of the liver. The liver specimens of 20 adult cadavers were used. And 6 liver cast specimens were dissected to observe the morphological structure and direction of intrahepatic branches of the Glisson system, and the important structures were analyzed quantitatively, and the lobes and segments of the liver were exposed. Some problems such as intraoperative protection of important structures are discussed. In order to provide anatomical basis for the reasonable selection of surgical methods in the operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322
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