国人肝段的再认识及其断面表现

发布时间：2019-02-23 14:18

【摘要】：现代医学影像学对肝内微小病变的精确定位和现代肝外科施行肝叶、肝段和亚肝段切除以及半肝、肝段和部分肝组织的移植，都对肝叶、肝段和亚肝段的划分提出了更高的要求。因此，肝段的解剖已成为放射学和外科学工作者日益关注的焦点。近年来普遍采用的肝段划分法是Couinaud肝段划分法。然而由于肝内管道的个体差异与交叉分布，Couinaud肝段的划分法在有些部位不符合肝内管道的实际分布，尤其不能满足医学影像学对肝内微小病灶的精确定位和肝外科对亚肝段切除及部分肝移植的需要。近期的研究发现：①肝静脉可能不是划分肝段的准确定位标志；②肝门静脉右前支和右后支有多种分支类型；③肝裂可能是弯曲的，呈波浪形甚至犬齿交错状。这些研究与传统的Couinaud肝段划分法有较大的差异。致使在肝外科临床实践中有关肝段的解剖还存在着不少争议。为澄清上述争议，有必要对国人肝段的划分法重新认识。早期的肝段解剖学研究多采用铸型标本和肝剥离标本，，由于脱离了肝的在体方位，对肝段的命名难免不够准确，也不能和断层影像直接对照。用断层解剖方法研究肝内管道的走行、分布规律，并在断面上对门静脉肝段进行精确划分，可充分保证肝的在体方位，不仅便于和断层影像直接对照研究，更有利于肝外科确定肝内病灶的准确位置，进而有利于各种肝外科手术的实施。但这方面的研究开展的尚少。多层螺旋CT及其三维重建技术的临床应用，可重建出肝内管道的三维图像，能充分显示肝内门静脉分支、肝静脉系统和肝的外形轮廓及肝裂等，使得在活体上评价各个个体的肝段类型成为可能，亦为寻找更精确的肝段划分法提供了必要的研究手段。然而单存地采用CT及其三维重建，由于部分容积效应的存在，其显示的肝内管道与标本上的真实管道之间尚存有差异，需将断层标本和CT图像结合起来探讨肝内管道和肝段。本课题将使用躯干部横、矢、冠状断层标本并结合多层螺旋CT(MSCT)图
[Abstract]:The precise localization of intrahepatic minimal changes by modern medical imaging and the excision of liver lobes, segments and subsegments of the liver and the transplantation of hemihepatic, segmental and partial liver tissues in modern liver surgery are all related to the liver lobes. The division of liver segment and subhepatic segment put forward higher requirements. Therefore, the anatomy of liver segment has become the focus of radiology and surgery. In recent years, Couinaud method is widely used to divide the liver segment. However, due to the individual differences and cross-distribution of the intrahepatic ducts, the method of dividing the Couinaud segments does not conform to the actual distribution of the intrahepatic ducts in some parts. In particular, it can not meet the need of precise localization of microlesions in liver by medical imaging and subsegmental resection and partial liver transplantation in liver surgery. Recent studies have found that: (1) hepatic vein may not be an accurate location marker for dividing hepatic segment; (2) there are many branches of right anterior branch and right posterior branch of hepatic portal vein; (3) hepatic fissure may be curved, wavy or even interlaced. These studies are different from the traditional Couinaud method. As a result, there are still many controversies about the anatomy of liver segment in the clinical practice of liver surgery. In order to clarify the above dispute, it is necessary to reunderstand the method of dividing the liver segment in Chinese. The early anatomical study of liver segment mostly used cast specimen and dissection specimen. Because of the disconnection of the liver in vivo, the naming of liver segment was not accurate enough and could not be directly compared with the tomographic image. The method of sectional anatomy was used to study the course and distribution of the hepatic duct, and to divide the portal vein segment precisely on the section, which could fully ensure the in vivo orientation of the liver, and was not only convenient for direct contrast study with the tomographic image. It is more helpful for liver surgery to determine the exact location of liver lesions, and then to carry out various kinds of liver surgery. However, the research in this area has not been carried out yet. The clinical application of multilayer spiral CT and its 3D reconstruction technique can reconstruct the three-dimensional images of intrahepatic ducts, and can fully display the branches of portal vein, the outline of hepatic vein system and liver, and the hepatic fissure, etc. It makes it possible to evaluate the liver segment types of individual in vivo, and it also provides the necessary research means for finding more accurate method of liver segment division. However, CT and its 3D reconstruction are used in single storage. Due to the presence of partial volume effect, there is still a difference between the intrahepatic conduit and the real conduit on the specimen. It is necessary to combine the sectional and CT images to explore the intrahepatic conduit and segment of the liver. In this study, the transverse, sagittal and coronal sections of the trunks will be used in combination with multilayer helical CT (MSCT) images.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R322

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