肝门板解剖及组织结构研究

发布时间：2018-05-17 15:58

本文选题：肝门板 + 肝硬化　；参考：《中国人民解放军军医进修学院》2008年硕士论文

【摘要】： 第一部分:肝门板的解剖及临床应用目的:了解肝门板(Hilar plate)的解剖结构,探讨肝门板在肝切除中的临床意义及对比分析经全肝血流阻断与经肝门板选择性血流阻断两种不同血流阻断方法下肝切除技术,临床疗效。方法:选取非肝病死亡尸体解剖患者肝脏3例及肝移植切除病肝伴有中重度肝硬化5例。分别解剖肝门板左主干支、左内叶支、左外叶上支、左外叶下支,右主干支、右后叶支、右前叶支,进行测量其宽度和深度。仔细观察肝门板各支干与周围管道的关系及与肝脏实质间的组织间隙。同时临床筛选行左半肝切除患者24例,随机分为两组,分为经全肝血流阻断组与经肝门板选择性血流阻断组,统计两组术中出血量、手术时间、术后肝功能变化以及住院时间,对比分析两种不同肝血流阻断方式的肝切除技术。结果:3例非肝病死亡患者肝脏肝门板左主干平均宽1.73cm、深1.53cm;左内叶支平均宽1.3cm、深1.07cm;左外上支平均宽1.07cm、深0.83cm;左外下支平均宽0.97cm、深0.7cm;右主干平均宽2.07cm、深1.73cm;右后叶支平均宽1.3cm、深1.3cm;右前叶支平均宽1.47cm、深1.1cm。5例肝硬化肝脏的肝门板左主干平均宽1.92cm、深1.16cm;左内叶支平均宽1.08cm、深0.94cm;左外上支平均宽1.06cm、深0.78cm;左外下支平均宽0.9cm、深0.68cm;右主干平均宽1.98cm、深1.62cm;右后叶支平均宽1.14cm、深1.12cm;右前叶支平均宽1.16cm、深1.04cm。肝门板与第一肝门入肝血管之间存在明显的组织间隙,较少的小血管交通支。肝门板在正常肝脏和肝硬化肝脏的分布及大小基本上无明显变化,组织间隙及位置相对固定。通过肝门板选择性血流阻断肝切除患者较全肝血流阻断行肝切除患者术后住院时间无统计学意义(p＞0.05),在手术时间、术中出血量上以及肝功能状态前者明显优于后者(p＜0.05)。结论:①肝门板为肝门部一纤维组织,在肝门部增厚向肝内延伸至肝段支,在肝外为肝门板向肝内延伸为Glisson鞘。②肝硬化肝脏肝门板与正常肝脏肝门板测量结果显示无变化,肝门板作为肝脏解剖上的一特殊结构,在肝脏病变过程中,相对稳定。③肝门板与肝内管道之间有着明显的组织间隙,与肝脏实质以及包绕的管道之间存在较少的交通血管支,为手术中分离血管进行血流阻断以及胆道手术术中分离胆管创造了有利条件。④分离肝门板能有效降低肝门部胆管特别是左右胆管汇合部位的高度,有助于胆管修补、肝内胆管结石以及胆管癌手术治疗视野的扩大。⑤经肝门板选择性肝脏血流阻断技术安全、可行,易于掌握,在临床运用中对于肝切除术后患者的影响明显低于全肝血流阻断患者,值得临床推广使用。第二部分:肝门板组织结构研究及其临床意义目的:了解肝门板组织构成以及包含神经、血管、淋巴管的情况,探讨肝门板在胆管癌肿瘤转移中的作用以及临床意义。方法:选取第一部分中3例非肝病死亡患者肝脏标本,以肝外左右胆管汇合部开始一直到肝内肝段支的肝门板进行横断面切除,选取合适断面组织进行HE染色,观察肝门板内血管、神经及淋巴管存在和分布情况。同时选取临床2例病理明确诊断为胆管癌的患者,行胆管癌根治术,切去手术切除的左半肝内左主干支以及左内叶支和左外叶支,进行组织染色,观察肿瘤的分布以及转移情况。结果:肝门板内分布有小的毛细血管、淋巴管以及神经组织。在肝门板内,血管、淋巴管相互伴行,与周围肝脏实质未见有小的交通支存在。肝门板内主要以纤维组织构成,组织间隙内存在各种血管、淋巴管以及神经组织。肝门部胆管癌2例中,肿瘤细胞沿淋巴管、血管和神经向远处转移,但不典型。结论:胆管癌以神经、淋巴转移为为主要转移途径,肝门板内可见明确的神经、淋巴以及小的血管组织,故在一定程度上肝门板可能参与胆管癌的远处转移。胆管癌标本中肝门板内神经、淋巴管转移不典型。
[Abstract]:The first part: the anatomy and clinical application of the liver door
Objective: to understand the anatomical structure of the Hilar plate and to explore the clinical significance of the liver door plate in the hepatectomy and to compare the clinical effect of two different blood blockage methods under the whole liver blood flow blocking and the selective blood flow blocking by the liver door plate.
Methods: 3 cases of autopsy with non liver disease and 5 cases of liver transplantation and severe liver cirrhosis were dissected. The left main branch of the liver door, the left internal branch, the left superior branch, the left lateral branch, the right main branch, the right posterior branch, the right anterior lobe, and the right anterior lobe were measured, and the width and depth of the branches were measured. 24 cases of left hemi hepatectomy were selected and divided into two groups randomly. The patients were divided into two groups, which were divided into the whole liver blood flow blocking group and the selective blood flow blocking group through the liver door. The amount of bleeding, the operation time, the postoperative liver function changes and the time of hospitalization were statistically analyzed in the two groups, and the two different liver types were compared and analyzed. The technique of hepatectomy with the way of blood flow blocking.
Results: the average width of the left main stem of liver liver door plate in 3 cases of non liver disease was 1.73cm, deep 1.53cm, the average width of left internal branch was 1.3cm, deep 1.07cm, the average width of left superior branch was 1.07cm, deep 0.83cm, the average width of left lateral branch was 0.97cm, deep 0.7cm, the mean width of the right trunk was 2.07cm, deep 1.73cm, the right posterior branch was broad 1.3cm, deep 1.3cm, the right anterior branch width averaged 1.1 deep, deep 1.1. The average width of the left main trunk of the liver of cm.5 liver cirrhosis was 1.92cm, deep 1.16cm, the average width of left internal branch was 1.08cm, deep 0.94cm, the average width of left superior branch was 1.06cm, deep 0.78cm, the average width 0.9CM, deep 0.68cm, the average width 1.98cm and deep 1.62cm of the right trunk, the right posterior branch and the breadth of the right posterior branch, the width of the right anterior branch and the deep hepatic portal. There was a clear tissue gap between the plate and the first hepatic portal into the hepatic vessels, with fewer small vascular traffic branches. The distribution and size of the liver door plate in normal liver and liver cirrhosis had no obvious change, and the space and position of the liver were relatively fixed. Postoperative hospitalization time was not statistically significant (P > 0.05). The operative time, intraoperative blood loss and liver function status were significantly better than those of the latter (P < 0.05).
Conclusion: (1) the hepatic portal is a fibrous tissue of the hepatic portal, extending into the hepatic portal and extending into the hepatic segment in the hepatic portal, and extending into the Glisson sheath in the hepatic portal plate to the liver. 2. The results of the liver portal plate and the normal liver door plate are not changed. The liver door plate is a special structure in the liver dissection. There is a clear intertissue gap between the hepatic portal and the intrahepatic duct, and there is a less traffic vessel between the liver parenchyma and the wrapped pipeline, which creates a favorable condition for the separation of blood vessels in the operation and the separation of the bile duct during the operation of the biliary tract. It is the height of the joint part of the left and right bile duct, which helps to repair the bile duct, the calculus of the intrahepatic bile duct and the enlargement of the field of vision for the treatment of cholangiocarcinoma. 5. The selective liver blood flow blocking technique is safe, feasible and easy to master. In clinical application, the influence of the patients after hepatectomy is obviously lower than that of the whole liver blood flow blocking patients, which is worthy of clinical practice. Promote the use.
The second part: the study and clinical significance of hepatic portal tissue structure
Objective: To investigate the composition of the hepatic hilar tissue, including the nerve, blood vessels and lymphatic vessels, and to explore the role and clinical significance of the hilar plate in the metastasis of cholangiocarcinoma.
Methods: in the first part, 3 cases of non liver disease dead patients were selected, and the liver door plate, which began to go to the hepatic segment of the liver, was excised with HE staining, and the distribution of blood vessels, nerve and lymphatic vessels in the liver door plate were observed and 2 cases of clinical pathology were selected. The patients who were diagnosed with cholangiocarcinoma underwent radical resection of cholangiocarcinoma, left main branches of left hemi liver, left internal branches and left external branches, and tissue staining was performed to observe the distribution and metastasis of the tumor.
Results: there were small capillaries, lymphatic vessels and nerve tissue in the liver door plate. There were no small traffic branches in the liver parenchyma. There were mainly fibrous tissue in the portal plate. There were various kinds of blood tubes, lymphatics and nerve tissue in the intertissue space. In 2 cases of hilar cholangiocarcinoma. The tumor cells metastases along lymphatic vessels, blood vessels and nerves, but not typical.
Conclusion: nerve, lymphatic metastasis is the main route of metastasis in cholangiocarcinoma. Clear nerve, lymph and small vascular tissue can be seen in the liver door plate, so the liver door may be involved in the distant metastasis of bile duct cancer to some extent.
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322

【参考文献】