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目的根据肝内肝门静脉的走形分布,提出肝脏分段的新概念,为影像学和肝脏外科提供资料。方法采用60例正常的活体肝移植供肝影像资料,研究右前叶肝内肝门静脉的走形和分布以及肝静脉及其属支的回流范围,10例Mevis三维软件重建图像,探讨两者之间的关系。结果 Couinaud分段中的Ⅷ段门脉支可大致分为腹侧支和背侧支,最多可达4支;约90%的背侧支越过肝右静脉分布到Couinaud分段中的VII段。V段的门脉分支大多来自右前叶或Ⅷ段门脉的腹侧支。因此,可将右前叶分为腹侧段:Couinaud分段中的Ⅷ段的腹侧段(S8v)和V段(S5)背侧段:Couinaud分段中的Ⅷ段的背侧段(S8d)两个部分。结论新的划分方法不仅有利于肝内病变的精确定位,而且便于肝脏外科实施新的、更安全的术式。
Objective According to the distribution of hepatic portal vein in liver, a new concept of liver segment was proposed to provide information for imaging and liver surgery. Methods 60 normal living donor liver transplantation images were used to study the shape and distribution of the hepatic portal vein in the right anterior lobe and the extent of reflux of hepatic veins and their branches. Ten Mevis 3D reconstruction images were used to explore the relationship between the two. Relationship. Results The segment Ⅷ in the Couinaud segment can be divided into ventral and dorsal branches with up to 4 branches. About 90% dorsal branches across the right hepatic vein distribute to segment VII in the Couinaud segment. Most of the portal vein branches of the V segment come from the ventral branches of the right anterior or Ⅷ segment portal vein. Thus, the right anterior leaflet can be divided into the ventral segments: the ventral segments (S8v) and V segments (S5) of the VIII segment in the Couinaud segment: the dorsal segment of the VIII segments in the Couinaud segment (S8d) Two parts. Conclusion The new classification method not only facilitates the accurate localization of intrahepatic lesions, but also facilitates the implementation of new and safer procedures in liver surgery.