左肝蒂解剖学特点对肝脏S4段切除术策略的优化

Optimization of liver S4 segmentectomy based on the anatomical characteristics of left hepatic pedicle

  • 摘要: 经典肝脏S4段切除术是典型的定构切除手术方式,但常忽视肝段内的精细解剖。肝脏S4段的肝蒂(G4)全部来源于左肝蒂。因此,笔者从左肝蒂的解剖学特点切入,从门静脉视角梳理G4数量与分布规律,结合对脐裂静脉的解剖特点及走行分析,阐述笔者团队对肝脏S4段真实边界的再认识。通过下降脐板创新手术入路施行肝脏S4段解剖性切除术,重新定义肝脏脐裂的精确位置和打开方式。同时基于左肝蒂内部管道关系,剖析术后胆漏的常见成因及防治策略。

     

    Abstract: The classic liver S4 segment resection is a typical structural resection procedure, but it often overlooks the detailed anatomy of this liver segment. The hepatic pedicle (G4) of S4 segment of liver is entirely derived from the left hepatic pedicle. The authors start with the anato-mical characteristics of left hepatic pedicle, analyze the quantity and distribution characteristics of G4 from the perspective of portal vein. Based on analysis of the anatomical characteristics and course of umbilical fissure vein, the authors expound the new viewpoint on the true anatomical range of S4 segment of liver. The application of the new approach of lowering the umbilical plate in the anato-mical resection of S4 segment of liver, the authors discuss the precise location and opening method of the umbilical fissure. In addition, based on the internal structural characteristics of left hepatic pedicle, the authors analyze the common causes and coping strategies of bile leakage complications during liver S4 segment resection.

     

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