肝脏解剖分段.ppt

SectionalAnatomyandSegmentationofLiver Segmentationoftheliver TwocategoriesCouinaud ssystem segment S1 S8 Couinaud 1989 S9 Couinaud 1994 andtheso calledAmericansystem sector thelateral medialorparamedian anteriorandposteriorsegmentsorsectors andthecaudatelobe Williams 1995 ConceptofCouinaud ssegmentclassificationsystem Theliverwasdividedintofoursegmentsbythreeverticalplanes andeachsegmentwasfurthersubdividedintotwosubsegmentsbyatransversescissure Eachsegmenthadabranch oragroupofbranches oftheportalveinatitscenterandatributaryofahepaticveinatitsperiphery 正中裂portalfissure Couinaud ssystem Couinaud ssystem Basement DistributionofGlissonsystemandhepaticveins 肝 左半肝右半肝 左外扇区左内扇区右前扇区右后扇区 左外上段 II 右前下段 V 右前上段 VIII 右后下段 VI 右后上段 VII 肝背扇区 主肝 I IX 左外下段 III IV 左外叶 左内叶 右前叶 右后叶 PortalVein PortalVein 门脉脐部 HepaticVein MiddleVein 肝段的划分方法 正中裂 肝中静脉 胆囊窝中点 分肝为左右半肝背裂 弧形线 分出尾状叶左叶间裂 门脉左支脐部 肝圆韧带 分出左内叶与左外叶左段间裂 肝左静脉 分出左外上段 II段 与左外下段 III段 右叶间裂 肝右静脉 分出右前叶与右后叶右段间裂 又称横裂 肝门脉右支 分右半肝为上下段 ConceptofCantlie sline Cantlie sline theprincipalborderormainlobarfissure isgenerallybelievedtobealongthehilarbifurcationoftheportalvein thefossaforthegallbladder theleftmarginorthemidlineoftheIVCandtheterminalportionoftheMHVoralineslightlyrightoftheMHV SectionalAnatomyofCadavericLiver Computedtomography VIII VII IV III II LevelofHVsintoIVC LHV MHV RHV 胃 肺 II III IV VIII VII I III I VII VIII IV II I III 脾 I II IV VIII VII III I III VI V IV Adrenalleft PVR III VI IV V gallbladder CBD PV Duod AdreR SpleenV VI V IV V VI IV V IV VI VI V V VI ComputedTomography IntroductionofMeVisFunctionalsegmentationandvolumeanalysis VIII VIII IVb VIII IVb VII VIII IVa III II VII I RV MV LV VIII VII IVa III II I LV MV RV VII VIII V II III DS IVa VIb 左叶间裂 门脉左支 门脉右支 I II III VIa VIa V VIII IV IIV 门脉右支 左叶间裂 III IVa IVb VIII V VI VII 胆囊 III VIa VIb V VI VII VIb V VI VII III VI V VI BoundariesbetweenIVaandIVb SubsegmentIVblayanteriortothesubsegmentIVaSubsegmentsIVaandIVbwasnotsuperiorandinferior butposterosuperiorandanteroinferior respectively TheboundaryisanobliqueplaneTributaryofahepaticvein leftmedialmiddlevein canserveastheanatomicallandmark 62 7 BoundariesbetweenIVaandIVb BoundariesbetweenIVaandI