肝脏分段系统

1、肝脏分段系统肝脏分段系统第1页叶、段、区、扇区左右叶、左右肝、左右半肝尾状叶、方叶肝脏分段系统第2页Liveranatomycanbedescribedusingtwodifferentaspects:morphologicalanatomyfunctionalanatomyThetraditionalmorphologicalanatomyisbasedontheexternalappearanceoftheliveranddoesnotshowtheinternalfeaturesofvesselsandbiliaryductsbranching,whichareofobviousimpo

2、rtanceinhepaticsurgery.C.Couinaud dividedtheliverintoeightfunctionallyindepedentsegments.肝脏分段系统第3页Gross Anatomy肝脏分段系统第4页Gross Anatomy肝脏分段系统第5页肝脏分段系统第6页Liver Classification System中华医学会（1960）：五叶四段（六段）分段法。Couinaud(1954):Glisson 系统和肝静脉分支和走行；Healey(1953):按照肝动脉和肝内胆管系统；The Brisbane（）：Gans(1955)、Hobsley(195

3、9):按照门静脉分叶标准；肝脏分段系统第7页Chinese Medical Association classification system3个主肝裂正中裂：胆囊切迹沿肝膈面向后上方抵于肝左静脉汇入下腔静脉处，脏面以胆囊窝和腔静脉窝连线为界；内有肝中静脉；左叶间裂：脐静脉切迹和左肝静脉汇入腔静脉处连线，膈面标志为镰状韧带附着线偏左侧，脏面以左纵沟为标识；内有左肝静脉叶间支；右叶间裂：肝右下缘相当于胆囊切迹与肝脏外侧缘外、中1/3交界处与右肝静脉汇入下腔静脉处连线；内有右肝静脉；2个段间裂左段间裂：肝左静脉汇入腔静脉处与肝左外叶左缘后、中1/3交界处连线；内有肝左静脉段间支；右段间裂：起自脏面

4、肝门右切迹，横行绕过右后叶外缘中点，止于右叶间裂交点；1个背裂背裂：肝脏后面上缘中央部，尾叶前方肝上极背侧额状位弧形肝裂；肝脏分段系统第8页Chinese Medical Association classification system肝脏分段系统第9页Couinaud classification system（1954）The Couinaud classification of liver anatomy divides the liver into eight functionally independent segments. Each segment has its own va

5、scular inflow, outflow and biliary drainage. In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct. In the periphery of each segment there is vascular outflow through the hepatic veins. The classification system uses the vascular supply in the liver to sepa

6、rate the functional units (numbered I to VIII).肝脏分段系统第10页Right hepatic vein：divides the right lobe into anterior and posterior segments.Middle hepatic vein：divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.

7、The Falciform ligament：divides the left lobe into a medial- segment IV and a lateral part - segment II and III.The portal vein：divides the liver into upper and lower segments.The left and right portal veins branch superiorly and inferiorly to project into the center of each segment.Segment IV is som

8、etimes divided into segment IVa and IVb according to Bismuth.Couinaud classification system（1954）肝脏分段系统第11页Couinaud classification system（1954）依据：以Glisson系统在肝内分布为基础, 以肝静脉为分段界限，法语国家应用较多。左、中、右3支主肝静脉走行区所形成纵形切面将肝分隔成4个个别, 称为四个扇区. 每个扇区又被门静脉左、右支水平切面分成上下2段. 分成： 2个半肝（hemiliver），4个扇区(sector)，8（or9）个段(segment)

9、肝脏分段系统第12页表面分界依据：（门裂（界、线）：含肝静脉走形线。）主门裂（main portal scissure，主界， Cantlies line）：膈面，胆囊切迹中点与肝上腔静脉左侧壁之连线；脏面，胆囊窝中点与腔静脉窝左侧壁之连线。内有肝中静脉。右门裂（ right portal scissure，右叶间裂）：膈面，起自腔静脉窝上口右缘，弯向右下方止于胆囊切迹与肝外缘中、外1/3交界处；脏面，沿右下角抵达肝门横沟右端。内有肝右静脉。左门裂（left portal scissure，左段间裂）：膈面，起自肝左静脉与肝上腔静脉汇合点，弯向左下方止于肝左缘后、中1/3交界处。内有肝左静脉。

10、The Falciform ligament：divides the left lobe into a medial- segment IV and a lateral part - segment II and III.Cantlies line :A line can be imagined running from the left of the vena cava and all the way forward to divide the liver and gallbladder into two halves. 肝脏分段系统第13页Couinaud classification s

11、ystem（1954）肝脏分段系统第14页Bismuth classification system修正Couinaud分类系统将IV段分为a、b2段肝脏分段系统第15页Healey&Schroy classification system（1953）按照肝动脉和肝内胆管系统划分；三级划分：半肝（或肝）、段（section）、亚段（segment）。Healey动脉胆道系统分段方法和couinaud门静脉分段 区分就是左肝分段有差异 、名字区分肝脏分段系统第16页The Brisbane classification system年中国肝脏教授组发表肝脏解剖和手术切除统一名称。肝脏分为2个别：

12、主肝尾状叶分界依据：肝中界面：胆囊窝和腔静脉窝相交平面。左区界面：经过脐裂和镰状韧带附着线。右区界面：无表面标志，右肝静脉走形其内。段界面：无表面标志，无主要结构走形其内。三级划分：半肝（或肝）、区（section）、段（segment）。肝脏分段系统第17页The Brisbane classification system肝脏分段系统第18页Liver surgeryRight hepatectomysegment V, VI, VII and VIII ( segment I).Extended Right or right trisectionectomysegment IV, V, VI, VII and VIII ( segment I).Left hepatectomysegment II, III and IV ( segment I).Extended Left or left trisectionectomysegment II, III, IV, V/VIII ( segment I).肝脏分段系统第