肝脏解剖分段讲课课件

1、肝脏解剖分段肝脏解剖分段Segmentation of the liverTwo categoriesCouinauds system (“segment”)(S1S8, Couinaud, 1989; S9, Couinaud, 1994) and the so-calledAmerican system (“sector”) (the lateral, medial or paramedian,anterior and posterior segments or sectors, and thecaudate lobe; Williams, 1995)Segmentation of the

2、 liverTwo cConcept of Couinauds segment classification systemThe liver was divided into four segments by three vertical planes, and each segment was further subdivided into two subsegments by a transverse scissure. Each segment had a branch (or a group of branches) of the portal vein at its center a

3、nd a tributary of a hepatic vein at its peripheryConcept of Couinauds segment 肝脏解剖分段讲课课件正中裂portal fissure正中裂portal fissureCouinauds systemCouinauds systemCouinauds systemBasementDistribution of Glisson system and hepatic veins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

4、& IX左外下段(III)IV左外叶左内叶右前叶右后叶Couinauds systemBasementDistrPortal VeinPortal VeinPortal Vein门脉脐部Portal Vein门脉脐部肝脏解剖分段讲课课件Hepatic VeinMiddle VeinHepatic VeinMiddle Vein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

5、肝为上下段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Concept of Cantlies lineCantlies line (the principal border or main lobar fissure) is generally believed to be along the hilar bifurcation of the portal vein, the fossa for the gall bladder, the left margin or the midline of the IVC and the terminal portion of the M

6、HV or a line slightly right of the MHV Concept of Cantlies lineCantl肝脏解剖分段讲课课件Sectional Anatomy of Cadaveric Liver&Computed tomography 肝脏解剖分段讲课课件Sectional Anatomy of Cadaveric LiverComputed tomography正中裂portal fissure背 裂 弧形线，分出尾状叶is generally believed to be along the hilar bifurcation of the portal

7、vein, the fossa for the gall bladder, the left margin or the midline of the IVC and the terminal portion of the MHV or a line slightly right of the MHVConcept of Couinauds segment classification systemTwo categoriesSubsegment IVb lay anterior to the subsegment IVaTributary of a hepatic vein (left me

8、dial middle vein) can serve as the anatomical landmark (62.Boundaries between IVa and IVbAmerican system (“sector”)anterior and posterior segments or sectors, and theTwo categoriesComputed tomography(the lateral, medial or paramedian,左段间裂肝左静脉，分出左外上段（II段）与(S1S8, Couinaud, 1989; S9, Couinaud, 1994) an

9、d the so-called(the lateral, medial or paramedian,Boundaries between IVa and IVbPortal VeinVIIIVIIIVIIIII Level of HVs into IVCLHVMHVRHV胃肺Sectional Anatomy of CadavericIIIIIIVVIIIVIIIIIIIIIVVIIIVIIIIIIIVIIVIIIIVIIIIII脾IIIIVIIVIIIIVIIIIII脾IIIIVVIIIVIIIIIIIIIVVIIIVIIIIIIIIIVIVIVAdrenal leftPV RIIIIVIV

10、IVAdrenal leftPV RIIIVIIVVgallbladderCBDPVDuodAdre RSpleen VIIIVIIVVgallbladderCBDPVDuodAdVIVIVVIVIVVVIIVVVIIVVIVVIVIVVIVIVVIVVVIVVI Computed Tomography 肝脏解剖分段讲课课件Computed tomographyComputed tomographySectional Anatomy of Cadaveric LiverBoundaries between IVa and IVb正中裂 肝中静脉胆囊窝中点 ，分肝为左右半肝anterior an

11、d posterior segments or sectors, and the左外下段（III段）Boundaries between IVa and IVbgallbladder左外下段（III段）Tributary of a hepatic vein (left medial middle vein) can serve as the anatomical landmark (62.左段间裂肝左静脉，分出左外上段（II段）与Two categoriesTributary of a hepatic vein (left medial middle vein) can serve as th

12、e anatomical landmark (62.Middle VeinCouinauds systemPortal VeinAmerican system (“sector”)caudate lobe; Williams, 1995)Subsegment IVb lay anterior to the subsegment IVaBoundaries between IVa and IVbComputed tomography肝脏解剖分段讲课课件肝脏解剖分段讲课课件肝脏解剖分段讲课课件肝脏解剖分段讲课课件Introduction of MeVisFunctional segmentatio

13、n and volume analysisIntroduction of MeVisVIIIVIIIVIIIIVbVIIIIVbVIIIIVbVIIVIIIIVbVIIVIIIIVaIIIIIVIIIRVMVLVVIIIIVaIIIIIVIIIRVMVLVVIIIVIIIVaIIIIIILVMVRVVIIIVIIIVaIIIIIILVMVRVAdrenal left(the lateral, medial or paramedian,背 裂 弧形线，分出尾状叶正中裂portal fissureSegmentation of the liverAdrenal leftBoundaries bet

14、ween IVa and IVbComputed tomographyPortal Vein(the lateral, medial or paramedian,Hepatic VeinBasementDistribution of Glisson system and hepatic veinsComputed tomographySubsegment IVb lay anterior to the subsegment IVaBoundaries between IVa and IVb正中裂portal fissureTributary of a hepatic vein (left me

15、dial middle vein) can serve as the anatomical landmark (62.caudate lobe; Williams, 1995)VIIVIIIVIIIIIDSIVaVIb左叶间裂门脉左支门脉右支Adrenal leftVIIVIIIVIIIIIDSIVaIIIIIIVIaVIaVVIIIIVIIV门脉右支左叶间裂IIIIIIVIaVIaVVIIIIVIIV门脉右支左叶间裂IIIIVaIVbVIIIVVIVII胆囊IIIIVaIVbVIIIVVIVII胆囊IIIVIaVIbVVIVIIIIIVIaVIbVVIVIIVIbVVIVIIIIIVIbVV

16、IVIIIIIVIVVIVVIVIBoundaries between IVa and IVbSubsegment IVb lay anterior to the subsegment IVa Subsegments IVa and IVb was not superior and inferior, but posterosuperior and anteroinferior,respectively.The boundary is an oblique planeTributary of a hepatic vein (left medial middle vein) can serve as the anatomical landmark (62.7%)Boundaries between IVa and IVbBoundaries between IVa and IVbBoundaries b