肝脏解剖分段.ppt

1、a,1,Sectional Anatomy and Segmentation of Liver,a,2,Segmentation of the liver,Two categories Couinauds system (“segment”) (S1S8, Couinaud, 1989; S9, Couinaud, 1994) and the so-called American system (“sector”) (the lateral, medial or paramedian, anterior and posterior segments or sectors, and the ca

2、udate lobe; Williams, 1995),a,3,Concept of Couinauds segment classification system,The 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 porta

3、l vein at its center and a tributary of a hepatic vein at its periphery,a,4,a,5,正中裂portal fissure,a,6,Couinauds system,a,7,Couinauds system,Basement：Distribution 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 & IX,左外下段(III)

4、IV,左外叶,左内叶,右前叶,右后叶,a,8,Portal Vein,a,9,Portal Vein,门脉脐部,a,10,a,11,Hepatic Vein,Middle Vein,a,12,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,a,13,Concept of Cantlies line,Cantlies line (th

5、e 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 MHV or a line slightly right of the MHV,a,14,a,15,Sectional Anatomy of Cadav

6、eric Liver & Computed tomography,a,16,VIII,VII,IV,III,II,Level of HVs into IVC,LHV,MHV,RHV,胃,肺,a,17,II,III,IV,VIII,VII,I,a,18,III,I,VII,VIII,IV,II,I,III,脾,a,19,I,II,IV,VIII,VII,III,a,20,I,III,VI,V,IV,Adrenal left,PV R,a,21,III,VI,IV,V,gallbladder,CBD,PV,Duod,Adre R,Spleen V,a,22,VI,V,IV,a,23,V,VI,IV

7、,a,24,V,IV,VI,a,25,VI,V,a,26,V,VI,a,27,Computed Tomography,a,28,a,29,a,30,a,31,a,32,a,33,a,34,Introduction of MeVis Functional segmentation and volume analysis,a,35,VIII,a,36,VIII,IVb,a,37,VIII,IVb,VII,a,38,VIII,IVa,III,II,VII,I,RV,MV,LV,a,39,VIII,VII,IVa,III,II,I,LV,MV,RV,a,40,VII,VIII,V,II,III,DS,

8、IVa,VIb,左叶间裂,门脉左支,门脉右支,a,41,I,II,III,VIa,VIa,V,VIII,IV,IIV,门脉右支,左叶间裂,a,42,III,IVa,IVb,VIII,V,VI,VII,胆囊,a,43,III,VIa,VIb,V,VI,VII,a,44,VIb,V,VI,VII,III,a,45,VI,V,a,46,VI,a,47,Boundaries between IVa and IVb,Subsegment 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 plane Tributary of a hepatic vein (left medial middle vein) can serve as the anatomical landmark (62.7%),a,48,Boundaries between IVa and IVb,a,49,Boundaries between IVa and IVb,a,50,Bo