肝脏解剖分段最全课件.ppt

1、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)Concept of Couinauds segment classific

2、ation 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 portal vein at its center and a tributary of a hepatic vein at its peripheryCan

3、tlies line(the principal border or main lobar fissure)Couinauds systemgallbladderBoundaries between IVa and IVb右段间裂：又称横裂,肝门脉右支，分右半肝为上下段Concept of Cantlies line正中裂：肝中静脉-胆囊窝中点，分肝为左右半肝Boundaries between IVa and IVb左段间裂：肝左静脉，分出左外上段（II段）与右段间裂：又称横裂,肝门脉右支，分右半肝为上下段Functional segmentation and volume analysis

4、(the lateral,medial or paramedian,Segmentation of the liverEach segment had a branch(or a group of branches)of the portal vein at its center and a tributary of a hepatic vein at its peripheryanterior and posterior segments or sectors,and the背 裂：弧形线，分出尾状叶Computed TomographyComputed tomography正中裂正中裂po

5、rtal fissureCouinauds systemCouinauds 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)IV左外叶左内叶右前叶右后叶Portal VeinPortal Vein门脉脐部Hepatic VeinMiddle Vein肝段的划分方法肝段的划分方法 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

6、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 lef

7、t margin or the midline of the IVC and the terminal portion of the MHV or a line slightly right of the MHV Sectional Anatomy of Cadaveric Liver&Computed tomography VIIIVIIIVIIIII Level of HVs into IVCLHVMHVRHV胃胃肺肺IIIIIIVVIIIVIIIIIIIVIIVIIIIVIIIIII脾IIIIVVIIIVIIIIIIIIIVIVIVAdrenal leftPV RIIIVIIVVgall

8、bladderCBDPVDuodAdre RSpleen VVIVIVVVIIVVIVVIVIVVVI Computed TomographyComputed Tomography背 裂：弧形线，分出尾状叶分出左内叶与左外叶正中裂：肝中静脉-胆囊窝中点，分肝为左右半肝Couinauds systemCouinauds system(“segment”)Subsegments IVa and IVb was not superior and inferior,but posterosuperior and anteroinferior,respectively.Concept of Couina

9、uds segment classification systemgallbladderBasement：Distribution of Glisson system and hepatic veinsIntroduction of MeVisFunctional segmentation and volume analysisVIIIVIIIIVbVIIIIVbVIIVIIIIVaIIIIIVIIIRVMVLVVIIIVIIIVaIIIIIILVMVRVVIIVIIIVIIIIIDSIVaVIb左叶间裂门脉左支门脉右支IIIIIIVIaVIaVVIIIIVIIV门脉右支门脉右支左叶间裂左叶间

10、裂IIIIVaIVbVIIIVVIVII胆囊IIIVIaVIbVVIVIIVIbVVIVIIIIIVIVVIBoundaries 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%)Boundaries between IVa and IVbBoundaries between IVa and IVbBoundaries between IVa and IVbBoundaries between IVa and IVbBoundaries between IVa and IVb