《肝脏解剖分段》PPT课件.ppt

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1、SectionalAnatomyandSegmentationofLiverSegmentationoftheliverTwocategoriesCouinaud’ssystem(“segment”)(S1–S8,Couinaud,1989;S9,Couinaud,1994)andtheso-calledAmericansystem(“sector”)(thelateral,medialorparamedian,anteriorandposteriorsegmentsorsectors,andthecaudatelobe;Williams,1995)ConceptofCo

2、uinaud’ssegmentclassificationsystemTheliverwasdividedintofoursegmentsbythreeverticalplanes,andeachsegmentwasfurthersubdividedintotwosubsegmentsbyatransversescissure.Eachsegmenthadabranch(oragroupofbranches)oftheportalveinatitscenterandatributaryofahepaticveinatitsperiphery正中裂portalfissure

3、Couinaud’ssystemCouinaud’ssystemBasement：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PortalVeinPortalVein门脉脐部HepaticVeinMiddleVein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

4、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’slineCantlie’sline(theprincipalborderormainlobarfissure)isgenerallybelievedtobealongthehilarbifurcationoftheportalvein,thefossaforthegallbladder,theleftmarginorthemidlineoftheIVCandtheterminalp

5、ortionoftheMHVoralineslightlyrightoftheMHVSectionalAnatomyofCadavericLiver&ComputedtomographyVIIIVIIIVIIIIILevelofHVsintoIVCLHVMHVRHV胃肺IIIIIIVVIIIVIIIIIIIVIIVIIIIVIIIIII脾IIIIVVIIIVIIIIIIIIIVIVIVAdrenalleftPVRIIIVIIVVgallbladderCBDPVDuodAdreRSpleenVVIVIVVVIIVVIVVIVIVVVIComputedTomographyIn

6、troductionofMeVisFunctionalsegmentationandvolumeanalysisVIIIVIIIIVbVIIIIVbVIIVIIIIVaIIIIIVIIIRVMVLVVIIIVIIIVaIIIIIILVMVRVVIIVIIIVIIIIIDSIVaVIb左叶间裂门脉左支门脉右支IIIIIIVIaVIaVVIIIIVIIV门脉右支左叶间裂IIIIVaIVbVIIIVVIVII胆囊IIIVIaVIbVVIVIIVIbVVIVIIIIIVIVVIBoundariesbetweenIVaandIVbSubsegmentIVblayanteriorto

7、thesubsegmentIVaSubsegmentsIVaandIVbwasnotsuperiorandinferior,butposterosuperiorandanteroinferior,respectively.TheboundaryisanobliqueplaneTributaryofahepaticvein(leftmedialmiddlevein)canserveastheanatomicallandmark(62.7%)BoundariesbetweenIVaandIVbBoundariesbetweenIV