肝脏分段系统

肝脏分段系统孔伟叶、段、区、扇区左右叶、左右肝、左右半肝尾状叶、方叶Liveranatomycanbedescribedusingtwodifferentaspects:morphologicalanatomyfunctionalanatomyThetraditionalmorphologicalanatomyisbasedontheexternalappearanceoftheliveranddoesnotshowtheinternalfeaturesofvesselsandbiliaryductsbranching,whichareofobviousimportanceinhepaticsurgery.C.Couinauddividedtheliverintoeightfunctionallyindepedentsegments.GrossAnatomyGrossAnatomyLiverClassificationSystem中华医学会（1960）：五叶四段（六段）分段法。Couinaud(1954):Glisson系统和肝静脉的分支和走行；Healey(1953):按照肝动脉和肝内胆管系统；TheBrisbane（2000）：Gans(1955)、Hobsley(1959):按照门静脉分叶标准；ChineseMedicalAssociationclassificationsystem3个主肝裂正中裂：胆囊切迹沿肝的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的连线为界；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的连线，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：肝的右下缘相当于胆囊切迹与肝脏外侧缘的外、中1/3交界处与右肝静脉汇入下腔静脉处的连线；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的后、中1/3交界处的连线；内有肝左静脉的段间支；右段间裂：起自脏面的肝门右切迹，横行绕过右后叶外缘中点，止于右叶间裂的交点；1个背裂背裂：肝脏背面上缘中央部，尾叶前方肝上极背侧额状位的弧形肝裂；ChineseMedicalAssociationclassificationsystemCouinaudclassificationsystem（1954）TheCouinaudclassificationofliveranatomydividestheliverintoeightfunctionallyindependentsegments.Eachsegmenthasitsownvascularinflow,outflowandbiliarydrainage.Inthecentreofeachsegmentthereisabranchoftheportalvein,hepaticarteryandbileduct.Intheperipheryofeachsegmentthereisvascularoutflowthroughthehepaticveins.Theclassificationsystemusesthevascularsupplyinthelivertoseparatethefunctionalunits(numberedItoVIII).Righthepaticvein：dividestherightlobeintoanteriorandposteriorsegments.Middlehepaticvein：dividestheliverintorightandleftlobes(orrightandlefthemiliver).Thisplanerunsfromtheinferiorvenacavatothegallbladderfossa.TheFalciformligament：dividestheleftlobeintoamedial-segmentIVandalateralpart-segmentIIandIII.Theportalvein：dividestheliverintoupperandlowersegments.Theleftandrightportalveinsbranchsuperiorlyandinferiorlytoprojectintothecenterofeachsegment.SegmentIVissometimesdividedintosegmentIVaandIVbaccordingtoBismuth.Couinaudclassificationsystem（1954）Couinaudclassificationsystem（1954）根据：以Glisson系统在肝内的分布为基础,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的纵形切面将肝分隔成4个部分,称为四个扇区.每个扇区又被门静脉左、右支的水平切面分成上下2段.分成：2个半肝（hemiliver），4个扇区(sector)，8（or9）个段(segment)表面分界依据：（门裂（界、线）：含肝静脉走形的线。）主门裂（mainportalscissure，主界，Cantlie‘sline）：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（rightportalscissure，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的中、外1/3交界处；脏面，沿右下角到达肝门横沟右端。内有肝右静脉。左门裂（leftportalscissure，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的后、中1/3交界处。内有肝左静脉。TheFalciformligament：dividestheleftlobeintoamedial-segmentIVandalateralpart-segmentIIandIII.Cantlie'sline:Alinecanbeimaginedrunningfromtheleftofthevenacavaandallthewayforwardtodividetheliverandgallbladderintotwohalves.Couinaudclassificationsystem（1954）Bismuthclassificationsystem修正Couinaud分类系统将IV段分为a、b2段Healey&Schroyclassificationsystem（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门静脉分段区别就是左肝的分段有差别、名字的区别TheBrisbane2000classificationsystem2002年中国肝脏专家组发表《肝脏解剖和手术切除统一名称》。肝脏分为2部分：主肝尾状叶分界依据：肝中界面：胆囊窝和腔静脉窝相交的平面。左区界面：通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，无重要结构走形其内。三级划分：半肝（或肝）、区（section）、段（segment）。TheBrisbane2000classificationsystemLiversurgeryRighthepatectomysegmentV,VI,VIIandVIII(±segmentI).ExtendedRightorrighttrisectionectomysegmentIV,V,VI,VIIandVIII(±segmentI).LefthepatectomysegmentII,IIIandIV(±segmentI).ExtendedLeftorlefttrisectionectomysegmentII,III,IV,V/VIII(±segmentI).LiversurgeryRightposteriorsectionectomysegmentVIandVIIRightanteriorsectionectomysegmentVandVIIILeftmedialsectionectomysegmentIVLeftlateralsectionectomysegmentIIandIII