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目的探讨腹腔镜下肝门血流阻断在肝切除术(LH)的解剖基础及手术路径。方法解剖尸体肝脏,分离血流阻断所涉及各肝门结构,观察在二维平面中毗邻,测量在肝外长度及夹角;观察LH视频中肝门结构,总结镜下的位置及特征。结果肝动脉平面低于肝管(90%),肝门静脉分叉位置固定于后方;肝左和肝中静脉在肝外大多共干(90%),肝右静脉与共干间存在间隙,与肝后下腔静脉(IVC)前方相通;肝短静脉位于IVC两侧,有(7±3)支;IVC韧带在尸体中易忽略,活体中较明显,为包绕IVC的膜性结构,厚度个体差异大;各结构在肝外长度及夹角为肝门血流阻断提供足够空间;镜下各结构位置及特征与实体比较有特殊性。结论 LH中应用肝门血流阻断有解剖依据及路径遵循。
Objective To investigate the anatomic basis and surgical path of laparoscopic hepatic portal vein occlusion in hepatectomy (LH). Methods The liver of the body was dissected and the structures of the hepatic portal involved in the blood flow block were separated. The adjacent structures in the two-dimensional plane were observed and the extrahepatic length and included angle were measured. The hepatic portal structure in the LH video was observed and the locations and features under the microscope were observed. Results The hepatic artery plane was lower than that of the hepatic duct (90%). The bifurcation of the portal vein was fixed in the posterior region. Most of the left and middle hepatic vein were outside the liver (90%). There was a gap between the right hepatic vein and common liver, Posterior inferior vena cava (IVC); hepatic short veins located on both sides of IVC with (7 ± 3) branches; IVC ligaments were easily neglected in the body and more evident in the living body, which were the membranous structures surrounding the IVC and thickness individuals The difference is large; each structure in the extrahepatic length and angle for the hepatic portal blood flow to provide sufficient space; the structure and location of the microscopic structure and the entity is more specific. Conclusion There are anatomical bases and pathways for hepatic portal vein occlusion in LH.