The Morphology Observation And Clinical Significance Of The Hepatic Pedicle Structure's Intrahepatic Branches

Objective:1.To study the distribution of hepatic pedicle structure within liver,make clear that distribution of portal vein , arteria hepatica and bile duct, in progress to analyses lobus hepatis and segmenta hepatis; 2.Discussing the position and marker of the blood vessel and bile duct being protected in liver operation, provide anatomical basis to clinic.Methods : with 20 (12 males, 8 females) liver samples, along the hepatoduodenal ligament from the hepatic portal to the distal direction stripping Glisson sheath, observation of the porta hepatis and fracture characteristics of the porta hepatis and pipeline structures. use the Polishing method approach to the affluent intrahepatic retrospective beam into a different position of the liver. all levels of the hepatic duct observation on the concourse, acts, hepatic artery and portal vein and its branches, as well as pipeline and outside the liver and the adjacent structure, and to observe all levels of the hepatic duct in different anatomical structure under conditions of surgery revealed manner. another pair of six mold pipeline corrosion liver specimens, with a focus on liver lobe of the liver beattie observed within the structure, focus on measuring and recording relevant data on vital structures photographed.Results : 1. The hepatic portal within the structure of the hepatic pedicle almost constant anatomical relationship between the liver portal mains at the front of the trunk, hepatic artery running from the left hepatic duct, three tubes bifurcation point is the relationship between hepatic duct around the converging point of the maximum, often buried in the liver horizontal groove, portal bifurcation point second , hepatic artery bifurcation point minimum, hepatic artery bifurcation point is not only low but significantly left. 2. The group specimens portal trunk in the hepatic portal action ditch about 90% (18/20), right stem absent were 10% (2/20), hepatic portal vein of the left stem from department, corner, sagittal and the department of the ministry of capsule form, the more anatomical location fixed, right larger anatomic variations. 3.The hepatic duct confluence with the common three-way, the group of normal liver about convergence-12, two direct convergence of the hepatic duct type and the right aberrant biliary variation convergence-4 cases respectively. The hepatic duct out the porta hepatis level would be quite different. Hepatic portal ducts adjacent to the mutual relations and affluent beam in the liver acts relatively constant. 4. Caudate lobe is not a real leaf, we will not be able to identify the signs of substantive nor constant vascular, duct units. Generally, caudate lobe is Cantlie lines and falciform ligament between two sagittal plane of the back part of the liver. since the lack of uniform standards. Because of the caudate lobe and the anatomical location of the anatomical structure of particularity the past 10 years, involving caudate lobe resection of the liver before being reported. In this paper, 20 cases of adult cadaveric liver specimens, observe the caudate lobe shape, border, and adjacent vascular duct distribution.Conclusions: 1. Liver surgery has high-risk and grasps difficult, the main causes are that it is rich in blood vessels of the liver, complex anatomical structure, difficult to control bleeding. 2. Lobus hepatis and segmenta hepatis have a directive function to concrete hepar operation way. each segment has its own separate pipeline system can be used as a surgical resection units. 3.Know well that hepar location and adjacent relation has great significance for liver biopsy,abscess puncture drainage of right lobus hepatis,liver transplant recipients and donor hepatectomy implantation ,and so on ,that can direct the operation.4.The first hepatic portals include hepar's horizontal ditch and liver pedicel.horizontal ditch crack deep but narrow , is covered by trailing edge of lobus quadratus hepatis. The liver inherence arterial , portal vein , common hepatic duct , nerve and lymphoid tissue wrap up the offside , the pedicel composing liver in liver dodecadactylon ligamentum commonly. the first hepatic portals content and dissecting for the surgery is of great significance. 5.The branching form and characteristic of liver portal vein have important significance to treats and diagnoses hepar disease in get involved operation, the selectivity hepatic portal venous embolism skill is a common use method of liver cancer treating. 6.Hepatic portal bile duct cancer is situated at the ramification location of liver , operation excision rate in the past is very low. Choose a suitable method of exposure can significantly improve the resection rate.7.According the distribution characteristic the bile duct ,brings forward three-level hepatic portal concept. every segmenta hepatis have its own hepatic portal. segmenta hepatis is the minimal functional unit being able to cut off in hepar surgery. according to the classification of hepatic portal concept,may make comparatively ideal functionality hepatectomy , have function liver to organize with reserve reaching a high limit.