肝脏解剖分段

SectionalAnatomyandSegmentationofLiver

肝脏解剖分段SegmentationoftheliverTwocategoriesCouinaud’ssystem(“segment”)(S1–S8,Couinaud,1989;S9,Couinaud,1994)andtheso-calledAmericansystem(“sector”)(thelateral,medialorparamedian,anteriorandposteriorsegmentsorsectors,andthecaudatelobe;Williams,1995)肝脏解剖分段ConceptofCouinaud’ssegmentclassificationsystemTheliverwasdividedintofoursegmentsbythreeverticalplanes,andeachsegmentwasfurthersubdividedintotwosubsegmentsbyatransversescissure.Eachsegmenthadabranch(oragroupofbranches)oftheportalveinatitscenterandatributaryofahepaticveinatitsperiphery肝脏解剖分段肝脏解剖分段正中裂portalfissure肝脏解剖分段Couinaud’ssystem肝脏解剖分段Couinaud’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肝脏解剖分段PortalVein肝脏解剖分段PortalVein门脉脐部肝脏解剖分段肝脏解剖分段HepaticVeinMiddleVein肝脏解剖分段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，分右半肝为上下段肝脏解剖分段ConceptofCantlie’slineCantlie’sline(theprincipalborderormainlobarfissure)isgenerallybelievedtobealongthehilarbifurcationoftheportalvein,thefossaforthegallbladder,theleftmarginorthemidlineoftheIVCandtheterminalportionoftheMHVoralineslightlyrightoftheMHV肝脏解剖分段肝脏解剖分段SectionalAnatomyofCadavericLiver&Computedtomography肝脏解剖分段VIIIVIIIVIIIII

LevelofHVsintoIVCLHVMHVRHV胃肺肝脏解剖分段IIIIIIVVIIIVIII肝脏解剖分段IIIIVIIVIIIIVIIIIII脾肝脏解剖分段IIIIVVIIIVIIIII肝脏解剖分段IIIIVIVIVAdrenalleftPVR肝脏解剖分段IIIVIIVVgallbladderCBDPVDuodAdreRSpleenV肝脏解剖分段VIVIV肝脏解剖分段VVIIV肝脏解剖分段VIVVI肝脏解剖分段VIV肝脏解剖分段VVI肝脏解剖分段

ComputedTomography肝脏解剖分段肝脏解剖分段肝脏解剖分段肝脏解剖分段肝脏解剖分段肝脏解剖分段肝脏解剖分段IntroductionofMeVisFunctionalsegmentationandvolumeanalysis肝脏解剖分段VIII肝脏解剖分段VIIIIVb肝脏解剖分段VIIIIVbVII肝脏解剖分段VIIIIVaIIIIIVIIIRVMVLV肝脏解剖分段VIIIVIIIVaIIIIIILVMVRV肝脏解剖分段VIIVIIIVIIIIIDSIVaVIb左叶间裂门脉左支门脉右支肝脏解剖分段IIIIIIVIaVIaVVIIIIVIIV门脉右支左叶间裂肝脏解剖分段IIIIVaIVbVIIIVVIVII胆囊肝脏解剖分段IIIVIaVIbVVIVII肝脏解剖分段VIbVVIVIIIII肝脏解剖分段VIV肝脏解剖分段VI肝脏解剖分段BoundariesbetweenIVaandIVbSubsegmentIVblayanteriortothesubsegmentIVaSubsegmentsIVaandIVbwasnotsuperiorandinferior,butposterosuperiorandanteroinferior,respectively.TheboundaryisanobliqueplaneTributaryofahepaticvein(leftmedialmiddlevein)canserveastheanatomicallandmark(62.7%)肝脏解剖分段BoundariesbetweenIVaandIVb肝脏解剖分段BoundariesbetweenIVaandIVb肝脏解剖分段BoundariesbetweenIVaandIV