肝脏解剖分段

RV
VII
.
左叶间裂
IVa
VIIIVIbFra bibliotekV 门脉右支 VII
III 门脉左支
II DS
.
VIa VIa
VIII V
门脉右支
左叶间裂 III
II I
IV IIV
.
III IVb IVa
VIII
胆囊
V
VI VII
.
VIb
III
VIa
V VI
VII
.
III VIb V VI
VII
.
V VI
.
VI
.
Couinaud’s system
.
Couinaud’s system
• Basement：Distribution of Glisson system and hepatic veins
左半肝
主 肝
肝
右半肝
左外扇区 左内扇区
右前扇区 右后扇区
肝背扇区 I & IX
左外上段（II） 左外下段(III)
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Boundaries between IVa and IVb
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Boundaries between IVa and IVb
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Boundaries between IVa and IVb
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Boundaries between IVa and IVb
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Boundaries between IVa and IVb
• Subsegment IVb lay anterior to the subsegment IVa
• Subsegments IVa and IVb was not superior and inferior, but posterosuperior and anteroinferior,respectively.
脾
.
IV VIII
VII
III
II I
.
PV R
V
VI
IV
III
I
Adrenal left
.
Duod
gallbladder
V
IV CBD
PV
III
Spleen V
VI
Adre R
.
IV V VI
.
IV V VI
.
IV V VI
.
V VI
.
V VI
.
Computed Tomography
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
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Concept of Cantlie’s line
Cantlie’s line (the principal border or main lobar fissure)
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Concept of Couinaud’s segment classification system
• The liver was divided into four segments by three vertical planes, and each segment was further subdivided into two subsegments by a transverse scissure.
is generally believed to be along the hilar bifurcation of the portal vein, the fossa for the gall bladder, the left margin or the midline of the IVC and the terminal portion of the MHV or a line slightly right of the MHV
• Each segment had a branch (or a group of branches) of the portal vein at its center and a tributary of a hepatic vein at its periphery
.
.
正中裂portal fissure
.
.
Sectional Anatomy of Cadaveric Liver &
Computed tomography
.
MHV
IV VIII
VII
RHV
III II
LHV 胃
肺
.
Level of HVs into IVC
IV
III
II
VIII
I
VII
.
IV VIII
VII
III III
II II
IV 右前下段（V） 右前上段（VIII） 右后下段（VI） 右后上段（VII）
.
左外叶 左内叶
右前叶 右后叶
Portal Vein
.
Portal Vein
门脉脐部
.
.
Hepatic Vein
Middle Vein
.
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，
Sectional Anatomy and Segmentation of Liver
.
Segmentation of the liver
Two categories
Couinaud’s system (“segment”) (S1–S8, Couinaud, 1989; S9, Couinaud, 1994) and the socalled American system (“sector”) (the lateral, medial or paramedian, anterior and posterior segments or sectors, and the caudate lobe; Williams, 1995)
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.
.
.
.
.
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Introduction of MeVis
Functional segmentation and volume analysis
.
VIII
.
IVb
VIII
.
IVb VIII
VII
.
III
IVa
II
MV LV
VIII
I
RV
VII
.
IVa MV
III
LV
II
I VIII
• The boundary is an oblique plane • Tributary of a hepatic vein (left medial
middle vein) can serve as the anatomical landmark (62.7%)
.
Boundaries between IVa and IVb