【摘要】： 肝臟是人體最大的實(shí)質(zhì)性腺體,其重量約為體重的1/40,通常為1200-1500克。在肝的臟面,有“H”形溝其中部呈橫行的溝稱為第一肝門。其內(nèi)有由肝管、門靜脈、肝固有動脈左右支、淋巴管及神經(jīng)組成的肝蒂出入肝實(shí)質(zhì)內(nèi),其中肝門靜脈及其分支、肝固有動脈及其分支、肝管及其分支被包于一結(jié)締組織鞘內(nèi)稱Glisson系統(tǒng)。它們不論在肝內(nèi)或肝門附近都走在一起。門靜脈與肝固有動脈進(jìn)入肝臟后反復(fù)分支,在肝小葉周圍形成小葉間靜脈和動脈,進(jìn)入肝血竇再經(jīng)中央靜脈注入肝靜脈,肝內(nèi)血管及膽管的復(fù)雜分布,為該部位手術(shù)帶來很大難度。外科治療的關(guān)鍵在于詳細(xì)了解肝內(nèi)血管及膽管的解剖結(jié)構(gòu),選擇合適的手術(shù)方式。為求手術(shù)達(dá)到良好效果,應(yīng)詳細(xì)了解肝臟及肝門部的解剖,可以減少術(shù)后并發(fā)癥和死亡率。自19世紀(jì)末起國外許多學(xué)者對肝臟解剖結(jié)構(gòu)進(jìn)行了研究,我國學(xué)者于20世紀(jì)50年代開始對肝臟解剖進(jìn)行了深入研究。但肝臟手術(shù)的出血及膽汁瘺仍是一個外科手術(shù)難以克服的障礙。外科醫(yī)生需要對肝臟的內(nèi)部解剖有進(jìn)一步了解。本文利用20具成人尸體肝臟標(biāo)本。以及6具肝臟鑄形標(biāo)本,解剖觀測了Glisson系統(tǒng)的肝內(nèi)分支形態(tài)結(jié)構(gòu)及走行方向,對重要結(jié)構(gòu)進(jìn)行量化分析,并對肝臟的分葉及分段、手術(shù)顯露、重要結(jié)構(gòu)的術(shù)中保護(hù)等問題做了闡述。以期為在手術(shù)中合理選擇術(shù)式提供解剖學(xué)依據(jù)。
[Abstract]:The liver is the largest solid gland in the body, weighing about a quarter of the body weight, usually 1200- 1500 grams. On the visceral surface of the liver, there is an H-shaped sulcus whose middle part is called the first hilum of the liver. The hepatic pedicle composed of hepatic duct, portal vein, left and right branches of the hepatic proper artery, lymphatic vessel and nerve enter and exit the hepatic parenchyma, in which the hepatic portal vein and its branches, the hepatic proper artery and its branches, The hepatic duct and its branches are encapsulated in a connective tissue sheath called Glisson system. They walk together both in the liver and near the hilum. The portal vein and the proper hepatic artery branch repeatedly after entering the liver, and the interlobular vein and artery are formed around the hepatic lobule. The hepatic vein is injected into the sinusoidal of the liver through the central vein, and the complicated distribution of the intrahepatic blood vessels and bile ducts is obtained. It is very difficult for the operation of this site. The key of surgical treatment is to understand the anatomical structure of intrahepatic blood vessels and bile ducts in detail and to select appropriate surgical methods. In order to achieve good results, we should understand the anatomy of liver and hepatic hilum in detail and reduce postoperative complications and mortality. Since the end of the 19th century, many foreign scholars have studied the anatomical structure of the liver, and Chinese scholars began to study the anatomy of the liver in the 1950s. But the bleeding of liver operation and bile fistula are still an insurmountable obstacle. Surgeons need to know more about the internal anatomy of the liver. The liver specimens of 20 adult cadavers were used. And 6 liver cast specimens were dissected to observe the morphological structure and direction of intrahepatic branches of the Glisson system, and the important structures were analyzed quantitatively, and the lobes and segments of the liver were exposed. Some problems such as intraoperative protection of important structures are discussed. In order to provide anatomical basis for the reasonable selection of surgical methods in the operation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322

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