摘要目的 解析左半肝Glisson系统的立体空间解剖结构及三级分支走行分布情况,为左半肝实施精准肝切除术提供解剖学基础.方法 对20例10%甲醛固定的成人尸体无病变肝脏标本进行应用解剖观察,重点对左半肝Glisson系统的立体空间解剖位置进行形态学观察,采集并分析左半肝Glisson系统各区域三级分支数目及走行数据.结果 左半肝Glisson系统主干(G左主)呈弓型走行,长度为(3.10±0.76)cm;右半肝Glisson系统主干(G右主)与G左主的夹角为175.70°±11.54°,G右主与肝十二指肠韧带(G肝总)的夹角为107.60°±13.82°,G左主与G肝总的夹角为76.70°±17.36°.左半肝Glisson系统的Ⅱ、Ⅲ、Ⅳ段区域三级分支总的数目呈3~8支不等,其中3支型、8支型各占1/20、4支型和6支型各占4/20、7支型占2/20,5支型占8/20;但Couniaud八段S2区域的分支有且只有1支.结论 左半肝Glisson系统立体空间解剖位置、各区域三级分支数目及走行并不完全符合Couinaud八段之描述,且存在着明显的个体差异.术前掌握左半肝Glisson系统的内部立体解剖结构,特别是三级分支数目及走行,是实施精准肝切除术的基础.

abstractsObjective To analyze the three-dimensional anatomical structures and distributions of the three branch of the Glissonean pedicle of the left liver , and provide anatomical basis for the precise hepatectomy of the left liver.Methods The morphological observation of the Glissonean pedicle of the left liver through dissecting 20 cases of adult corpses without liver pathological changes was made , the anatomical position of three-dimensional space and the number of the three branch of in each region of the Glissonean pedicle of the left liver, data were then collected and the statistical analysis was made .Results The length of the Glisson pedicle of left hepatic was (3.10 ±0.76)cm.Angles between the stem of the Glisson pedicle of right liver(GR) /the stem of the Glisson pedicle of left liver (GL) are 175.70°±11.54°; angles between GR/GT were 107.60°±13.82°; angles between GL /ligamentum hepatoduodenale (GT) were 76.70°± 17.36°.The shapes of the Glissonean pedicle stem of the left hepatic presenting arch , the number of radial level 3 branches was between 3 -8, in which, the 3 types and the 8 types accounted for 1 /20, the 4 types and the 6 types were 4 /20, the 7 types were 2 /20, and 5 types were 8/20.There was only one branch in S2 section.Conclusions The anatomical position of three-dimensional space and the number of the three branch of in each region of the Glissonean pedicle of the left liver does not entirely fit the description of Couinaud's segment, obvious individual differences do exist .So, understanding three-dimensional of the anatomy of the Glissonean pedicle of the left liver before operation , especially the number of the three branch are the basis of precise hepatectomy.