Mirilas Petros, Skandalakis J E
Centers for Surgical Anatomy and Technique, Emory University, Atlanta, Georgia 30322, USA.
Am Surg. 2002 Sep;68(9):832-5.
Peritoneal attachments of the liver to the diaphragm include the falciform ligament, the left triangular ligament, and the coronary ligament with the right triangular ligament. It is often surgically convenient when the gastroesophageal junction is explored to refer to a "right" and a "left" coronary ligament, but this is anatomically unjustified. To reassess the issue there are no "right" and "left" coronary ligaments; there are only the left triangular ligament and the complex of coronary and right triangular ligament. The latter is the lateral unification of the layers of the coronary ligament. The liver is posteriorly connected to the diaphragm, and therefore the coronary ligament has superior and inferior layers rather than anterior and posterior layers. Embryologically these ligaments reflect the remnants of the developmental pathways of the liver in the septum transversum, and in the mature organism they are peritoneal connections. Besides the liver is suspended in the bare area mostly by fibrous attachments and by the hepatic veins. Consequently the term "ligament" for these structures has to be revised. Therefore we suggest the terms "left triangular peritoneal attachment" of the liver and "coronary peritoneal attachment" instead of "left triangular ligament" and "coronary ligament."
肝脏与膈肌的腹膜附着包括镰状韧带、左三角韧带以及冠状韧带和右三角韧带。在探查胃食管交界处时，将冠状韧带分为“右”和“左”冠状韧带在手术中通常较为方便，但这在解剖学上是不合理的。为重新评估这一问题，实际上并不存在“右”和“左”冠状韧带；只有左三角韧带以及冠状韧带和右三角韧带复合体。后者是冠状韧带各层的外侧融合。肝脏在后方与膈肌相连，因此冠状韧带具有上、下两层，而非前、后两层。从胚胎学角度来看，这些韧带反映了肝脏在横隔中发育路径的残余部分，在成熟机体中它们是腹膜连接结构。此外，肝脏大多通过纤维附着和肝静脉悬吊于裸区。因此，对于这些结构的“韧带”这一术语必须进行修正。所以我们建议用肝脏的“左三角腹膜附着”和“冠状腹膜附着”来取代“左三角韧带”和“冠状韧带”。
