Fasel Jean H D
Clinical Anatomy Research Group, Departments of Cellular Physiology, Metabolism and Surgery, University Medical Center and Hospital, Geneva, Switzerland.
Anat Rec (Hoboken). 2008 Jun;291(6):636-42. doi: 10.1002/ar.20658.
Subdivision of the human liver into eight portal venous segments (according to Couinaud) is largely established in the anatomical and clinical community. However, this concept is challenged by an increasing number of surgical and radiological reports. We reexamined the intrahepatic portal venous architecture to understand the inconsistencies published. For this purpose, we studied the livers of 20 deceased who had donated their body to the Anatomy Department. The organs were investigated by portal venous injection, subsequent liver corrosion, and analysis of the branching pattern. After a usual bifurcation of the portal vein (order 0 vessel) into a right and left branch (first order vessels), the number of second order branches observed was between 9 and 44, with an average of 20. This seemingly trivial matter of fact suggests that the human liver does not consist of the eight segments presumed, but of many more. Supposedly contradictory observations turn out to be explainable by differing combinations of this large number of territories, and not simply by anatomical variability. For practical surgical purposes, we conclude that the useful eight-segment scheme needs conceptual reappraisal when a more realistic approach to the individual hepatic territoriality in the patients under consideration is demanded. We submit a "1-2-20-concept" as a possible key.
根据库尼亚德（Couinaud）的方法，将人类肝脏划分为八个门静脉段在解剖学和临床领域已基本确立。然而，这一概念正受到越来越多外科和放射学报告的挑战。我们重新审视了肝内门静脉结构，以理解已发表的不一致之处。为此，我们研究了20名捐赠遗体给解剖学系的死者的肝脏。通过门静脉注射、随后的肝脏腐蚀以及对分支模式的分析来研究这些器官。门静脉（0级血管）通常分为右支和左支（一级血管）后，观察到的二级分支数量在9至44个之间，平均为20个。这一看似微不足道的事实表明，人类肝脏并非由假定的八个段组成，而是由更多段组成。看似相互矛盾的观察结果可以通过这大量区域的不同组合来解释，而不仅仅是解剖学变异。出于实际手术目的，我们得出结论，当需要对所考虑患者的个体肝脏区域划分采用更现实的方法时，有用的八段方案需要进行概念上的重新评估。我们提出一个“1-2-20概念”作为可能的关键。
