Lee Jung Hun, Jin Guang Yu, Jin Zhe Wu, Yu Hee Chul, Cho Baik Hwan
Department of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, Republic of Korea.
Surg Radiol Anat. 2010 Dec;32(10):911-7. doi: 10.1007/s00276-010-0643-3. Epub 2010 Mar 4.
Classical anatomical resection does not always guarantee tumor-free margins when the tumor overrides traditional anatomical planes. Surgeons and interventionists frequently need to focus on the peripheral branches of Glisson's sheath in patients with poor hepatic reserves, particularly when the tumor is deep seated. The present study used anatomical liver dissection to investigate the spatial distribution of the branches of Glisson's sheath in each of four liver sectors.
Sixty-four adult human liver specimens were dissected. The size and ramification patterns of Glisson's sheath in each sector were analyzed in terms of bilateral homology within two paramedian sectors and within two lateral sectors.
Each liver sector had a characteristic Glisson's sheath in terms of trunk shape and ramification pattern. The two paramedian sectors showed point symmetry. Most of the branches of the two paramedian sectors emerged from the top of a short stout trunk. Although the two paramedian sectors were similar in terms of basic configuration, the ramification axes were almost perpendicular to each other. Unlike the paramedian sectors, the two lateral sectors showed not much homology.
The peripheral branches of Glisson's sheath were generally longer (approximately 5 cm) and thicker than anticipated. Extirpation strategies should take into account that each liver sector has a characteristic Glisson's sheath ramification pattern.
当肿瘤跨越传统解剖平面时，经典的解剖性切除并不总能保证切缘无肿瘤残留。对于肝储备功能差的患者，外科医生和介入医生常常需要关注肝门部Glisson鞘的外周分支，尤其是当肿瘤位置较深时。本研究采用肝脏解剖方法来探究Glisson鞘分支在四个肝段中的空间分布情况。
对64例成人肝脏标本进行解剖。从两个旁正中肝段和两个外侧肝段的双侧对称性方面分析各肝段Glisson鞘的大小和分支模式。
各肝段在Glisson鞘主干形态和分支模式方面均有其特征。两个旁正中肝段呈点对称。两个旁正中肝段的大多数分支起自短粗主干的顶部。虽然两个旁正中肝段在基本结构方面相似，但分支轴几乎相互垂直。与旁正中肝段不同，两个外侧肝段的相似性不大。
Glisson鞘的外周分支通常比预期的更长（约5厘米）且更粗。肝切除策略应考虑到各肝段具有特征性的Glisson鞘分支模式。
