Wolf H, Gross F, Merz A, Schuler A
Facharzt für Allgemeinmedizin, Niederstotzingen, Germany.
Z Gastroenterol. 2013 Mar;51(3):271-7. doi: 10.1055/s-0032-1325353. Epub 2013 Mar 13.
Liver segment definition due to Couinaud is the basis for localisation of focal liver lesions in imaging, in the follow-up or for planning operations. A literature review shows variety in segment definition and the frontier between segment II and III in the left liver lobe, in the course of the portal vein level and in variations of liver veins. The aim of this study is to demonstrate liver segment anatomy in sonography compared to anatomic preparations and the literature. This leads to a proposal for a unique nomenclature and illustration.
152 liver healthy persons (77 F, 75 M, mean age 63.3 years (18 - 91 years) were examined with standardised abdominal ultrasound in longitudinal, transversal and axis planes. (Angle) measurements were taken to define the left hepatic vein (Fissura sinistra), the Ramus umbilicalis of the portal vein (Fissura umbilicalis), the portal vein level and the amount and variations of the liver veins.
The left hepatic vein was found with a mean angle of 24° (0 - 70°) left to the median axis, the Pars umbilicalis of the portal vein wasalmost strictly in the mid axis. The portal vein level was located with a mean angle of 61° (5 - 110°) right to the median with no variations of the two main branches. 27 (18 %) out of the remaining 151 patients showed variations of the liver veins: 7 × (4.6 %) a doubled mid hepatic vein, 12 × (8 %) a doubled left hepatic vein, 4 × (2.7 %) 3 left liver veins were found with a short (≤ 1 cm) common trunk, 1 × each (0.7 %) four left liver veins with a short common trunk, one trifurcation of the mid hepatic vein, one doubled right liver vein and one common trunk (2 cm) of all 3 main liver veins leading to the inferior V. cava.
The surgical functional liver segment definition by Couinaud is the basis for localisation of focal liver lesions. The frontier between segment II and III is mainly described as a horizontal plane in the literature. The course of the left liver vein (fissura sinistra) has a mean angle of 24° left to the median and not like the umbilical fissure, which is found almost strictly in the median plane. The left hepatic vein(s), their course and liver vein variations are well demonstrated by sonography (99.3 % in this study). Anatomic landmarks as well as variations and a unique nomenclature should be well known and considered in the localisation of focal liver lesions, their feeding vessels and liver segment anatomy.
库尼亚德（Couinaud）提出的肝段定义是在影像学检查中对肝脏局灶性病变进行定位、随访或手术规划的基础。文献综述显示，在左肝叶中，肝段定义以及肝段Ⅱ和Ⅲ之间的边界在门静脉水平及肝静脉变异方面存在差异。本研究的目的是通过超声检查展示肝段解剖结构，并与解剖标本及文献进行对比。由此提出一种独特的命名法和图示方法。
对152例肝脏健康者（77例女性，75例男性，平均年龄63.3岁（18 - 91岁））进行标准化腹部超声检查，检查平面包括纵切面、横切面和斜切面。测量（角度）以确定左肝静脉（左裂）、门静脉脐部支（脐裂）、门静脉水平以及肝静脉的数量和变异情况。
左肝静脉与正中轴左侧的平均夹角为24°（0 - 70°），门静脉脐部支几乎严格位于正中轴上。门静脉水平与正中轴右侧的平均夹角为61°（5 - 110°），其两个主要分支无变异。在其余151例患者中，27例（18%）出现肝静脉变异：7例（4.6%）肝中静脉双支，12例（8%）左肝静脉双支，4例（2.7%）发现3支左肝静脉有短（≤1 cm）的共同干，各1例（0.7%）有4支左肝静脉具短共同干、肝中静脉三分叉、右肝静脉双支以及所有3支主要肝静脉汇入下腔静脉有2 cm的共同干。
库尼亚德提出的手术功能性肝段定义是肝脏局灶性病变定位的基础。在文献中，肝段Ⅱ和Ⅲ之间的边界主要描述为一个水平面。左肝静脉（左裂）的走行与正中轴左侧的平均夹角为24°，与几乎严格位于正中平面的脐裂不同。超声检查能够很好地显示左肝静脉及其走行以及肝静脉变异（本研究中显示率为99.
