Department of Anatomy, Calcutta National Medical College, 32, Gorachand Road, Kolkata, 700014, West Bengal, India.
Sananda, 17/1A Canal South Road, Purbachal, Kasba, Kolkata, 700078, West Bengal, India.
Surg Radiol Anat. 2020 Dec;42(12):1425-1434. doi: 10.1007/s00276-020-02485-9. Epub 2020 May 3.
Hepatobilliary surgery is nowadays increasingly done throughout the world with advent of newer liver imaging modalities. Considering recent interest for accurate interpretation of different radiological images and performing surgical procedures, a precise understanding of hepatic surface anatomy is challenging due to high prevalence of previously identified morphological variations. Accordingly, a cadaveric study was attempted to revisit the morphological details of liver updating the unusual configurations along with their clinico-anatomical correlations and thus, compare the analysis of present study with previous published data.
We studied 110 formalin-fixed adult cadaveric livers of unknown age and sex having no pathological lesion or damage.
More than one morphological variation in combination was observed on repeated occasions in same liver specimen. The anatomical classification based on Netter's criteria was chosen in order to be coherent with previous studies to define different variations with addition of other subtypes. Accordingly, classical wedgeshaped livers were present in 57.3% specimens. Considering different morphological features, 78 (70.9%) variant livers were noted in terms of shape (as transverse saddle shaped, square shaped, globular, quadrilateral, pyriform or boot-shaped), altered numbers and position of fissures (affecting either one or more lobe in addition to absent fissure for ligamentum teres) or lobes (as aplasia, hypoplasia or hypertrophy) or processes (in addition to abnormalities of processes extending from caudate or quadrate lobe tongue-like process or appendix fibrosa hepatis or mini-accessory lobe) or impressions (as costal or variant visceral impressions affecting inferior surface) or evidence of pons hepatis(35.5%) orin combinations of all above.
Awareness of hepatic surface variation is worth knowing in successful planning of hepatobilliary surgeries with least complications.
随着新型肝脏成像模式的出现，当今世界各地越来越多地进行肝胆外科手术。考虑到对不同影像学图像的准确解读和外科手术的近期兴趣，由于先前确定的形态变异的高流行率，精确理解肝表面解剖结构具有挑战性。因此，进行了一项尸体研究，旨在重新审视肝脏的形态细节，更新不常见的配置及其临床解剖相关性，并将本研究的分析与以前发表的数据进行比较。
我们研究了 110 例来自未知年龄和性别的福尔马林固定成人尸体肝脏，这些肝脏没有病理损伤。
在同一肝脏标本中多次观察到一种以上的形态变异组合。选择基于 Netter 标准的解剖分类，以便与以前的研究保持一致，以定义不同的变异，并添加其他亚型。因此，经典的楔形肝脏在 57.3%的标本中存在。考虑到不同的形态特征，以形状（如横马鞍形、方形、球形、四边形、梨形或靴子形）、裂孔数量和位置的改变（影响一个或多个叶，加上没有蒂状韧带裂孔）或叶（如发育不全、发育不良或肥大）或过程（除了从尾状叶或方叶延伸的异常舌状过程或纤维状肝阑尾或小副叶）或印象（如肋或变异内脏印象影响下表面）或肝桥（35.5%）或上述所有组合的方式，注意到 78（70.9%）个变体肝脏。
了解肝表面变异对于肝胆外科手术的成功规划具有最小的并发症是值得的。
