Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
Department of Pathology, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
J Hepatobiliary Pancreat Sci. 2023 May;30(5):551-557. doi: 10.1002/jhbp.1250. Epub 2022 Oct 29.
Laennec's capsule is the proper membrane covering the entire surface of the liver parenchyma, including around the Glissonean pedicles and hepatic veins. Laennec's capsule around the hepatic veins has been clinically reported to comprise two layers: the hepatic and cardiac Laennec's capsules. However, where the cardiac Laennec's capsule is derived from and the two capsules' separability are still unclear. This study aimed to investigate the anatomy of the two capsules using cadaveric specimens.
Histopathological examinations of autopsy specimens from four cadavers were conducted. Each specimen was sliced in the longitudinal section to include the pericardium, right hepatic vein (RHV), and inferior vena cava (IVC). Additionally, long-axis specimens of the RHV were obtained to determine the separability of the capsules and to examine the extent to which the capsules extended along the RHV. Laennec's capsule was estimated using elastic fiber staining.
The cardiac Laennec's capsule is derived from the pericardium (parietal and visceral) and diaphragm and runs parallel with the IVC and hepatic veins associated with the hepatic Laennec's capsule. The two capsules were separable micro- and macroscopically. The hepatic Laennec's capsule was observed from the root to the peripheral side and the cardiac Laennec's capsule from the root to the middle side of the hepatic vein.
The existence of the two layers of Laennec's capsule around the hepatic veins was confirmed histologically and they were separable. Identification and decollement of these layers would contribute to establishing safe and feasible anatomic liver resection techniques.
Laennec 囊是覆盖整个肝实质表面的固有膜，包括 Glisson 蒂和肝静脉周围。临床上已报道肝静脉周围的 Laennec 囊由两层组成：肝心包 Laennec 囊和心心包 Laennec 囊。然而，心心包 Laennec 囊的来源以及两囊的可分离性尚不清楚。本研究旨在使用尸体标本研究两囊的解剖结构。
对 4 具尸体解剖标本进行组织病理学检查。每个标本均沿长轴切开，包括心包、右肝静脉（RHV）和下腔静脉（IVC）。此外，还获得了 RHV 的长轴标本，以确定两囊的可分离性，并检查两囊沿 RHV 延伸的程度。使用弹性纤维染色估计 Laennec 囊。
心心包 Laennec 囊起源于心包（壁层和脏层）和膈肌，与 IVC 和与肝静脉相关的肝心包 Laennec 囊平行。两囊在微观和宏观上均是可分离的。肝心包 Laennec 囊从根部到周边观察，心心包 Laennec 囊从根部到肝静脉中间观察。
肝静脉周围存在两层 Laennec 囊，组织学上可分离。识别和分离这些层将有助于建立安全可行的解剖性肝切除术技术。
