Takasaki K
Department of Gastroenterological Surgery, Tokyo Women's Medical College, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
J Hepatobiliary Pancreat Surg. 1998;5(3):286-91. doi: 10.1007/s005340050047.
A new concept of hepatic segmentation along with the Glissonean pedicle tree, and the basis of hepatic resection by the Glissonean pedicle transection method are presented. The portal triad continues from the hepato-duodenal ligament to the intra-hepatic portion as the Glissonean pedicle. That is, the artery, portal vein and bile duct, together with connective tissue, are sheathed by the peritoneum to form a fibroid bundle. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver and the trunks of the secondary and more peripheral branches run inside the liver. The ramification pattern of the tertiary branches which branch out from each secondary branch is different from patient to patient. The liver is nourished by the secondary branches of the Glissonean pedicle. Each secondary branch feeds one segment. The liver can thus be separated into three segments and an additional caudate area. The area fed by each one of the tertiary branches is cone-shaped; fermed a "cone unit". Each segment conists of six to eight cone units. In limited resections, the number of cone units to be respected is adjusted and the tertiary branches which feed these areas must be transected selectively through a hilar or a parenchymal approach. To date we have experienced no complications with this procedure, employed for 832 patients with hepatocellular carcinoma.
提出了一种基于肝蒂系统的肝脏分段新概念，以及肝蒂横断法肝切除术的基础。门静脉三联从肝十二指肠韧带延续至肝内部分，形成肝蒂。也就是说，动脉、门静脉和胆管以及结缔组织被腹膜包裹，形成一个纤维束。肝蒂一级分支的全长和二级分支的起始部位于肝外，二级及更外周分支的主干走行于肝内。从每个二级分支发出的三级分支的分支模式因人而异。肝脏由肝蒂的二级分支供血。每个二级分支供应一个肝段。肝脏因此可分为三个肝段和一个额外的尾状叶区域。每个三级分支供血的区域呈锥形，形成一个“锥体单元”。每个肝段由六到八个锥体单元组成。在局限性肝切除术中，根据需要保留的锥体单元数量进行调整，必须通过肝门或肝实质入路选择性横断供应这些区域的三级分支。迄今为止，我们对832例肝细胞癌患者采用该手术方法，未出现并发症。
