Study Of Applied Anatomy And Imaging On Laparoscopic Surgery Of Liver

Object: To provide applied anatomic and imaging basis for operations of laparoscopic liver surgery and to design secure and convenient operation pathways.Methods: (1)Thirty antisepsis adult liver specimens were studied for the laparoscopic applied anatomy of the liver artery, portal vein and transverse furrows. (2)The structures of left triangle ligament, right coronary ligament and the laparoscopic operation pathway of the secundum porta hepatis were studied on 30 liver specimens injected with latex. On 20 cases of living body and 5 specimens with hyaline vessels, the blood supply of faciform ligament and its clinical significance in laparoscopic liver surgery were studied. (3)The diameters of the branches of portal vein and hepatic vein were observed and measured on 30 liver casting-form specimens. (4)Ten liver casting specimens were resected anatomically to seek for the best lamellae of all kinds of laparoscopic liver operation. In order to research the diameter, distribution and position of the main blood vessel on the lamellae, 30 antisepsis adult liver specimens were cut down. (5)The value of three dimensional CT or MR angiography were evaluated as a tool for laparoscopic surgery of liver on 4 liver casting-form specimens, 2 normal people and 8 patients whose tumor in liver were going to be resected by laparoscopy.Results: (1)About the first porta hepatic: (1)All the_ 30 common hepatic arteries origined from celiac trunk and had 4 types of branch. (2)There were 5 types of relationship between the right hepatic artery and extrahepatic bile duct. (3)80% intrahepatic arteries had only one ramus. (4)There were 3 confluence forms in portal vein. (5)The transverse furrow appeared "slot" shape and it's length was 4.19+0.36cm. (6)The relationship between portal vein and liver artery and hepatic duct was clear. (2) About the ligment and thesecundum porta hepatic:(1)The blood supply of faciform ligament were from two kinds of aortic arch confromated by the left inferior phrenic artery and the middle segment artery of liver. There were three parts of the artery distribution in faciform ligament. The vein of faciform ligament crossed with the artery, and anastomosed to two branches to influx the left inferior phrenic vein. (2)The superior liver artery origined from left gastric artery or inferior phrenic artery, and its occurrence rate was 80%.The diameter of the branch of the superior liver artery while crossing the left posterior upper edge vein was 0.32mm. (3)There were three layers between right coronary ligament and central vein of liver or right hepatic vein. (4)The distance between superior border of liver and diaphragm was 1.15 + 0.29cm. (5)86.7 percent left hepatic veins had the same trunk with central vein of liver. There were surgery interspaces among hepatic veins. (3)About the liver anamotic resection: (1) The best lamella of left lateral segmentectomy was the sagittal plane at 1 cm of the left of incisure of round ligament of liver. (2)The best lamella of left hepatecomy was the parallelism panel at 1 cm of the left of the central fissure of liver. (3)The best lamella of right hepatecomy was the parallelism panel at 1.5cm of the right of the central fissure of liver. (4)The best lamella of bisegmentectomy V and VI was the panel through the lay of the transverse furrows. (5)The best lamella of segmentectomy IVb was the panel through the lay of the transverse furrows and the correspondence prominence on the diaphragmatic surface of liver. (4)About the three dimensional reconstruction imaging:(1)The three dimensional spiral CT angiography of casting-form specimens showed the farthest branch of the portal vein and its border was smooth and clear. The spatial relationship of portal vein and hepatic parenchyma was also clear. (2)The three dimensional spiral CT angiography of patients can show the fifth grade banch of portal vein clearly while the hepatic vein was blurry. In this imaging, there was not branch of portal vein in the tumor. The laparoscopic operation confirmed the diagnose...