The Glissonian approach of the hilum.
The Glissonian approach of the hilum.
复制标题
肺门的格里森入路。
DOI：
10.1024/1023-9332.5.3.143
复制
发表时间：
1999
期刊：
影响因子：
--
通讯作者：
K. Tay
中科院分区：
文献类型：
--
作者：
B. Launois;G. Maddern;K. Tay
对肝脏节段解剖的详细了解导致了基于门静脉Trinity（肝动脉、肝管和门静脉）肝内分布的切除手术的快速发展。经典的筋膜内或肝外入路是在肝实质外分离门静脉、肝动脉和肝管的适当分支。另一种方法，筋膜外入路，是在分割大量肝组织后直接解剖蒂的整个鞘，以到达蒂，蒂被鞘包围，鞘来自Glisson囊。这个Glissonian鞘包围着门户Trinity。在经裂入路或肝内入路中，这些鞘管可以从前方（在分离主裂、右裂或脐裂后）或从肝门后方进入。我们描述的技术接近Glissonian鞘，因此肝蒂结构及其分支的肝内后入路，允许早期划定肝段，而不需要辅助技术。此外，还讨论了在技术和肿瘤环境中使用该技术的适应症。
The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.