胆囊三角的应用解剖学在腹腔镜胆囊切除术中的应用
【摘要】 ［目的］探讨胆囊三角区的血管、胆管及肝管解剖关系，为腹腔镜胆囊切除术提供解剖学依据.［方法］给26具防腐成年尸体标本行胆囊三角区显微解剖，观测胆管及血管的走行分布特点及与周围结构的解剖关系.［结果］ 胆囊管的长度为（31.12±1.16）mm,直径为（3.12±0.26）mm；左右肝管汇合点距肝表面长度为（12.26±1.18）mm，左肝管长度为（16.26±1.42）mm，右肝管长度为（8.86±0.72）mm，少数标本的肝总管于肝内汇合.单支型胆囊动脉可走行于肝总管的前方或肝总管的后方；双支型和多支型胆囊动脉可同时走行于肝总管的前方或肝总管的后方，也可分别走行于肝总管的前方或后方.胆囊动脉直径为（1.68±0.40）mm，肝右动脉直径为（3.20±1.50）mm.部分标本胆囊三角内可见1，2个胆囊淋巴结，直径为（3.32±0.26）mm.［结论］胆囊动脉在其起始、分支及走行等方面存在变异；胆囊管长短不一，形态多样，管径变化较大，存在较多的变异.行腹腔镜胆囊切除术时，应该仔细辨认胆囊管、肝总管及胆总管的关系及解剖学特征，以防止对胆囊三角区组织结构的破坏.
ABSTRACT:OBJECTIVETo investigate the microstructure of the Calot’s triangle sector, and analyze its important construction with quantization and provide its anatomic basis for the laparoscopic cholecystectomy.METHODSThe microdissection for the Calot’s triangle sector was perfromed in 26 of antiseptic cadaveric specimens to be observed the distribution of cystic ducts and blood vesseles as well as its relations with the adjacent structures.RESULTSThe length and diameter of ductus cysticus was (31.12±1.16)mm, and (3.12±0.26)mm, repectively. The length of vertical line segment from confluence of the left and right hepatic duct to surface of the liver was (12.26±1.18)mm, of the left hepatic duct was (16.26±1.42)mm, and of the right hepatic duct was (8.86±0.72)mm. Few confluence of the left and right hepatic duct was inner of the liver. The cystic artery’s origin may come from the proper hepatic artery, the right hepatic artery, the left hepatic artery or the gastroduodenal artery. The right hepatic arteria can pass through the Calot’s triangle and can also pass through the front or the back of the common hepatic duct. The diameters of cystic artery and right branch of proper hepatic artery were (1.68±0.40)mm and (3.20±1.50）mm, respectively. There were 1 or 2 of cystic lymph node in the Calot’s triangle, and the diameter of that was (3.32±0.26）mm.CONCLUSIONThe terminus a quo，branch and courser of cystic artery have variations, and the ductus cysticus have different lengths, caliberes and diverse patterns. Therefore, at the laparoscopic cholecystectomy, it should be careful identification of the relations and anatomical characteristics between the ductus cysticus, common hepatic duct and bile duct in order to prevent the damages of tissue structures in the Calot’s triangle sector.
Key words:calot’s triangle;cholecystectomy, laparossopic;autopsy。
使用腹腔镜行胆囊切除术作为外科学新技术，具有创伤小及恢复快等优点，但术后并发症发生率高于传统的开腹术，尤其是胆囊三角区的并发症多见.因此本研究探讨了胆囊三角区的解剖学特征，旨在为用腹腔镜行胆囊切手术提供形态学依据.
1 材料和方法。
1.1 材料 选取经常规防腐处理的成年尸体标本26具，其中男性的为18具，女性为8具；所有标本腹部均无外伤，皮肤完整无缺损，排除腹腔内病变；动脉系统内均灌注混有红色染料的乳胶.
1.2 方法 尸体呈仰卧位，常规开腹暴露肝脏，将肝脏向上翻起，从肝的胆囊窝中将胆囊稍加分离，分别观察胆囊底、体、颈的位置及形态、胆囊三角区的构成及毗邻，再沿胆总管起始部向肝门方向解剖肝总管及左、右肝管，使其充分暴露.在胆囊三角区内寻找胆囊动脉，沿其逆行追踪解剖出肝右、左动脉、肝固有动脉和胃十二指肠动脉.观察胆囊动脉，并对其起始部位、分支数目、走行、血管直径及与周围结构的毗邻关系进行解剖学观察和测量，即对胆囊管、肝总管的汇合方式、位置分型及分布规律进行解剖学观察及测量，记录相关数据，对重要结构进行拍照.测量数据时取3次测量的平均值.