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간의 광범위 절제술 : 광범위 좌간엽 절제술 1예 A Case of Extended Left Hepatic Lobectomy
張起呂,梁德鎬,金在萬 인제대학교 1980 仁濟醫學 Vol.1 No.2
저자들은 좌간과 우간 전구역에 퍼져 있는 원발성 간암에 대하여 광범위 좌간 절제술을 실시하였다. 이와같은 절제술은 지금까지 발표된 일이 없었다. 그래서 지금까지 해부학 면(planes)에 의하여 분류된 6형의 간 대량절제술중에 추가 되어야 한다고 생각된다. 즉 1. 간 우엽절제술, 2. 간 좌엽절제술, 3. 광범위 간 우엽절제술(Trisegmentectomy by Starzl et al.), 4. 광범위 간 좌엽절제술(저자들에 의함), 5. 전구역 절제술, 6. 내구역 절제술, 7. 외구역 절제술, 그밖에 전구역, 내구력 절제술(간중엽 절제술)의 가능성을 제안했고 후구역 절제술은 간 감자를 이용할 수 있음을 지적했다. Recently we have experienced a case of extended left hepatic lobectomy for primaryliver carcinoma. It is postulated by authers that using modern anatomic terminology, the massive hepatic resection may be classified as follows; 1.Standard hemi-hepatic lobectomy a) Right lobectomy involves removal of the liver to the right of the main lober fissure after the right portal triad at the porta hepatis and the right hepatic vein posteriorly were isolated, ligated and dissected. b) Left lobectomy involves removal of the liver to the left of the main lobar fissure after left portal triads at the porta hepatis and the left hepatic vein superiorly were isolated, ligated and dissected. 2.Hepatic trisegmentectomy a) Extended right lobectomy is simple right lobectomy plus the medial segmentectomy of the the left lobe to the right of the left segmental fissure. b) Extended left lobectomy is simple left lobectomy plus the anterior segmentectomy of the right lobe to the left of the right segmental fissure. 3.Middle lobectomy a) Anterio-medial segmentectomy or bisegmentectomy involves removal of the liver between the right segmental fissure and the left segmental fissure after the anterior segmental branches and the medial segmental branches of the portal triads and the middle hepatic vein were isolated, ligated anti dissected. b) Anterior segmentectomy is simple removal of the liver between the right segmental fissure and the main lobar fissure after the anterior branches of the portal triad and the middle hepatic vein were isolated, ligated and dissected. c) Medial segmentectomy is removal of the liver between the lobar fssure and the left segmental fissure after the medial branches of the portal triad and the middle hepatic vein were isolated, ligated and dissected. 4.Hepatic segmentectomy a) Lateral segmentectomy b) Posterior segmentectomy It is our purpose to focus upon a neglected aspect of the extended left hepatic lobectomy, or the anatomy encountered in dissecting the anterior segmental braches of the portal triad which enter the anterior segment of the right lobe.