Vinoth, S (2010) Study of the segmental anatomy of liver and its clinical importance. Masters thesis, Stanley Medical College, Chennai.
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Abstract
AIM OF STUDY: Surgeries of liver have advanced much in the past years and the more advancement in the field has brought surgeries along with more conservative procedures. This has made the need of a thorough knowledge of liver anatomy important. Liver is the largest organ in the abdomen with large blood flow which perform many important functions. It has its own insults in the form of infections, primary tumors and also secondary metastasis. It has a good regenerating capacity. This capacity of regeneration has been made to maximum use by the surgeons. In the past, large part of the liver were removed during procedures for primary liver tumours and the area for regeneration was large. MATERIALS AND METHODS; This study of segmental anatomy of liver was done in the Department of Anatomy, Stanley Medical College, Chennai Venue of study: 1. Department of Anatomy, Stanley Medical College, Chennai. 2. Department of Forensic Medicine, Stanley Medical College, Chennai. 3. Department of Radiology, Stanley Medical College, Chennai. Collection of specimens: The liver specimens with which the study of segmental anatomy was studied were procured from the Department of Forensic Medicine, Stanley Medical College, Chennai. All the specimens studied were adult specimens. All the specimens were taken from post – mortem bodies. The cause of death was due to reasons other than liver problems. During the harvesting of the liver specimens no gross anomalies were noted. During the harvesting of the specimens the falciform ligament was retained and a long portal pedicle along with the gall bladder was taken. The inferior vena cava was cut at the level little above and below the posterior surface of the liver. This was done to preserve the opening of the hepatic veins into the inferior vena cava. This study of segmental anatomy of liver was conducted in 100 specimens in the following methods. MATERIALS: 1. Cadaveric specimen – 30, 2. Autopsy specimen – 30, 3. Radiological method – 20, 4. Ultrasound method – 20, METHODS: During this study of the segmental anatomy of liver the following methods were used 1. Manual dissection method, 2. Radiological study by contrast method, 3. Ultrasound method. OBSERVATIONS: The study of the segmental anatomy of liver and its clinical importance done at the Department of Anatomy, Stanley Medical College, is based upon the hepatic veins which divided the liver into lobes and the branching of the portal vein, hepatic artery and the hepatic duct. In this study the manual dissection method was used to observe the branching pattern of hepatic veins and portal vein. In the radiological method the urograffin contrast agent was used to study the segmental branching pattern of hepatic artery and the hepatic duct. In the ultrasound method which was the easiest to perform and great deal of information was available in short time. In this method the hepatic veins, portal vein and the hepatic duct were also observed. SUMMARY: The need for more limited resection of the liver has prompted the researchers to look closer into the segmental anatomy of the liver and find more about this organ and about the anomalies that can spring surprises. This study of segmental anatomy of liver was done on 100 liver specimens at the Department of Anatomy, Stanley Medical College, Chennai. The study was done by various methods like the manual dissection method on 60 specimens. Studies like the radiological methods where a contrast agent like the urograffin was used to study the hepatic artery and hepatic duct on 20 specimens. For the ultrasound method 20 patients were subjected for the study at the Department of Radiology, Stanley Medical College. In this study the hepatic vasculature was studied first, as this forms the basis of the segmental pattern of the liver and also the functional anatomy. In this study the three major hepatic veins, the right hepatic vein, left hepatic vein and the middle hepatic vein were observed in all the specimen. In 87 % of observation the middle hepatic vein joined with the left hepatic vein and formed a common trunk before draining into the inferior vena cava. A single vein was seen draining the caudate lobe the liver. In all the 80 specimens studied the portal vein had bifurcation pattern of division into right and left portal vein and also had segmental division to all the segments of the liver. The caudate lobe was seen to receive portal blood from both the right and left portal vein. A single variation was observed in one specimen where an accessory portal vein was seen from the right anterior division of portal vein to the quadrate lobe. No variations was seen in the hepatic artery pattern of segmental branching. Triple confluence of the hepatic ducts was seen in one specimen. All the segments were seen in all the 80 liver specimens observed. This observations on the segmental anatomy of the liver and its variations has great importance to the opening surgeon because a neat surgery is the gateway to successful results. In the past decades, lobotomies were regularly performed, where a large amount of liver tissue was sacrificed for a small tumor present and the results were poor. With more conservative surgeries the segmental pattern of the liver becomes important. The variations at this segmental level should be kept in mind to avoid disastrous results.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | segmental anatomy, liver, clinical importance. |
| Subjects: | MEDICAL > Anatomy |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Oct 2019 06:56 |
| Last Modified: | 05 Oct 2019 06:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11682 |
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