Liver surgery

2021-02-10 12:00 AM

Before pouring into the duodenum, the bile duct together with the main pancreas forms the hepatopancreas balloon, with the hepatic pancreatic sphincter preventing the duodenum fluid from flowing into the bile duct.

The liver is an important organ not only for the digestive system but also has other important functions such as detoxification, glucide metabolism, protides, lipids, etc. The liver is an organ in the peritoneum, located in the upper mesenteric layer. colon transverse, in the cell below the right diaphragm but encroach the epigastric cell and the lower-left diaphragmatic cell.

Outward appearance

The liver is shaped like half a watermelon, has two sides and a bank

Diaphragm surface

Convex pressures the diaphragm has four parts:

Figure. Liver (diaphragm surface)

1.Ligament of the rim 2. Sickle ligament 3. Round ligament

The upper part involves the right lung and pleura, the heart and pericardium, the left lung and pleura.

The anterior part is related to the anterior chest wall.

In the two upper and anterior parts, the sickle ligament attached to the liver divides the liver into two parts: the right side belongs to the right lobe of the liver and the left one belongs to the left one.

The right part is related to the right chest wall.

The posterior part has the ceiling, which is not covered by the peritoneum. Here the liver is hung into the diaphragm by the diaphragmatic ligament of the liver.

Visceral surface

Flat, associated with other organs such as the stomach, duodenum ... There are three grooves forming an H-shape.

The right groove has two parts: anterior gallbladder fossa, and posterior vena cava furrow.

The left groove consists of two parts: the anterior is the circular ligament slot, the posterior is the slit of the venous ligament.

The horizontal furrow is the portal of the liver containing the base of the liver and its branches.

The H-groove divides the visceral surface into four lobes, the left lobe, the right lobe, the square one, and the caudate lobe.

The lower bank

separating the front part of the diaphragm from the visceral surface. There are two defects: gallbladder defect and cirrhosis ligament defect.

Figure. The visceral surface of the liver

  1. Ligament round 2. Square lobe 3. Press the colon 4. Ligament of the vein 5. Lower aorta 6. Gallbladder

Ligaments and means of fixing the liver

Lower aorta

Sticks to the liver and has hepatic veins that connect the hepatic tissue host to the inferior vena cava.

Ligament of the rim

Consisting of two glutinous folds going from the peritoneum to the liver. The distance between the two leaves is limited so the ceiling area. The two leaves come together to form the right and left triangular ligaments.

Sickle ligament

Connect the diaphragm surface of the liver to the anterior abdominal wall and the diaphragm.

Small splices

Connect the liver to the stomach and duodenum, the free margin of the small junction contains the liver stem.

Round ligament of the liver

Is an embryonic umbilical vein site, located between the leaves of the sickle ligament going from the umbilical cord to the liver.

Ligaments of veins

A relic of the embryonic vein, going from the left portal vein to the inferior vena cava.

Blood vessels of the liver

Unlike other organs, the liver not only receives blood from the artery, which is its own hepatic artery, but also receives blood from the portal vein.

Separate hepatic artery

The common hepatic artery is the end branch of the organ trunk artery, after the duodenal artery branch was renamed to a separate hepatic artery, running up to the hepatic opening divided into two branches right and left to nourish the liver.

Portal vein

Veins receive most of the blood from the digestive system as well as from the spleen to the liver before it is poured into the general circulatory system. The portal vein is caused by splenic veins meeting with mesenteric veins forming, running up the liver to divide the right and left branches. On the portal vein, receives many lateral branches such as gallbladder veins, umbilical veins, left gastric veins, right pyloric veins, pyloric veins and upper rectal veins ... The portal vein divides into the right and left branches to run into the right half and the left half.

In the case of blocked portal vein causing portal hypertension, causing many serious consequences such as abdominal distension, esophageal enlargement, hemorrhoids ... The above manifestations are caused by blood from the portal vein through the liver. You should go through the loops between the door system and the host system:

The esophageal ring is caused by the portal vein left in the portal system, which is the branch of a single vein in the host system. When the portal pressure increases, the esophageal varicose phenomenon.

The rectal junction due to the upper rectal vein is the branch of the inferior mesenteric vein belonging to the portal system to the middle rectal branch, the lower rectal branch is the branch of the inner pelvic vein of the host system. When the portal pressure increases, hemorrhoids form.

The ring around the navel is due to the circular ligament vein of the portal system with the upper, lower, and inner thoracic veins of the host system.

The hepatic artery, the portal vein and the aortic bile duct, make up the liver stalk located between the two small connective membranes. The relationship between these three components is as follows: posterior portal vein; separate hepatic artery located anterior left side; the bile duct is located anterior to the right. The three components run together and divide into smaller and final branches at the doorway.

Liver veins

Consisting of three veins are the right hepatic vein, the middle hepatic vein and the left hepatic vein. These veins carry blood from the liver to the lower aorta.

Segmenting the liver lobe according to the biliary tract

Due to the need for surgery, surgeons have worked to divide the liver into smaller parts. Currently there are many ways to divide the liver by segment, the authors are based on the division of the biliary tract in the liver to divide the liver into segments. The following is how to divide the liver according to Ton That Tung. The lobes and lobes are defined by slits, of which a unique slit, the left intercostal slot, is real on the surface of the liver.

The gap between the liver

On the diaphragm side goes from the gallbladder defect to the left margin of the inferior vena cava.

On the visceral surface goes from the middle of the gallbladder to the left margin of the inferior vena cava.

The middle fissure divides the liver into two halves, the right and left liver, and the medial vein in the middle slot.

Right lobe fissure

From the right bank of the inferior vena cava is parallel to the right bank of the liver, three fingers from this shore, the slot contains the right hepatic vein. The right interstellar cleft divides the right liver into two segments, the posterior segment and the anterior segment.

Left lobe interstitial fissure

The diaphragm surface, the slot is the line holding the sickle ligament.

The visceral surface and slot correspond to the longitudinal groove.

The left lobe fissure contains the left hepatic vein, dividing the left liver into two segments of the middle and lateral segments.

Secondary cleft between right lobe

Usually ambiguous, dividing the anterior segment into the lower segment V and VIII, and the posterior segment to the lower segment VI and VII.

Secondary cleft between left lobe

On the diaphragm side goes from the left bank of the inferior vena cava to the posterior 1/3 and the anterior third of the left liver. On the visceral surface: going from the left end of the liver to the posterior 1/3 and 2/3 before the lower left edge of the left liver. This cleft divides the lateral lobe into the lower lobes of the II and III, while the lower I segment corresponds to the caudate.

Figure. The lower lobes of the liver

Molasses

The bile is formed in the liver, poured into the bile ducts, then into the lobules interlaboratory, from which in turn are transported to the larger bile vessels to eventually focus on the right and left hepatic ducts. These two tubes are joined together to form a common liver tube. The hepatic duct is combined with the gallbladder into the bile duct. People often divide the bile path into two parts, the extra-hepatic bile and the liver.

Biliary tract in the liver

The hypoglycemic and segmental bile ducts are located in the liver parenchyma.

Extra-hepatic biliary tract

Including main and secondary bile.

Main bile duct: includes the liver canal and Sunday bile duct.

The hepatic duct consists of the right hepatic duct and the left hepatic duct, which is a common hepatic duct.

The common bile duct is caused by the hepatic duct that meets with the gallbladder duct. Before pouring into the duodenum, the bile duct along with the main pancreas forms the shadow of the hepatopancreas, with the hepatobiliary sphincter preventing the duodenum fluid from flowing into the main bile duct and pancreas.

Secondary biliary tract: includes gall bladder and gallbladder canal.

A gallbladder is a place for bile, pear-shaped, on the visceral surface of the liver. Consists of a base, a body and a neck connected to the gallbladder duct.

The gallbladder tube connects the gall bladder and the common bile duct.

Figure. Extra-hepatic biliary tract

  1. Right liver canal 2. Gallbladder neck 3. Gallbladder body 4. Gallbladder bottom 5. Lumbar plate 6. Baby papilla 7.8. Large papillary 9. Left hepatic canal 10. Common hepatic duct 11. Gallbladder canal 12. Bile ducts 13. Duodenum 14. Main pancreatic canal 15. Shadow of hepatopancreas