Karaciğerin Segmenter Anatomisi
Özet
Karaciğer, yaklaşık 1500 gram ağırlığıyla vücudun en büyük solid organı olup sağ üst abdominal kavitede yer alır ve dıştan Glisson kapsülü ile sarılıdır. Peritoneal uzantılar ve ligamentöz yapılar sayesinde karın içindeki konumunu koruyan organ, Cantlie çizgisi ile anatomik olarak sağ ve sol loba ayrılır. Fonksiyonel segmentasyonu temel alan Couinaud, Goldsmith ve Woodburne ile Bismuth sınıflandırma sistemleri cerrahi anatomide en sık kullanılan yöntemlerdir. Bu sistemlere göre karaciğer, her biri bağımsız bir portal pedikülden (hepatik arter, portal ven ve safra kanalı) beslenen 8 fonksiyonel segmente ayrılır. Organın kan akımının %25'i çölyak trunkustan köken alan hepatik arterden, %75'i ise süperior mezenterik ven ile splenik venin birleşmesiyle oluşan portal venden sağlanır. Hepatik arter anatomisi portal vene kıyasla daha fazla varyasyon göstermekte olup bu varyasyonlar Michels sınıflaması ile tanımlanmıştır. Venöz drenaj ise temel olarak sağ, sol ve orta hepatik venler aracılığıyla vena kava inferiora gerçekleştirilir. Karaciğerin bu segmental ve vasküler anatomisinin bilinmesi, cerrahi onkoloji ve genel cerrahi pratiklerinde rezeksiyonların güvenle uygulanması açısından kritik önem taşır.
The liver, weighing approximately 1500 grams, is the largest solid organ in the body, located in the right upper abdominal cavity and enclosed by Glisson's capsule. Secured by peritoneal attachments and ligamentous structures, the liver is divided into right and left lobes by Cantlie's line. In surgical anatomy, the classification systems of Couinaud, Goldsmith and Woodburne, and Bismuth are the most widely utilized frameworks for functional segmentation. According to these systems, the liver is divided into 8 functional segments, each supplied by an independent portal pedicle consisting of a hepatic artery, a portal vein, and a bile duct. The liver receives 25% of its blood supply from the hepatic artery originating from the celiac trunk, and 75% from the portal vein formed by the confluence of the superior mesenteric and splenic veins. The hepatic arterial anatomy exhibits significant variations compared to the portal vein, which are categorized by the Michels classification. Venous drainage is primarily directed to the inferior vena cava via the right, left, and middle hepatic veins. Understanding this detailed segmental and vascular anatomy is highly crucial for safely performing resections in surgical oncology and general surgery practices.
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