今日看到一本肝胆书上的一段话：

随着肝移植和外科技术的日趋精细，传统的肝段八分法已经远远不能满足临床需求，2009年瑞士学者Fasel等通过 对25例门静脉铸型解剖学标本进行螺旋CT扫 描, 发现来自左、右门静脉二级分支水平的分 支不是8支, 而是9-44支, 平均20支. 虽然他们的 发现与Couinaud八段分法存在矛盾, 但他们认为 Couinaud八段分法是对于肝门静脉的二级的各 个分支进行集合重组而得出的结论. 于是他们 建议将肝脏在门静脉主干水平称为1个门静脉 区, 在左、右门静脉一级分支水平分为左、右2 个区, 在左、右门静脉二级分支水平分为20个 区, 就是“1-2-20概念”。

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因此查到最先提出这个概念的原文看了一下，文章的结论是：We suggest the human liver to be considered as corresponding to 1 portal venous territory at the level of the portal vein, to 2 territories at the level of the right and left branch of the portal vein, and to 20 at the level of the rami of the right and left branch. This “1-2-20-concept” is a rationale for reconciling apparent discrepancies with the eight-segment concept. On a pragmatic level, in cases in which imaging or surgical observations do not fit with Couinaud’s scheme, we propose clinicians not to autonomically conclude to the presence of an anatomical variation, but to become aware of the presence of an average of 20 (and not 8) second-order portal venous territories within the human liver.

插图为：

The portal vein was injected with acrylic resin using manual pressure. After hardening of the resin, the livers were macerated in 20% KOH for 4 days, at a temperature of 55°C. The vascular casts were rinsed and air-dried.

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Portal venous branching pattern in a corrosion cast, with emphasis on the second-order branches. In the liver illustrated, the number of those branches was 22, 18 of which can be seen in the inferior view (1–18). LPV left branch of the portal vein, RPV right branch of portal vein.

另外2篇文章的图：

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左图为肝脏八分法分段，右图为1-2-20概念的分段

以上图片，普外科医生基本都能看懂。

小编虽然是普外科医生，但不是肝胆外科专业，基于标准的八分法的肝脏手术还没见几个，现在的肝胆手术就已经进展到如此精细了吗？