经颈静脉肝内门体内支架分流术中经下腔静脉直接穿刺门静脉分支的可行性研究  

Shunt establishment directly from retrohepatic IVC to PV branches: anatomical study and clinical value during TIPSS procedures

作　　者：邢冲冲[1] 王艳萍[1] 张金山[1] 

机构地区：[1]解放军总医院放射科

出　　处：《中华放射学杂志》1997年第10期698-700,共3页Chinese Journal of Radiology

摘　　要：目的：通过观察肝门部门静脉、肝实质与肝后段下腔静脉之间的解剖关系，探讨经颈静脉肝内门体内支架分流术（ＴＩＰＳＳ）中经下腔静脉直接穿刺门静脉分支的可行性。材料与方法：观察１０例新鲜人体尸检正常肝脏标本的肝后段下腔静脉与肝脏以及门静脉分歧部、门静脉左右主支与肝脏和肝后段下腔静脉间的解剖关系，并对１０％福尔马林固定后的标本做光镜下观察。结果：１０例标本中，肝后段下腔静脉的一部分通过肝尾状叶与门静脉分歧部相连。门静脉分歧部及左右主支均位于肝外。门脉分歧部与门脉左右主支的上壁、后上壁与肝实质连接紧密。光镜下见门静脉分歧部、门静脉左右主支与肝实质间存在致密结缔组织。结论：肝外门静脉分歧部、门静脉左右主支均可作为ＴＩＰＳＳ术中的安全穿刺点；经下腔静脉直接穿刺门静脉分支，在一些情况下，可以作为一种新的ＴＩＰＳＳ入路。Purpose: To observe anatomical relationship of the portal vein (PV), the hepatic parenchyma and the inferior vena cava (IVC) at the level of the hepatic portal, and to discuss the feasibility of a new access of TIPSS: shunt established directly from IVC to PV branches. Materials and methods: Ten fresh normal human livers obtained from autopsy were examined, and the special relationship of PV bifurcation, the right and left PV branches, the retrohepatic IVC, and the caudal lobe of the liver were observed. Three weeks after fixation, the samples were examined under light microscope. Results: The PV bifurcation and the beginning of the PV branches were located extrahepaticly in the 10 samples. The upper and back wall of PV bifurcation and PV branches were adherent to the liver. A distance of 2 cm long of retrohepatic IVC was attached to the caudal lobe of the liver, and thus contacted with PV branches. Compact connective tissue could be found between PV branches and liver parenchyma under microscope. Conclusion: Shunt establishment directly from retrohepatic IVC to PV branches, in some cases, can serve as an alternative method which may salvage failed cases of TIPSS. The PV bifurcation and the beginning of PV branches located extrahepaticly can be punctured safely and briefly during TIPSS procedures.

关 键 词：TIPSS术 下腔静脉 门静脉分支 穿刺 解剖学 

分 类 号：R602[医药卫生—外科学]