活体肝移植右半肝内肝静脉的应用解剖  

Applied anatomy of hepatic vein in right hemi-liver for living donor liver transplantation

作　　者：刘本菊[1] 周庭永[1] 钱学华[1] 张琳[3] 李彦彦[1] 吕发金[2] 

机构地区：[1]重庆医科大学解剖学教研室,重庆400016 [2]重庆医科大学第一附属医院放射科,重庆400016 [3]重庆医科大学装甲兵技术学院门诊部,长春130117

出　　处：《解剖学杂志》2009年第4期511-514,532,共5页Chinese Journal of Anatomy

摘　　要：目的：为活体肝移植提供右半肝内肝静脉的解剖学资料。方法：采用50例无病变成人尸体肝标本进行解剖剥离，对肝右静脉（RHV）及属支、副肝右静脉（aRHV）和肝中静脉（MHV）右半肝属支等进行观测。结果：RHV分型中A型、B型分别为74．0％和26．0％。RHV主干属支汇合形式可分为3种，其中90．0％为树状，8．0％呈2支型，2．0％呈3支型。RHV主要属支共（5．88±2．26）支，Ⅴ段、Ⅵ段、Ⅶ段、Ⅷ段主要属支直径分别为（4．05±1．06）mm、（3．96±0．86）mm、（4．64±1．57）mm、（4．46±1．30）mm，长度分别为（21．51±11．24）mm、（28．94±15．90）mm、（30．14±14．41）mm和（23．03±11．14）mm；Ⅴ、Ⅷ段静脉血液同时汇入RHV和MHV者分别占66．O％、88．0％，Ⅴ段静脉血仅通过MHV回流者占34．0％。直径≥3．00mm的aRHV的出现率为60．0％。结论：RHV引流范围同时受MHV和aRHV影响，主要属支数目不恒定，其右叶上段属支管径较下段粗，右后叶属支较前叶属支长。右叶部分活体肝移植术前应充分掌握右半肝内肝静脉的解剖学资料，以利于制定合理的手术方案。Objective： To provide anatomic data on hepatic vein in the right hemi-liver for living donor liver transplantation （LDLT）. Methods： 50 normal aduh cadaveric livers were dissected. The right hepatic vein （RHV）, the tributaries of RHV, accessory right hepatic vein （aRHV） and the tributaries of middle hepatic vein （MHV） in the right hemi-liver were observed. Results： The rates of type A and type 13 of RHV were 74.0% and 26.0%, respectively. There were three confluence patterns of tributaries of main trunk of RHV, in which the rates of one trunk, two trunks and three trunks were 90. 0%,8.0% and 2.0%, respectively. The number of main tributaries of RHV was 5.88±2.26. The diameter of main tributaries in segments Ⅴ, Ⅵ, Ⅶ and Ⅷ were （4.05±1.06）mm,（3.96±0. 86）mm,（4. 64±1.57）mm and （4. 46±1.30） mm, and the length were （21.51±11.24）mm, （28.94±15.90）mm, （30. 14±14. 41）mm and （23.03±11.14）mm respectively. The rates of venous blood of segments g and W inflowing to RHV and MHV simultaneously were 66.0% and 88. 0%, respectively. The venous blood was recirculated only by MHV in 34.0% cases. The frequency of aRHV whose diameter was more than 3.00 mm was 60.0%. Conclusion： The draining scope of RHV was influenced by MHV and aRHV simultaneously. The number of main tributaries was not constant. The diameter of tributaries in the upper right liver was thicker than that in the inferior right liver, and the length of tributaries in the posterior right liver was longer than that in the anterior right liver. The anatomic data on the hepatic vein in the right hemi-liver should be mastered sufficiently before right lobe partial LDLT to design reasonable operation plan.

关 键 词：活体肝移植 肝右静脉 应用解剖 

分 类 号：R657.3[医药卫生—外科学] R323.1[医药卫生—临床医学]