肝后隧道手术高危区的解剖特点及临床应用研究  

Anatomical characteristics of danger zone in retrohepatic tunnel procedure and its clinical application

作　　者：罗昆仑 方征 余锋 刘洪 田志强 

机构地区：[1]解放军第一○一医院肝胆外科,江苏无锡214044

出　　处：《中国普通外科杂志》2012年第1期1-4,共4页China Journal of General Surgery

摘　　要：目的:探讨肝后隧道及手术高危区的解剖特点及临床应用价值。方法:解剖20具成人尸体肝脏标本,收集经前入路绕肝提拉法右半肝切除术27例患者的临床资料,分别统计汇入肝后下腔静脉和肝后隧道路径上肝短静脉总数。结果:解剖研究中发现,肝短静脉主要从左右两侧汇入肝后下腔静脉,且较多集中于中、下1/3段;在肝后隧道路径上,汇入肝后下腔静脉的肝短静脉主要集中在下1/3段前方,平均(2.90±1.07)支,上1/3段仅有1例出现1支肝短静脉,中1/3段20例中仅4例出现1支肝短静脉;肝右后下静脉多出现在肝后下腔静脉的中、下1/3段,出现率达85.0%(17/20)。临床手术中发现,在肝后隧道路径上,汇入肝后下腔静脉肝短静脉主要集中在下1/3段,平均(3.21±1.67)支,多数病例此区域上下距离约3～4 cm,同时此区域中肝右后下静脉出现率达85.2%(23/27);27例中仅1例有1支肝短静脉汇入中段肝后下腔静脉前方。结论:肝后隧道手术高危区位于肝后下腔静脉下段前方3～4 cm区域,有较多肝短静脉伴随肝右后下静脉汇入。准确把握此区域的解剖特点并进行解剖分离是成功建立肝后隧道的关键。Objective： To investigate the anatomical characteristics of the danger zone during dissection of the retrohepatic tunnel and determine its clinical application. Methods： Anatomical dissections were performed on the liver specimens from 20 adult cadavers, and the clinical data of 27 patients undergoing right hepatectomy with liver hanging maneuver through anterior approach were also collected. The total number of the short hepatic veins entering the inferior vena cava （IVC） at the retrohepatic portion or at the dissecting path of the retrohepatic tunnel was counted separately. Results： In terms of anatomical findings, the majority of short hepatic veins which drain into the retrohepatic WC were found to arise from the left and right aspects of the retrohepatic WC, and were mainly present in the middle and lower third of the retrohepatic WC segment. At the tunnel dissection route, the openings of the short hepatic veins were mainly present in the lower third of the anterior surface of the retrohepatic WC with average number of 2.90＋ 1.07, while only one case was found having a short hepatic vein in the upper third and 4 cases were found having a short hepatic vein in the middle third of the retrohepatic IVC. Ihe inferior right hepatic vein was found mostly present in the middle and lower third of the retrohepatic segment and its occurrence rate was 85.0% （17/20）. In terms of the intraoperative record, the short hepatic veins entering the retrohepatic IVC were mainly concentrated in the lower third of the course of retrohepatic tunnel, the average number of short hepatic veins was 3.21＋1.67, the distance of this zone in most cases from top to bottom was about 3-4 cm and the occurrence rate of the inferior right hepatic vein in this zone was 85.2%. Of the 27 patients, only one case had a short hepatic vein entering the anterior middle segment of the retrohepatic IVC. Conclusion： lae danger zone of the retrohepatic tunnel is located in the anterior surface of the lower segment of retrohepatic IVC w

关 键 词：肝切除术/方法 肝后隧道 肝/解剖学 手术高危区 

分 类 号：R735.7[医药卫生—肿瘤]