绕肝提拉法“肝后隧道”建立的标准及解剖学依据  

An anatomical study on retrohepatic tunnel used for procedures of liver hanging maneuver

作　　者：罗昆仑[1] 方征[1] 刘洪[1] 余锋[1] 田志强[1] 陆雷 

机构地区：[1]解放军第一0一医院肝胆外科,无锡214044 [2]南京解放军第八十一医院肝移植中心

出　　处：《中华普通外科杂志》2012年第6期452-455,共4页Chinese Journal of General Surgery

摘　　要：目的探讨绕肝提拉法肝后隧道建立的f临床解剖学依据。方法解剖20具成人尸体肝后下腔静脉标本，收集15例晚期肝炎后肝硬化行背驮式肝移植患者病肝切除后肝后下腔静脉的临床资料，制订肝后隧道路径标准，统计汇入肝后下腔静脉及肝后隧道路径上肝短静脉总数。结果肝短静脉主要从左右两侧汇入肝后下腔静脉，汇人肝后下腔静脉的肝短静脉多集中于中、下1／3段（F=9．188，P〈0．01）。在肝后隧道路径上，汇人肝后下腔静脉的肝短静脉主要集中在下1／3段前方，而其他两段分布较少（χ2=48．524，P〈0．01）。肝硬化组汇人肝后下腔静脉的肝短静脉数与尸检组相比差异无统计学意义（t=0．405，P〉0．05），但肝硬化组肝后隧道常发生解剖结构变异。结论肝后下腔静脉前间隙是一潜在性腔隙，具有独特的解剖学特点，是安全建立肝后隧道的解剖依据。但在晚期肝炎后肝硬化患者手术中应慎用肝后隧道。Objective To evaluate the anatomical basis of retrohepatic tunnel used for liver hanging maneuver. Methods The anatomy of inferior vena cava （IVC） was studied in 20 healthy adult cadavers and 15 patients with advanced cirrhosis who underwent piggyback liver transplantation to confirm the existence of the path of retmbepatic tunnel and count the number of short hepatic veins draining into retrohepatic IVC. Results Short hepatic veins mainly drain into the IVC on its left and right sides. The number of short hepatic veins that drain into the upper or middle portion of the IVC was significantly more than that into the lower portion （ χ2 = 48. 524, P 〈 0. 01 ）. On the path of retrohepatic tunnel, most short hepatic veins that drain into the IVC are located on the front side （F = 9. 188, P 〈 0. 01 ）. There was no significant difference in the number of short hepatic vein between the groups of liver cirrhosis and that of healthy adults （ t = 0. 405, P 〉 0. 05 ）, but anatomic variation of post-hepatic tunnel is common in liver cirrhotics. Conclusions Retrohepatic tunnel was a potential space and had a unique anatomical feature. The establishment of retrohepatic tunnel by liver hanging maneuver is safe in noncirrhotics. However, in advanced posthepatitic cirrhosis, retrohepatic tunnel should be used with caution.

关 键 词：肝硬化 腔静脉 下 解剖学 局部 肝短静脉 

分 类 号：R657.3[医药卫生—外科学]