TIPSS治疗肝硬化门脉高压的应用解剖研究  

Study of Applied Anatomy of Therapy Cirrhosis Portal Hypertension by TIPSS

作　　者：庞瑞麟[1] 孙学进[1] 杜伟[1] 赵卫[1] 李莉媛[1] 胡继红[1] 姚成霖[1] 余发昌[2] 赵毅 

机构地区：[1]昆明医学院第一附属医院医学影像学科,650032 [2]昆明医学院解剖教研室,650031

出　　处：《影像诊断与介入放射学》2000年第2期65-67,共3页Diagnostic Imaging & Interventional Radiology

摘　　要：观察34个正常人离体肝脏标本的肝、门静脉主支的立体空间关系,为建立肝、门静脉内支架分流提供解剖学依据。材料与方法:34个新鲜离体肝脏标本(剥制标本30个、铸型4个),并与10例肝硬化的肝、门静脉DSA影像学资料进行对照分析。结果:肝硬化的门静脉长度缩短、管内径变小,平均右支长度较正常缩短7.5mm、管内径变小2.3mm、左支长度缩短3.4mm、管内径变小0.9mm;肝、门静脉间距缩小、角度加大,平均肝右静脉至门静脉右支(RHV—RPV)间距缩小4.5mm、角度加大21.6,肝中静脉至门静脉左支(MHV—LPV)间距缩小7.0mm、角度加大26.9°。结论:TIPS与治疗的理想穿刺路径是RHV—RPV,其次为MHV—LPV。门静脉分叉部位于肝实质内23例(占69.1％)、肝实质外11例(占30.9％)、且下壁裸露,位于肝动脉前上方,应避免在门脉分叉部穿刺,以防损伤肝动脉或肝外门静脉引起腹腔内出血。To observe the solid and space relationship of the hepatic vein and portalvein main branches of 34 cases normal human livers, based for transjugular intrahepatic portosystemic shunt (TIPSS) Methods; 34 cases of new livers, including 30 cases of stuffing samples and 4 cases of casting samples, and compare with 10cases of cirrhosis hepatic vein and portal vein DSA image data. Results; Portal vein length of cirrhosis shortens and vessel inner diameter diminished. On average, right branch length shortens 7. 5mm, inner diameter diminishes 2. 3mm, left branch length shortens 3. 4mm, and inner diameter diminishes 0. 9mm than normal liver. Space between hepatic vein and portal vein reduced and angle of them increased, Space of RHV - RPV reduced 4. 5mm and angle - increased 21. 6°, MHV - LPV reduced 7. Omm and angle - increased 26. 9°. Conclusion: RHV - RPV is the ideal puncture path of TIPSS, and then MHV - LPV. 23 cases of portal vein bifurcations located inner liver matter (69. 1% ), 11 cases located outer liver matter (30. 9% ), and bareness of lower wall and located the front and over of hepatic artery. So, to avoid puncturing at portal vein bifurcation prevents inner abdomen hemorrhage from damaging hepatic artery.

关 键 词：肝脏解剖 门体静脉分流术 肝硬化门脉高压 

分 类 号：R575.2[医药卫生—消化系统]