国人正常肝静脉流出道及其毗邻结构的解剖学研究  

Anatomic study of normal hepatic vein outflow tract and its adjacent structure in Chinese

作　　者：朱蕻潮 徐浩[1] 王德广[2] 陈启鸿[1] 周文杰[1] 王猛[1] 

机构地区：[1]徐州医学院附属医院介入放射科,221006 [2]徐州医学院人体解剖学教研室

出　　处：《中华解剖与临床杂志》2016年第3期204-209,共6页Chinese Journal of Anatomy and Clinics

基　　金：江苏省“十二五”科教兴卫工程创新团队资助项目（LJ201143）

摘　　要：目的：观察和测量国人正常肝静脉（ HV）流出道及其毗邻结构,为临床应用提供解剖学基础。方法2014年3月—2015年3月,对57例正常成人尸体标本进行解剖,观测肝左静脉（ LHV）、肝中静脉（ MHV）及肝右静脉（ RHV）汇入下腔静脉（ IVC）的开口类型、开口的水平位置关系、开口上缘与膈肌裂孔的位置关系,比较LHV、MHV及RHV开口直径的大小及其开口上缘至膈肌裂孔的距离；观察膈肌裂孔形态及其与IVC之间的组织结构,比较膈肌裂孔长径、短径的大小。两样本之间比较采用t检验；多样本之间比较采用单因素方差分析,两两比较采用LSD-t检验。结果57例肝脏标本HV的开口类型有4种：IVC壁有2个HV开口（LHV＋MHV,RHV）占73.68%（42/57）,有3个HV开口（LHV、MHV、RHV）占17.54%（10/57）,RHV开口旁存在直接开口于IVC的肝右上静脉占5.26%（3/57）,RHV开口处被条索样结构分隔占3.51%（2/57）。 LHV、MHV及RHV开口的直径分别为（9.25±1.84）mm、（8.94±1.52）mm及（14.29±2.84）mm,RHV直径大于LHV及MHV直径（P值均＜0.01）。49例LHV或共干（LHV＋MHV）开口上缘高于RHV,占85.96%（49/57）；8例与RHV开口上缘等高,占14.04%（8/57）。39例RHV和37例LHV、MHV开口位于膈肌裂孔下方,2例LHV＋MHV共干开口上缘位于膈肌裂孔上方。位于膈肌裂孔下方的LHV、MHV及RHV开口上缘至膈肌裂孔的最短距离分别为（3.19±0.74）mm、（3.62±0.81）mm及（9.03±3.02）mm,RHV开口上缘至膈肌裂孔的距离大于LHV、MHV至膈肌裂孔的距离,差异均有统计学意义（P值均＜0.01）。膈肌裂孔的长径和短径分别为（26.94±3.47） mm及（19.62±2.80） mm,裂孔长径大于短径（ t=10.242, P＜0.01）,HE染色显示膈肌裂孔处的IVC管壁外分布大量纤维结缔组织。结论正常成人HV汇入IVC的开口类型中以LHV及MHV共干最多见,其开口水平位置多高于RHV开口,少部分RHV开口被条索状结构分开Objective To provide anatomic basis for the clinical application,the data were obtained by utilizing anatomic study of normal hepatic venous （ HV） outflow tract and its adjacent structure in Chinese.Methods The data were observed and measured in 57 normal adult cadaver from March 2014 to March 2015. The following parameters were obtained： the opening form of left hepatic vein （ LHV）, middle hepatic vein （ MHV） and right hepatic vein （ RHV） drained into the inferior vena cava （ IVC） . The relationship of horizontal position among the openings of LHV, MHV and RHV. The position relations between openings of HV and diaphragm hiatus. The opening diameters of LHV, MHV and RHV, and the distances from the upper margin of HV to diaphragm hiatus were compared. The morphology of the diaphragm hiatus and the structure in the space between IVC and the wall of the hiatus were observed. The long diameter and short diameter of the diaphragm hiatus were compared. Quantitative data difference between two samples was analyzed by independent-sample t test, and the difference among more samples was analyzed by one-way ANOVA. LSD-t test was used in the comparison between any two means. Results There were four opening forms of HV in 57 cases.The probability of HV with two openings（LHV＋MHV, RHV） joining into IVC was 73. 68%（42/57）, with three openings （LHV, MHV, RHV） joining into IVC was 17. 54%（10/57）, with the right superior vein which joins into IVC directly at the side of the RHV was 5. 26%（3/57）, with cable structure in the opening of RHV was 3. 51% （2/57）. The opening diameters of LHV, MHV and RHV were （ 9. 25 ± 1. 84 ） mm, （ 8. 94 ± 1. 52 ） mm, and （ 14. 29 ± 2. 84 ） mm, respectively. The diameter of RHV was larger than that in LHV and MHV（all P values 〈0. 01）. The probability of the upper margin of LHV or main trunk （ LHV ＋MHV ） which was higher than the upper margin of RHV was 85. 96% （49/57）. The probability of the openings of them in the same horiz

关 键 词：肝静脉 流出道 腔静脉 下 膈 解剖学 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R657.3[医药卫生—基础医学]