选择性半肝血流阻断的围肝门解剖学研究及临床应用

发布时间：2018-03-27 11:35

本文选题：半肝血流阻断　切入点：肝门　出处：《青岛大学》2011年硕士论文

【摘要】：目的：解剖观测第一肝门部的结构及肝管、肝门静脉、肝固有动脉的分支分布情况,探讨选择性半肝血流阻断的安全路径。方法：选取经10%甲醛固定、肉眼观察无病变的成人尸体肝脏标本40例,解剖观察第一肝门部的结构及各管道问的位置关系,观察测量各管道左、右支在第一肝门处所发出分支的直径及相邻支之间的距离；寻找半肝血流阻断的安全路径并完成22例肝脏手术,对手术时间、出血量、肝功能指标(白蛋白、谷丙转氨酶(ALT)、总胆红素)进行了观察分析。结果：本组40例标本第一肝门处肝门静脉与肝管、肝固有动脉的毗邻关系均为肝左、右管在前,肝固有动脉左、右支居中,肝门静脉左、右支在后；各管道与肝实质间有可解剖的组织问隙(肝管三角、肝蒂上间隙)。肝左、右管的汇合点最高,距离其上缘肝组织的距离(3.22±1.10)mm；肝门静脉的分叉点稍低(7.32±0.92)mm；肝固有动脉的分叉点最低。肝左、右管第一分支之间的距离为(43.76±0.82)mm,肝门静脉左、右支第一分支之间的距离为(44.18±0.98)m,肝固有动脉左、右支第一分支之间的距离为(45.16±1.12)mm。与pringle法全肝血流阻断术相比,选择性半肝血流阻断患者ALT、总胆红素在术后1、3、6天有统计学意义,白蛋白术后3、6天有统计学意义。结论：肝门部肝管、门静脉、肝动脉共同包被在Glisson鞘内,排列有序,三者位置相对恒定。肝门静脉分叉部右侧为相对无血管安全区。肝管三角、肝蒂上间隙是一安全的解剖间隙,是施行选择性半肝血流阻断安全入路。
[Abstract]:Aim: to observe the structure of the first hepatic hilum and the distribution of the hepatic duct, portal vein and proper hepatic artery, and to explore the safe route of selective hemihepatic blood flow occlusion. Methods: 40 adult cadaveric liver specimens fixed with 10% formaldehyde were observed with the naked eye. The structure of the first hepatic hilum and the location of the first hepatic portal were observed and the left of each conduit was observed and measured. The diameter of the right branch at the first hepatic hilum and the distance between the adjacent branches; search for a safe path of hemihepatic blood flow occlusion and complete 22 liver operations. The operative time, amount of blood loss, liver function index (albumin, albumin, etc.). Alanine aminotransferase (alt, total bilirubin) was observed and analyzed. Results: the relationship between portal vein and hepatic duct at the first hepatic hilum was found in 40 cases. The adjacent relationship of hepatic proper artery was left hepatic artery, right hepatic artery was anterior, right branch was middle, portal vein was left and right branch was posterior. There are dissectable tissue spaces between each duct and hepatic parenchyma (triangle of hepatic duct, superior space of hepatic pedicle). The convergence point of left and right hepatic duct is the highest. The distance from the upper edge of the liver was 3.22 卤1.10 mm, the bifurcation point of hepatic portal vein was 7.32 卤0.92 mm lower, the bifurcation point of the hepatic proper artery was the lowest, the distance between the first branch of the right and left hepatic duct was 43.76 卤0.82 mm, the distance between the first branch of the portal vein and the right branch was 44.18 卤0.98 mm, the distance between the first branch of the right branch and the right branch was 44.18 卤0.98 mm, and the distance between the first branch of the right branch and the right branch was 44.18 卤0.98 mm. The distance between the first branches of the right branch was 45.16 卤1.12mm. compared with the pringle method, the total bilirubin in the patients with selective hemihepatic blood flow occlusion was significantly different from that in the patients with selective hemihepatic blood flow occlusion at 1: 3 and 6 days after operation, and that by albumin at 3 and 6 days after operation. Conclusion: the hepatic portal duct, portal vein and hepatic artery are encapsulated in the Glisson sheath in order, and the three positions are relatively constant. The right side of the hepatic portal vein is a relative no-vessel safety zone. The superior hepatic pedicle space is a safe anatomic space and is a safe approach for selective hemihepatic blood flow occlusion.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322.47

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