主肝静脉和肝短静脉的应用解剖学研究

发布时间：2018-06-22 21:09

本文选题：肝 + 肝静脉　；参考：《青岛大学》2007年硕士论文

【摘要】： 目的:通过解剖测量的方法对第二、三肝门内的主肝静脉和肝短静脉的位置、分型、数量、管径等参数进行观察和测量,以期为临床上中心型肝癌的切除、尾状叶肿瘤的切除、肝脏移植病肝的切除、活体肝移植供肝的获取等提供解剖学基础。方法:应用60具成人尸体标本,观察以下参数:1.下腔静脉(IVC)肝后段的口径变化以及与肝静脉开口的关系;2.肝左、中、右静脉的肝外长度、注入IVC管径、与镰状韧带的夹角;3.第三肝门中肝短静脉(SHVs)分别汇入下腔静脉的左侧壁、前壁和右侧壁,SHVs分为左、中、右三排,观察并测量SHVs的数量、位置、口径及其与主肝静脉的关系;4.沿IVC后壁正中线切开肝后段,测量肝右后下静脉(IRHV)的口径、位置和肝外行程。结果:解剖学观测结果显示:1.IVC肝后段近心端内径为(28.8±1.12)mm,远心端内径为(22.2±1.05)mm,肝左、中、右静脉开口于IVC肝后段上1/4段,其中肝左、中静脉共干者73%(44例),肝左、中、右静脉共开口者2%(1例),三支分别汇入者25%(15例),肝左静脉开口位置最高,其次为肝中静脉,肝右静脉开口位置最低;2.肝左静脉注入IVC管径值为7.1-18.1(10.3±1.9)mm,肝外长度为2.2-17.9(6.7±1.3)mm,与镰状韧带间的夹角为32.29±11.23°;肝中静脉注入IVC管径6.9-18.9(11.8±2.3)mm,肝外长度为2.4-10.8(5.4±1.3)mm,与镰状韧带之间的夹角为43.04±11.55°;肝右静脉注入IVC管径值为9.5-22.1(13.7±2.6)mm,肝外长度为2.6-11.8(6.8±1.5);3.SHVs 3～35支从不同的方向和节段注入IVC,其直径为1.5-17.8(5.4±1.4)mm。肝右静脉直径与SHVs直径呈负相关,肝左静脉直径与SHVs数目呈正相关。IRHV出现率为83.3%,平均直径为2.6-8.0(4.3±1.2)mm,位于肝脏面肾压迹处,开口位置低,有1～2mm的肝外行程,IRHV直径大小与肝右静脉大小呈负相关。结论:IVC自下而上先向右前上方,后向左后上方至隔的IVC裂孔,在腔静脉沟中呈凸向右的弓形弯曲;该弯曲处为IVC相对狭窄的区域;肝左、中静脉共同汇入IVC者居多73%,肝左、中、右静脉中,肝右静脉管径最粗,而肝左静脉的肝外长度最长。不同肝脏标本SHVs的变化大,多数情况下,管径粗者数量少,管径细者数量多。SHVs的口径、数目和主肝静脉口径、数目相互补偿。肝右静脉直径愈大SHVs直径愈小,肝右静脉直径愈小SHVs直径愈大。肝左静脉直径愈大SHY数量越多少,肝左静脉直径愈小SHVs数量愈少。
[Abstract]:Objective: to observe and measure the location, classification, quantity and diameter of the main hepatic vein and the short hepatic vein in the second and third hilar of the liver by anatomical measurement. The anatomical basis is provided for liver resection of liver transplantation disease and the acquisition of donor liver from living donor liver transplantation. Methods: 60 adult cadavers were used to observe the following parameters: 1. 1. The diameter of the posterior segment of the inferior vena cava (IVC) and its relationship with the opening of the hepatic vein. The extrahepatic length of the left, middle and right hepatic veins was injected with the diameter of IVC and the angle between the right vein and the falciform ligament. The short hepatic vein (SHVs) of the third middle hepatic porta was introduced into the left wall of the inferior vena cava, the anterior wall and the right wall of SHVs were divided into three rows: left, middle and right. The number, position, caliber and relationship between SHVs and the main hepatic vein were observed and measured. The posterior hepatic segment was cut along the median line of the posterior wall of IVC, and the diameter, position and extrahepatic travel of the right posterior inferior hepatic vein (IRHV) were measured. Results: the anatomical results showed that the proximal diameter of the posterior segment of the IVC liver was (28.8 卤1.12) mm, the diameter of the distal end was (22.2 卤1.05) mm, the left, middle and right veins of the liver were open to the upper 1 / 4 segment of the posterior segment of the liver of IVC, the left and middle hepatic veins were 73% (44 cases). The total opening of right vein was 2% (1 case), and that of three branches was 25% (15 cases) respectively. The position of the left hepatic vein was the highest, followed by the middle hepatic vein and the lowest position of the right hepatic vein. The diameter of IVC was 7.1-18.1 (10.3 卤1.9) mm, the extrahepatic length was 2.2-17.9 (6.7 卤1.3) mm, the angle between IVC and falciform ligament was 32.29 卤11.23 掳, the diameter of IVC was 6.9-18.9 (11.8 卤2.3) mm, the external length was 2.4-10.8 (5.4 卤1.3) mm, the angle between IVC and sickle ligament was 43.04 卤11.55 掳, the diameter of IVC was 9.5-22.1 (13.7 卤2.6) mm. The external length of IVC was 2.6-11.8 (6.8 卤1.5) / 3.The diameter of IVC was 1.5-17.8 (5.4 卤1.4) mm. The diameter of right hepatic vein was negatively correlated with the diameter of SHVs, and the diameter of left hepatic vein was positively correlated with the number of SHVs. The occurrence rate of IRHV was 83.3, with an average diameter of 2.6-8.0 (4.3 卤1.2) mm. There was a negative correlation between the diameter of 1~2mm and the size of right hepatic vein. ConclusionTwo one IVC from bottom to top, from left to the septal hole of IVC, is arched to the right in the sulcus of vena cava, which is a relatively narrow area of IVC, and the left and middle veins of liver are mostly confluence of IVC, left and middle of the liver. In the right vein, the diameter of the right hepatic vein was the thickest, and the extrahepatic length of the left hepatic vein was the longest. The changes of SHVs in different liver samples were great. In most cases, the number of diameter of SHVs was small, and the number of diameter of SHVs was more. The diameter of SHVs and the diameter of main hepatic vein compensated each other. The larger the diameter of the right hepatic vein, the smaller the diameter of S HVs and the smaller the diameter of the right hepatic vein. The larger the diameter of the left hepatic vein, the more S HY, the smaller the diameter of the left hepatic vein, the less the S HVs.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R657.3;R322

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