50例童尸肝固有动脉肝外分支的观察

THE BRANCHING OF THE PROPER HEPATIC ARTERY IN 50 CHINESE CHILDREN

本文收集了50例童尸的材料,主要就肝固有动脉的位置、分支与其部位以及各分支的起始、位置(部分分支)、异常等作了比较详细的观察。所得结果并与其他作者作了相互比较。一、肝固有动脉位于门静脉左侧者,占34%,其分支于肝总管左侧分者最为多见,占64%。肝固有动脉分为肝右、左动脉两支者,占74%。肝固有动脉缺如者,占18%。二、肝右动脉起于正常肝固有动脉者39例,占78%,起于腹腔肝总动脉者4例,占8%。起于肠系膜上动脉者3例,占6%,起于其他动脉者4例,占8%。迷走代替动脉的出现率占14%有副肝右动脉的有2例占4%。肝右动脉经肝总管后方入Calot氏三角者32例,占64%,经肝总管及右肝管后方者7例,占14%,另外经和胆道系无关之处入肝右叶者12例,占24%。不论正常或异常肝右动脉,经Calot氏三角入肝右叶者,占74%。三、肝左动脉起于正常肝固有动脉者,占76%,起于腹腔肝总及胃左动脉者,各占10%,起于肝右及胃左动脉者各占6%和8%。另外4%起自其他动脉。迷走代替及副肝左动脉的出现率,均占14%。其次,尚发现副胃左动脉有9例,占18%;有吻合弓者13例,占26%。四、肝中动脉有一条者41例,占82%;其中起自肝左动脉者24例,占48%,起自肝右动脉者13例,占26%,起自其他动脉者,占8%。双肝中动脉仅遇见一例。肝中动脉缺如者,占16%。五、肝固有动脉分支类型:第Ⅰ型,占68%,第Ⅱ型,占12%,第Ⅲ型,占4%,第Ⅳ型,占6%,第Ⅴ—Ⅸ型,各占2%。

The manner of branching of the proper hepatic artery,its relationship with sur-rounding structures and the source of origin of the left,right and middle hepatic ar-teries were examined in 50 Chinese child cadavers.The proper hepatic artery was found in 45 cases with 5 cases devoid of this artery.In the 45 cases the proper hepatic artery divided itself into a left and a right hepatic artery in 37 cases(74%);a right and a middle hepatic artery in 2 cases(4%)and in 1 case each(2%each)into a left and a middle or a left,a right and in addition a middle hepatic artery.In the remaining 4 cases the proper hepatic artery was either continued into the middle(1 case,2%)or the right(1 case,2%)or the left(2 cases,4%)hepatic artery.The proper hepatic artery was situated on the left side of the portal vein in 17 cases(34%);left and anterior to this vein 16 cases(32%)and in front of it in 8 cases(16%).The point of division of the proper hepatic artery was on the left side of the common bile duct in 32 cases(64%).In the 50 cadavers there were 52 right hepatic arteries,2 of which being the acces-sory right hepatic arteries derived from the left hepatic or the gastroduodenal artery.In the remaining 50 cases,those derived from the proper hepatic artery comprised the most of the cases(39 cases,78%),others were from the common hepatic artery(4 cases,8%)or the superior mesenteric artery(3 cases,6%).There were 7 cases in which the artery was derived from the superior mesenteric artery(3 cases,6%).The number of the left hepatic artery was 57,of which 7 being the accessory type,derived from the left gastric(4 cases,8%)or the right hepatic(3 cases,6%).The origin of 50 left hepatic arteries was mainly from the proper hepatic artery(38 cases,76%)or the common hepatic artery(5 cases,10%).The remaining 7 cases were derived from the left gastric artery(5 cases,10%).The middle hepatic artery was found in 341 cases(82%)derived either from the left hepatic(24 cases,48%)or the right hepatic artery(13 cases,26%).Only few arose from other sources.The branching of the proper hepatic artery was classified into 9 types;the first type comprised the majority of the cases(30 cases,60%),in which the left and right hepatic arteries were derived from the proper hepatic or common hepatic artery with the middle hepatic artery derived from the left,right or the proper hepatic artery.