肝内门—腔静脉分流术相关的肝内血管应用解剖

Applied anatomy of intrahepatic vessels related to intrahepatic portosys- temic shunt

在成人３２例肝标本上，解剖观测了各肝静脉的长度、横径、夹角和肝静脉与相应门静脉拟分流处距各肝门的长度及穿刺距离。结果表明：肝内门—腔静脉分流术应首选肝右静脉与右门静脉及分支间穿刺，穿刺时穿刺针应与正中矢状面和下腔静脉分别呈右７５．３°±４．７°和１４０．３°±１０．２°，进入肝右静脉４．０±１．１ｃｍ，向下方或前下方推进１．８±０．９ｃｍ，即可刺入右门静脉及其分支；其次可选用肝中静脉和肝左静脉与左门静脉及分支间穿刺；当肝静脉有变异时，可选用右后下静脉与右门静脉及分支间穿刺。

he lengths,calibres and angles of hepatic veins,as well as the distances from the hepaticportals to the intended shunt point of hepatic veins and portal veins were investigated on 32 adultliver specimens.The results showed that the right hepatic and right portal veins as well as theirbranches,should be firstly selected as the puncturing vessels in portosystemic shunt.During punc-turing,the needle vvas stabed into right hepatic vein for 4.0± 1.1cm,with angles of 75.3±14.7degreses and 140.3±10.2 degrees to the medium sagittal plane and inferior vena cava respective- iy,then the needle vvas pushed 1.8±0.9 cm inferiorly or anterioinferiorly to get into the rightportal vein or its branches,The second puncturing place is between the middle or the left hepaticveins and the left portal vein,The right posteroinferior hepatic vein and right portal vein could beselected in hepatic vein variation cases.