副肝静脉的影像解剖学研究

The study of imaging anatomy in accessory hepatic veins

目的：利用肝脏标本并结合活体肝脏的超声与CT图像，对副肝静脉（accessory hepatic veins，AHV）的走行、口径及其与下腔静脉的夹角进行对照研究，为肝移植手术、肝切除术、肝癌的介入治疗以及提高临床影像手段对AHV的显示率，提供解剖学与影像学依据。方法：①随机选用经福尔马林固定的离体无病变肝脏12例，沿下腔静脉（IVC）后壁正中剖开管腔，观察AHV开口情况，并在解剖放大镜下仔细解剖剥离AHV，观察其来源，走向，数量，测量AHV的长轴与IVC长轴的夹角。②随机选健康查体者600人进行超声检查，取剑突下纵切，中上腹部横切，右腋前线纵切，观察AHV的汇入部位、走向、数量、口径及其与下腔静脉轴线的夹角。③随机选80例因胆囊、胰腺或肾脏疾病行CT强化检查，肝脏正常者扫描图像，观察AHV的汇入部位、走向、数量、口径及其与下腔静脉轴线的夹角情况。结果：①12具尸体标本共有AHV79支，人均6．12±1．13（2～10）支，平均口径0．36±0．11（0．1～1．0）cm；AHV和IVC呈锐角者57支，人均5．21±1．61支，平均口径为0．22±0．14cm，约占总数量的72％；呈直角者22支，人均1．91±0．79支，平均口径为0．42±0．16cm，占总数量的28％。②600例体检者超声检查显示AHV共490支，平均0．78±0．41（0～3）支／例，平均口径0．38±0．19cm。显示的AHV与IVC的夹角多呈直角或近似直角，约88％（431／490），170例显示较粗大的肝右后下静脉，口径0．3～0．81cm，平均0．40±0．19cm。③80例肝强化CT图像，仅24例显示粗大的肝右后下静脉，未见细小尾状叶静脉显示。结论：正常中国人AHV变异较大；在肝右后下静脉显示方面超声与螺旋CT检查相似，在细小AHV显示方面超声检查优于螺旋CT图像。

Objective：To investigate the trace, caliber of the accessory hepatic veins（AHV）, the angle between AHV and the inferior vena cava（IVC） ,and contrast the AHV sensitivity by ultrasound and CT.Methods： （1）Choese 12 non- pathologic livers which is fixed by formalin,dissect WC along posterior median line to observe the AHV caliber,observe the source,trace, and the number of AHV using the magnifier of dissection,and investigate the angle between the long shafts of AHV and IVC（fight angle or acute angle） .（2）Choese 600 samples by random and take the ultrasound exam of vertical section of xiphoid process, cross section of middle abdomen, and coronary section of waist to investigate the AHV join position, number, caliber and the angle between the shafts of AHV and WC（right angle or acute angle） .（3）Choese 80 samples by random who take the intensified spiral CT scan for such as gallbladder, pancreas or kidney diseases and without liver pathological changes to observe the AHV caliber.Results：（1）Tbere are 79 AHV in 12 specimen, average is 6.12 ± 1.13（2 - 10）, average caliber is 0.36 ± 0.11 （0.1 - 1.0）cm. There are 57 AHV which is acute angle between IVC and AHV, average is 5.21 ± 1.61, average caliber is 0.22 ± 0.14cm, account for 72% in total. There are 22 AHV which is fight angle between IVC and AHV, average is 1.91 ± 0.79, average caliber is 0.42 ± 0.16cm, account for 28% in total;（2）There are 490 AHV in 600 samples, average 0.78 ± 0.41（0 - 3）, average caliber is 0.38 ± 0.19cm,the angle between IVC and AHV is fight angle or close to fight angle （88%, 431/ 490 ）. And there are 170 inferior right hepatic vein in 600 samples, caliber is 0.3 - 0.81 cm, average 0.40 ± 0.19cm; （3）There are only 24 inferior right hepatic vien （IRHV） in 80 spiral CT scan. The smaller AHV did not show. Conclusion：The AHV of healthy Chinese variance is big; it is similar that of inferior right hepatic vein in ultrasound and spiral CT, and the ultrasound better than spiral CT for smaller AHV.