肝静脉的冠状断层解剖学研究

SECTIONAL ANATOMY OF THE HEPATIC VEINS ON THE CORONAL PLANE

目的为MRI和多层螺旋CT在冠状断面上诊断肝疾患及肝外科手术提供断层解剖学依据。方法用30例成人躯干部连续冠状断层标本、10例成人腹部MRI冠状图像及5例成人肝内管道多层螺旋CT三维重建图像,观测了肝左、中、右静脉及其重要属支的走行、分布及其与肝门静脉的关系。结果依左外叶的外形特征,将肝左静脉的回流形式分为4型。来自段Ⅷ腹侧部的静脉全部汇入肝中静脉,来自段Ⅷ背侧部的静脉全部汇入肝右静脉。而位于段Ⅷ腹侧部和背侧部之间的静脉(V8i),其回流形式可分为3型。肝右静脉的主干多出现于下腔静脉及其稍后层面,在冠状断面上可分为4型。结论冠状断面在显示肝静脉及其属支的上、下走行方面具有明显优势。以V8i为标志,将段Ⅷ分为腹侧和背侧两个亚段。这种亚段划分有利于探讨一种新的和更加安全的肝外科手术方式。

Objective To provide sectional anatomic data for the coronal imaging diagnosis and surgical treatment of the diseases of the liver. Methods The course, distribution of left, middle, and right hepatic veins and their important tributaries as well as the relationship with the hepatic portal veins were investigated using serial coronal sections of the trunk of 30 adult cadavers, coronal MR images of abdomen of 10 adult healthy volunteers and three-dimensional MSCT image of intrahepatic ducts of 5 healthy adults. Results The draining form of left hepatic vein can be divided into 4 types according to the external shape character of left lateral lobe. All veins of the ventral area of segment Ⅶ opened into the middle hepatic vein. All veins of the dorsal area of segment Ⅶ joined the right hepatic vein. However, the veins （V8i） situated between the ventral and dorsal areas of segment Ⅶ can be divided into 3 types on the draining form. Right hepatic vein usually appears on the section through or behind the inferior vena cava with 4 types on the coronal plane. Conclusions Coronal section has obvious advantage to show the course of hepatic veins in the longitudinal direction. Segment Ⅶ can be divided into dorsal and ventral subsegments according to V8i, This method of subsegmental division may contribute to the development of new and safer surgical procedures of the liver.