尾状叶门静脉的应用解剖学

Applied anatomy of the portal branches in the caudate lobe of liver

目的:为腹腔镜肝尾状叶切除等手术提供形态学基础。方法:32具尸体标本采用大体解剖方法观测尾状叶门静脉数量、直径、走行、来源、游离部长度(肝外长度)及毗邻解剖关系;对15例铸型标本的尾状叶门静脉进行观测;采用64排螺旋CT对5例新鲜肝标本进行扫描,并进行三维重建。记录螺旋CT影像下尾状叶门静脉内径、数量、走向及毗邻关系,与解剖研究结果比较。结果:1支以上的固有尾状叶门静脉的出现率为62.5%,其中主要以固有尾状叶门静脉后支和前支为主(27.5%),另外也有固有尾状叶门静脉左支和右支(12.5%);腔静脉旁部门静脉主要为1支,10例腔静脉旁部的实质也有固有尾状叶的分支(主要为右支或前支);尾状突门静脉主要为1支,来自于门静脉左、右支;重建的三维图像可以直观形象地体现尾状叶门静脉的空间位置关系,并可按各种方向任意旋转演示。结论:尾状叶门静脉呈左、右支双重供应,但以左侧供应为主;明胶-氧化铅血管造影可真实显示尾状叶门静脉。

Objective： To provide the morphological data for the operation of the liver. Methods： （1） 32 liver specimens were observed, including the location of the portal branches in the caudate lobe and its diameter and length. （2） The cast specimens of 15 cadavers were prepared to investigate the tributaries and courses of the portal branches of the caudate lobe. （3） CT was used to examine the anatomic relationship between the caudate lobe of the liver and the portal branches of the caudate lobe in 5 liver specimens. Results： In 20/32 （62.5%） cases there was more than one branch, with a posterior caudate branch in 15/32 （27.5%） cases, and an anterior caudate branch in 11/32 （12.5%） cases. The most frequent combination of the branches （11/40,27.5% of cases） was that of the posterior and anterior branches. In 11/32 （34% ） cases, there were paracaval branches originating from the portal vein or its branches and distributed toward the paracaval portion. In 23/32 （71.9%） eases there was a single branch to caudate process. It predominantly originated from the right branch and left branch of the portal vein. 3D reconstructed models could perfectly display the relationship of the portal branches of the caudate lobe and rotation in every direction. Conclusion： The portal branches in the caudate lobe of the liver originate from the left and the right branches of the portal vein, except for the left branch. It can actually show the portal branches in the caudate lobe of the liver by the lead oxide-gelatin injection technique.