尸检肝门部门静脉解剖与TIPSS术中穿刺技术的再探讨

Shunt Establishment from Hepatic Vein to PV Branches and Bifurcation: Anatomical Study and Clinical Value of TIPSS Procedures

目的：通过观察肝门部门静脉与肝实质之间的解剖关系，讨论ＴＩＰＳＳ术中选择门脉左右主支或门脉分歧部作为穿刺点的可行性。材料与方法：对１０例新鲜人体尸检正常肝脏标本，观察门静脉分歧部、门静脉左右主支与肝脏之间的空间关系及解剖联系，并对１０％福尔马林固定后的标本切片作光镜下观察。结果：１０例标本中，门静脉分歧部及左右主支均位于肝外。门脉分歧部与门脉左右主支的上壁、后下壁与肝实质连接紧密。光镜下见门静脉分歧部、门静脉左右主支与肝实质间存在致密结缔组织。结论：肝外门静脉分歧部、门静脉左右主支均可作为ＴＩＰＳＳ术中的安全穿刺点。

Purpose:To observe anatomical relationship of the portal vein (PV) and the liver at the level of the hapatis porta,and to discuss the feasibility of puncture of extrahepatic PV branches when trying to establish a portosystemic shunt during TIPSS procedures.Materials and Methods:10 fresh normal human livers got from autopsy were examined, and the spacial relationship of PV bifurcation,the right and left PV branches and liver was observed.3 weeks after fixation,the samples were examined under light microscope.Results:All the PV bifurcation and the beginning of the PV branches were located extrahepaticly in the 10 samples.The upper and back wall of PV bifurcation and PV branches were adherent to the liver,Compact connective tissue could be found between PV branches and liver parenchyma under microscope.Conclusion:the PV bifurcation and the beginning of PV branches located extrahepaticly can be punctured safely and briefly during TIPSS procedures.