肝中静脉属支解剖及其在活体肝移植中的意义

Anatomy of tributaries of middle hepatic vein for application in living donor liver transplantation

目的：为临床活体肝移植提供有关肝中静脉属支的形态学资料.方法：采用50例无病变成人尸体肝标本进行解剖剥离,对肝中静脉及属支进行观测,并采集相关数据进行统计分析.结果：肝中静脉主要属支为（5.26±1.16）支,直径大于5.00mm的肝中静脉主要属支的出现率为76.0%;肝Ⅳ段静脉血大多由肝中静脉回流;肝中静脉均参与肝Ⅴ段回流,Ⅴ、Ⅶ段由肝中静脉和肝右静脉共同引流者分别占66.0%和90.0%;肝Ⅲ段静脉单独由肝中静脉引流占10.0%;肝中静脉引流肝Ⅵ段静脉血者占22.0%.结论：肝中静脉主要属支数目不恒定,形态结构多异,临床活体肝移植术前应根据肝中静脉主干的汇合形式、主要属支的分型、管径及引流范围等,进行个性化分析,研究出较理想的手术方案.

Objective： To provide morphological data of tributaries of the middle hepatic vein for living donor liver transplan- tation. Methods： 50 non-illness adult eadaveric livers were dissected to observe the main trunk and tributaries of middle hepatic vein, and correlated data were measured and analyzed. Results： The number of the main tributaries of middle hepatic vein was （5.26±1.16）. The frequency of the main tributaries whose diameter was more than 5.00 mm was 76.0%. The venous blood of segment Ⅳ was mostly recirculated by middle hepatic vein. The middle hepatic vein entirely participated the recirculation of the venous blood of segmentⅤ. The rates of venous blood of segment Ⅴ and Ⅷ inflowing to the middle hepatic vein and right hepatic vein simultaneously were 66.0% and 90. 0,% respectively. There was 10. 0% of all cases that the venous blood from segment Ⅱ was recirculated only by middle hepatic vein. The rate of venous blood of segment Ⅵ inflowing to the middle hepatic vein was 22.0%. Conclusion： The number of the main tributaries was inconstant, and the morphous and construction was different. Before living donor liver transplantation, we should study individually the best program according to the confluent form of the main trunk of the middle hepatic vein, the type of the main tributaries, diameter, and the scope of recirculation to design reasonable operation plan.