活体右半肝供者肝脏血管和胆道解剖变异分析

Anatomic Variations of Vessels and Biliary Channels in Right Lobe Living Donor Liver

目的:探讨活体肝移植右半肝供者血管、胆道解剖学特点。方法:依据门静脉分型、肝静脉解剖分型、胆道分型及肝动脉解剖分型,观察90例右半肝活体肝移植供者的肝静脉、门静脉、肝动脉及胆道的解剖学特点。结果:正常门静脉的比例为94.4%(85/90),三叉型门静脉的比例为5.6%(5/90);肝动脉变异率较高;正常胆道的比例为66.7%(60/90),三叉型胆道占20%(18/90),3型胆道的比例为12.2%(11/90),4型胆道占1.1%(1/90);肝中静脉和肝左静脉共干的比例为70.0%(63/90),大于5mm的肝右下静脉出现概率为26.6%(24/90),左内叶上段静脉汇入肝左静脉的比例为68.8%(62/90),共同汇入肝左静脉和肝中静脉的比例为21.1%(19/90),汇入肝中静脉的比例为10.0%(9/90)。结论:肝脏血管和胆道的解剖变异很常见,准确的术前评估对于活体肝移植至关重要。

Objective：To analyze the anatomical variations of vessels and biliary channels in right lobe living donor liver.Methods：The surgical anatomy of vessels and biliary channel structures were evaluated by reviewing the results of preoperative assessment in 90 right lobe grafts of a single surgical team.The data were analyzed in relation to surgical management of anatomical variations.？Results：There was 94.4% of classic anatomy portal vein （PV）,5.6% had a trifurcated PV.The hepatic artery （HA） anatomic variations were very common.The cases of 66.7% had normal anatomy of biliary channels,20% had a trifurcated biliary anatomy,in 12.2% the right anterior bile duct or the right posterior bile duct opened into the left bile duct,and 1.1% was of type 4.In 70.0% of the donor,the middle hepatic vein and the left hepatic vein had common trunk,most （68.8%） veins of S4 imported into the left hepatic vein.The incidence of large inferior right hepatic vein（〉 5 mm） was 26.6%.Conclusion：The anatomic variations of the liver are very common.The precise assessment of vascular and biliary anatomy is vital for appropriate surgical management.