经静脉韧带门腔分流的应用解剖

APPLIED ANATOMY OF REALIZING INTRAHEPATIC PORTOSYSTEMIC SHUNT PASSING LIVER VENOUS LIGAMENT

目的：探讨门腔分流新途径。方法：选择成人正常肝４４例，解剖观测肝圆韧带、静脉韧带等。结果：静脉韧带走行于肝下面的静脉韧带裂内，连于门静脉左支和下腔静脉之间，长约 ４． ０９± ０· ６１ ｃｍ；肝圆韧带连于脐和门静脉左支之间，其肝外段和肝内段分别长约 １４． ５１±３．４４ ｃｍ，５． ７５± ０． ９９ ｃｍ。静脉韧带和肝圆韧带内均有间断残腔存在，且以近心段最为明显，分别长达 １．９９±０． ３９ ｃｍ和２．９１±０．６２ ｃｍ。肝圆韧带和静脉韧带均可用直径 ２ ｍｍ的铁丝使其再通。结论：于脐处切口，扩张再通肝圆韧带、静脉韧带至下腔静脉，实现门腔分流通道具有可行性。

To explore a new path of protosystemic shunt. Methods: Fourly-four normal adult livers were chosen; the venous ligament and round ligament of liver were anatomized, observed and measured. Results: The venous ligament lay in the venous ligament fissure and connected between the left branch of portal vein and inferior vena cava. It was about 4. 09±0. 61 cm in length. The round ligament of liver linked between umbilicus and left branch of portal vein, and its inner and outer segments of liver were 14.51± 3. 44 cm and 5. 75 ± 0. 99 cm in length respectively. There were residual cavity both in venous ligament and in round ligament, especially their segments near the heart, 1, 99± 0. 39 cm and 2. 91 ± 0. 62 cm in length respectively. The venous ligament and round ligament could be repassed with iron wire of 2 mm in diameter. Conclusion: If an incision is made at umbilical part, it is possible expanding and repassing round ligament and venous ligament to inferior vena cava to establish the canal for portosystemic shunt.