劈离肝移植肝脏的应用解剖学研究

Applied anatomy study of splitting liver transplantation

目的探讨在劈离式肝脏移植中，获得良好劈离供肝的途径。研究两种主要劈离方式的差异。方法对３６例甲醛固定成人尸肝、４例新鲜肝脏进行劈离肝移植的应用解剖学研究。分别采用标准方式和改良方式两种方法，根据肝脏解剖结构进行比较。同时对本组４０例肝脏按Ｃｏｕｉｎａｕｄ分段对肝静脉、门静脉、肝动脉的分布范围、管径、肝外长度等进行解剖学观察与测量。结果①经典劈离方式中，右半植肝断面上Ⅴ、Ⅷ段区域出现粗大中肝静脉分支；②本组４０例肝脏６７．５％Ⅷ段、１００％Ｖ段（部分或全部）通过中肝静脉回流。结论改良劈离方式与经典劈离方式相比更安全可靠，在供肝大小适合的情况下应成为临床劈离式肝脏移植的首选术式。

Objective To study how to gain the qualified splitting liver and the differences between two main splitting ways in the splitting liver transplantation. Methods Anatomy of 38 formaldehyde fixative livers, and 4 fresh livers were studied. The livers were divided into two groups, one was classical splitting, the other was modified splitting. Meanwhile, diameter, length of the hepatic vein, portal vein, hepatic artery and biliary duct were observed and measured. Results ①In the classical splitting, thick branch of middle hepatic vein was found on the splitting surface of the right half liver. ② Among 40 livers, 67.5% of the eighth segment and 100% of the fifth segment (all or some)drained to middle hepatic vein. Conclusion Modified spitting is more safe and reliable than classical splitting, so it is the first choice when the size of donor liver is suitable.