左外叶活体肝移植肝静脉的临床应用解剖

Applied anatomy of hepatic veins in living left lateral lobe liver transplantation

目的 :观察肝左叶静脉解剖结构 ,模拟左外叶活体肝移植肝静脉切取方法。方法 :解剖正常人肝脏标本 30具 ,观察肝脏铸型标本 30具 ,测量肝左静脉长度、管径及属支分布情况。结果 :肝左静脉主要由左外叶上段静脉支和下段静脉支汇合并延续而成 ,主要接收或不接收较有意义的属支有左后上缘静脉支和左叶间裂静脉支。结论 :肝左外叶静脉血管解剖变异较多 ,活体取肝前应仔细研究其结构特点 ,设计合理的切取模式 ;移植前肝静脉需行必要的整形 ,以便与受体静脉进行吻合。少数情况下肝左外叶活体移植为禁忌证。

Objective:To study the anatomic structure of hepatic veins of Chinese and imitate living left lateral lobe liver transplantation to cut and obtain hepatic veins.Methods:The length,diameter and the branches of the hepatic veins were observed and measured on 30 normal adult livers and 30 cast models of liver. Results:Formed chiefly by the combination and extension of the left lateral superior vein and the left lateral inferior vein,hepatic left veins(HLV)clinical significantly might accept or not accept the left posterior upper edge vein(LPUEV) and left fissure between lobe vein(LFBLV).Conclusions:There were many anatomic variation of left hepatic vein.The anatomic structure should be researched and well designed to gain a partial liver graft from a living donor before performing living liver transplantation.Hepatic veins should be reconstructed if necessary,so as to anastomose with recipient hepatic vein or the inferior vena cava.In some cases,the left lateral living liver transplantation might be contraindicated.