人肝静脉间侧支循环的标本观察和临床意义

Management of hepatic vein injury influenced by collateral circulation between main hepatic veins in human liver

目的通过观察30例人肝静脉间的侧支循环,分析肝静脉受阻后其血流方向、梯度的改变及其临床意义。方法预备30例用肝素灌洗保存的尸肝,用墨汁、泛影葡胺等造影剂逆行灌注各肝静脉,观察造影剂在肝内的分布情况并测定其组织含量。结果各肝静脉间肝实质内和肝表面被广泛染色和造影剂充盈,各肝静脉区泛影葡胺组织含量大至相同(P>0.5),仅左、右肝静脉间泛影葡胺组织含量有一定差异。结论对于正常肝脏,肝静脉阻塞或结扎时肝静脉内血液可通畅地流向相邻的肝静脉;但当肝脏有明显硬化、纤维化时,相邻两支肝静脉同时受阻或结扎,则远侧肝组织血液循环可能受到一定影响。

Objective To analyze the direct influences of collateral circulation of hepatic veins on management of hepatic vein injury.Methods Collateral circulation between hepatic veins was ob- served in 30 cases of human cadaverous liver.Contrast media(Chinese ink,Angiografin)were infused to hepatic veins in the 30 cases and their distribution and contents observed and detected.Results The content of Angiografin was similar among sections of hepatic veins(P>0.05)but significantly differ- ent between right hepatic vein and the left one(P<0.05).Conclusions When obstruction and liga- tion occur in 1 or 2 main hepatic veins,the blood in this area will smoothly flow into other hepatic veins.However,ligation of 2 adjacent hepatic veins should not be performed in cirrhotic liver.