肝中静脉及其属支的应用解剖

Applied anatomy of the middle hepatic vein and its branches

目的通过对肝中静脉(middle hepatic vein,MHV)及主要属支的观测,为胆道外科手术中MHV损伤和出血以及肝切除和肝移植手术中MHV属支的保留与重建提供解剖学基础。方法在51例成人无病变标本肝膈面沿肝中裂切开肝实质显露MHV及肝段(Ⅴ和Ⅷ)的分离解剖以显露MHV分支,观测MHV的起源、汇入下腔静脉(IVC)形式以及突入胆囊床属支的解剖形态等。结果 MHV起源类型分3型,即胆囊窝、肝脏Ⅴ段和肝脏Ⅵ段,以胆囊窝起源为主;MHV主要属支分布具有多样性,肝脏Ⅴ、Ⅷ段都可能存在一支到多支;MHV汇入下腔静脉(IVC)的形式,以肝左、肝中静脉合口居多,占70.6%;MHV突入胆囊床属支长度(17.95±5.35)mm,直径(4.35±0.65)mm,C点多位于胆囊纵轴的右侧(45.1%)。结论肝中静脉及其属支清晰的解剖学认识对于胆道外科手术、肝切除以及肝移植手术有着重要意义。

Objective To observation of the main branches of middle hepatic vein, To provide the anatomic basis for the injury and hemorrhage of MHV in the biliary tract surgery, and Retention and reconstruction of MHV in the Liver resection and liver transplantation. Methods In 51 cases of adult liver disease-free specimen diaphragmatic surface, Along the middle crack cut the liver in liver revealed MHV and the anatomy of the liver to expose the MHV branch, Observation of MHV origin, empties into the in- ferior vena cava and the anatomy of the genus into the gallbladder bed. Results The origin of MHV type is divided into 3 types, namely, gallbladder fossa, Section Ⅴ and Ⅵ section of the liver, based on the origin of the gallbladder fossa. The distribution of the main branches of middle hepatic vein is diverse, and V and Ⅷ segments of the liver may be one or more ; MHV empties into the inferior vena cava in the form of left hepatic vein with middle hepatic vein, the majority.Length of the MHV branches into the gall- bladder bed （ 17.95 ± 5.35 ） mm, diameter （4.35 ± 0.65） mm, Most c point is at the right of the longitudinal axis of the gallbladder （45.1%）. Conclusion A clear understanding of the anatomy of the middle hepatic vein and its tributaries is of great significance for the operation of biliary tract surgery, liver resection and liver transplantation.