前入路绕肝提拉法肝后隧道的解剖学研究

目的:探讨前入路绕肝提拉法手术的临床解剖学依据.方法:解剖分离21具成人尸体的肝后下腔静脉标本,采集20例因肝硬化行背驮式肝移植患者的肝后下腔静脉的临床影像资料,按不同的绕肝提拉法可能的路径和不同宽度肝后隧道(10 mm,6 mm)统计可能遇到的肝静脉.结果:前入路绕肝提拉法的标准路径平均可遇到肝短静脉的中位数是1(0～3),标准路径右上方的路径(肝后下腔静脉右缘、距肝下缘1 cm)和标准路径之间、不同宽度肝后隧道之间差异有统计学意义(P＜0.05),肝硬化组与无肝硬化对照组之间无明显差异(P＞0.05).结论:前入路绕肝提拉法肝切除手术是可行的.

Applied Anatomy of Retro - hepatic Tunnel During Anterior Hepatectomy by Liver Hanging Maneuver

Objective:To investigate the clinical anatomic data of anterior hepatectomy by liver hanging maneuver(LHM).Methods:The inferior vena cava(IVC) behind liver were dissected and separated on 21 cadavers.The clinical image data of IVC behind liver from 20 cases with liver cirrhosis(LC) received the piggyback liver transplantation.According to different possible pathways of LHM and various widths of retro-hepatic tunnel(10 mm,6 mm),the probability of meeting hepatic vein during operation was estimated.Results:According standard pathway of the anterior hepatectomy by liver hanging maneuver,the median of frequency which represent the possibility of meeting hepatic short veins on the way of operation was one(zero to three).There was statistical difference of the median between in top-right pathway which was in right border of retro-hepatic IVC and was 1 cm from the inferior border of liver,and in standard pathway(P<0.05).The median varied from the widths of retro-hepatic tunnels also.However,the median in liver cirrhosis group and normal group were not obvious difference(P>0.05).Conclusions:The anterior hepatectomy by liver hanging maneuver is feasible.