多层螺旋CT增强扫描显示肝静脉正常解剖及变异

目的采用多层螺旋CT增强扫描显示肝静脉正常解剖及变异情况,为活体肝移植及肝叶切除提供解剖学数据.方法100例行CT增强扫描,用肝静脉期(70s)采集数据,应用薄层横断面(1～2 mm)行多平面重组(MPR)、最大密度投影(MIP)法重建.对肝静脉的解剖和变异进行分型,并测量其直径,同时测量右后下肝静脉的直径和肝外段长度.结果100例中3大支肝静脉单独汇入下腔静脉占71%;肝左静脉和肝中静脉共干占29%.肝左静脉直径(6.8±1.8)mm;肝中静脉直径(6.7 1.7)mm;肝右静脉直径(7.9±2.5)mm;右后下肝静脉显示率83%(83/100),右后下肝静脉直径(4.1±1.5)mm;右后下肝静脉肝外段显示率59%(49/83),右后下肝静脉肝外段长度(4.0±1.8)mm.结论多层螺旋CT增强扫描MPR及MIP图像能很好地显示肝静脉正常解剖及变异情况.     

双下腔静脉畸形一例

临床本科生于解剖实践中,发现一具成年男性尸体的少见双下腔静脉(Double inferior vena cava)变异.其变异位置、形态如图1所示:该例标本右髂外静脉(A)与右髂内静脉(B)于右骶髂关节前方汇合形成右髂总静脉(C),向上于第4腰椎下缘右前方汇入右下腔静脉(D).右下腔静脉继续沿腹主动脉右侧和脊柱右前方上行,其压扁管径为36.81 mm.左髂内静脉(E)于第5腰椎体前方由左下行向右上,于第4腰椎下缘右前方斜行汇入右下腔静脉.左髂外静脉(F)自前外行向后内,至第4腰椎左缘,在腹主动脉后方,发出粗大横行分支(G,称髂联合)注入右下腔静脉,该分支压扁管径22.63 mm.左髂外静脉本干续沿腹主动脉左后方和脊柱左前方上行,延续为左下腔静脉(H),于第1腰椎水平处约成直角注入左肾静脉(I),其外侧为左睾丸静脉(J)汇入左肾静脉.左下腔静脉长度为88.73 mm,压扁管径为9.31 mm.在第5腰椎左下方,左髂外静脉发出一交通支(K),与左髂内静脉吻合,该交通支长度为9.98 mm.     

左肾静脉主要属支的影像学应用解剖

目的:为与左睾丸静脉和左肾上腺静脉相关的临床影像学诊断和治疗提供解剖学资料。方法:成年男尸70具,分别测量左睾丸静脉和左肾上腺静脉的开口至下腔静脉(左缘)和左肾门的距离,以及左肾上腺静脉与左睾丸静脉两开口之间的水平距离,并进行统计学相关性分析。结果:①左睾丸静脉开口距下腔静脉35.6±9.1mm,距左肾门26.1±10.1mm。②左肾上腺静脉开口距下腔静脉29.6±11.8mm,距左肾门31.5±13.6mm。③62.7％的左肾上腺静脉开口于左睾丸静脉内侧,两者相距13.3±7.2mm;23.7％开口于左睾丸静脉外侧,相距8.8±6.6mm;两者相对的占13.6％。结论:两静脉开口距下腔静脉的距离与肾静脉长度呈直线正相关关系;肾静脉越长,两开口距下腔静脉距离越远、距肾门距离相对越近,但两开口之间的距离与肾静脉长度无关。本文还就调查中出现的变异情况提醒临床工作者注意。     

左头臂静脉位于升主动脉后方一例*

正笔者在局部解剖的过程中发现左头臂静脉位于升主动脉后方变异标本1例,老年男性标本(身高161 cm)的左头臂静脉于主动脉弓下方行于升主动脉后方注入上腔静脉。解剖过程与测量参数报道如下。开胸后发现,双肺癌变,脏胸膜与胸壁粘连,心大小测量数值为,右缘95.80 mm,下缘134.90 mm,左缘150.76mm。进一步解剖发现,左头臂静脉与右头臂静脉之间有一交通静脉。上腔静脉长65.50 mm,上腔静脉管径19.80mm,左头臂静脉汇入上腔静脉处距右锁骨中线距离46.56mm。右头臂静脉长58.65mm,左头臂静脉长107.28mm,左头臂静脉汇入上腔静脉处管径12.08mm,左、右头臂静脉间右一交通静脉位于主动脉弓前上方走行,距离左头臂静脉末端17.48 mm汇入右头臂静脉。交通静脉长     

双侧头臂静脉变异一例

<正>在解剖一具成年男性镜面人标本时,发现其左、右两侧头臂静脉变异较大,左头臂静脉缺如,右头臂静脉直接汇入左心房。为积累解剖学数据,现报道如下。本例标本上腔静脉及奇静脉与正常解解剖标本分布相反,均位于左侧胸腔。上腔静脉(外径30.90 mm)在正中线左侧29.48 mm处,自右心房起始至左颈内静脉与左锁骨下静脉分支处长度为81.84 mm。奇静脉(外径25.56mm)位于正中线位置。左、右两侧头臂静脉与正常解剖标     

左侧肾静脉裂孔及肾动脉走行变异一例

<正>笔者在解剖1具成年女性尸体时,发现左侧肾静脉裂孔及肾动脉走行变异,此类变异较为罕见,现报道如下。左肾静脉为1支起于肾门中央,外径12.12 mm,向右横行11.16 mm形成一长径为9.60 mm,短径为3.34 mm的卵圆形静脉裂孔,该裂孔有肾动脉的分支穿过(图1)。左肾上腺静脉和左卵巢静脉汇入左肾静脉,最后注入下腔静脉。左肾动脉于肠系膜上动脉起始点下方4.04 mm处起自腹主动脉,起始外径为7.06 mm,于左肾静脉上方向左外上行7.24 mm发出一支肾副动脉后,延续为肾动脉主干。肾副动脉向左上方移行,发出肾上腺下动脉后,继续走行最后汇入肾上极。肾动脉主     

膈下动脉、肾上腺动脉及肾动脉变异一例

<正>笔者在对1具男性尸体标本进行解剖时,见膈下动脉、肾上腺动脉及肾动脉变异。几处变异均较有临床意义,且多处变异存在于同一标本较为罕见。为积累国人解剖学数值资料并为临床提供参考,现报道如下。左膈下动脉、左肾上腺动脉变异:左膈下动脉有2支,1支起自腹主动脉侧壁,管径为1.86 m,途中发出数支进入肾上腺上部,后又进入膈肌。另外1支起自腹腔干上壁,沿着胃后壁上行,其起始管径为3.34 mm。主干在起始处稍上方发出一小分支进入膈肌,沿     

双上腔静脉伴迷走右锁骨下动脉及卵圆孔未闭的变异一例

正双上腔静脉变异常见于报道,但双上腔静脉伴迷走右锁骨下动脉及卵圆孔未闭的变异却罕见报道。本例为成年女性尸体,现将在解剖过程中发现的变异报道如下。(1)双上腔静脉变异:右颈内静脉和右锁骨下静脉在右胸锁关节后方汇合成右上腔静脉;左上腔静脉由左颈内静脉和左锁骨下在左胸锁关节后方汇合而成,于主动脉弓及左心房后方下行,最终汇入冠状窦。从左胸锁关节到冠状窦行程长10.96cm,且未见有与右上腔静脉的吻合支。(2)迷走右锁骨下动脉:主动脉弓上缘从右至左发出4支,依次为右颈总动脉(外径7.68mm)、左颈总动脉     

双侧肾静脉异常1例

解剖一成年男性尸体标本时 ,见其双侧肾静脉均异常 ,现报道如下。右肾静脉分为前后两干 (见附图 )。前干管径较细 ,出肾门处外径约 1.8ｍｍ ,走行于后干前面 ,在距下腔静脉右缘约 5ｍｍ处汇入后干。后干管径较粗并由肾窦内粗细不等的 3支静脉汇合而成 ,管径分别为2 .5、3.2、4 .8ｍｍ。右肾静脉总长度 1.6ｃｍ ,入下腔静脉外径 12 .3ｍｍ。左肾静脉变异较大 ,其二干分别汇入下腔静脉如(附图 )。左肾静脉干由肾窦内 2支静脉汇合而成 ,外径分别为 4 .6ｍｍ、5.3ｍｍ ,2支距肾门约 2 .5ｍｍ处合为一干外径 9.8ｍｍ。距肾门 0 .9ｃｍ处在左肾静…     

树鼩肝移植的解剖基础

目的　为树鼩肝移植的开展提供解剖学基础。 方法　解剖12只成年树鼩观察肝脏形态、毗邻及主要血管、胆管的走形和分布,并在解剖基础上探讨和对3组树鼩采用“双袖套管法”行肝移植术。 结果　树鼩肝动脉直径（0.63±0.21）mm,均发自腹腔干;肝上下腔静脉距横膈（5.35±0.55）mm,直径（6.86±0.61）mm;肝下下腔静脉直径（5.28±0.58）mm;肝门静脉由肠系膜上静脉及脾静脉汇成,直径（3.86±　0.57）mm;胆总管由胆囊管及肝总管汇成,长度（15.5±2.6)mm;直径(0.75±0.12)mm。3组树鼩顺利行肝移植术操作,术后存活时间为3h、5h和6h。 结论　树鼩在解剖学基础上建立肝移植模型具有一定的可行性。     

13～15岁内蒙青少年胸段椎旁大血管与胸椎的位置关系

目的 探讨正常13～15岁青少年主动脉,上、下腔静脉与椎体之间的解剖空间关系,为其前路或后路手术方式提供依据。 方法 收集内蒙古地区63例13～15岁青少年正常胸腰CT资料,其中13岁15例,14岁21例,15岁27例。将连续扫描的胸腰椎断层影像原始数据以DICOM格式导入Mimics 16.0软件分析与测量,以左侧横突末端与棘突末端焦点确定为原心O点,测量主动脉距原点O的距离（AO）、主动脉-椎体角（α）、上腔静脉距原点O的距离（V₁O）、上腔静脉-椎体角（β）、下腔静脉距原点O的距离（V₂O）、下腔静脉 椎体角（θ）。 结果 AO, α：13岁（52.16±3.21）mm,（1.89±0.47）°;14岁（52.63±2.28）mm,（-1.91±0.97）°;15岁（57.57±3.52）mm,（-2.47±0.66）°;Ⅴ₁O,β：13岁（66.71±5.82）mm,（-5.14±1.42）°;14岁（77.01±2.89）mm,（-11.18±2.64）°;15岁（78.54±0.70）mm,（-20.61±2.05）°;Ⅴ₂O,θ：13岁（62.69±5.66）mm,（-23.85±1.92）°;14岁（65.71±5.39）mm,（-18.46±2.77）°;15岁（75.98±8.49）mm,（-18.58±2.09）°, 不同椎体之间大血管与椎体间距和角度差异有统计学意义（P＜0.05）。结论 掌握不同椎体之间大血管与椎体之间距离和角度,有助于降低脊柱置钉过程中血管损伤的发生率。     

Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.     

肝静脉,肝短静脉注入下腔静脉壁处在肝移植术中的应用

目的 探讨采用膈下肝段下腔静脉壁前半部钳夹,解决肝移植术中无肝期下肢静脉回流障碍。方法 对17例成人尸肝进行解剖,以时钟刻度方法描述肝静脉、肝短静脉注入下腔静脉壁的位置。结果 肝左静脉、肝右静脉、肝中静脉均注入下腔静脉前半壁(即3～9点),肝短静脉多为针眼大小,注入部位多在5～9点之间(154支),少数注入9～11点(9支)。结论 肝移植术中可以采用下腔静脉壁前半钳夹,解决无肝期下肢静脉回流障碍。     

多层螺旋CT多平面重建髂静脉压迫特征和分型的研究

目的 探讨多层螺旋CT(MSCT)多平面重建(MPR)无下肢症状的髂静脉压迫人群的髂静脉压迫特征和分型。方法 采用回顾性横断面研究方法。收集2018年6月-10月浙江中医药大学附属第一医院全腹部或下腹部MSCT增强扫描中发现存在髂静脉压迫的200例无下肢疾病症状受检者,其中男92例、女108例,年龄18~92岁。分析受检者的左、右侧髂静脉的压迫类型、压迫点个数、最大压迫部位及发生率;测量最大压迫部位髂静脉短径、面积、近远端1 cm髂静脉面积、压迫范围、髂总静脉与下腔静脉的夹角,计算最大压迫部位髂静脉狭窄率。应用SPSS 25.0软件,采用独立样本t检验、秩和检验和χ²检验对数据进行统计分析。分析指标:(1)比较左、右侧髂静脉压迫的部位及定量指标测量值;(2)左侧及右侧髂总静脉压迫的不同年龄、性别、面积、狭窄率的差异;(3)左、右侧髂总静脉不同狭窄程度时的性别差异;(4)髂静脉压迫分型的基本特征及各型之间定量特征。结果 (1)最大压迫部位:位于左髂总静脉180例、右髂总静脉56例、下腔静脉分叉处10例、左髂外静脉7例、左髂总静脉分叉处3例和右髂外静脉1例;左髂总静脉受压占比(90.0%)较右髂总静脉(28.0%)高,差异有统计学意义(χ²=158.909, P＜0.01),但不同年龄段(＜65岁与≥65岁)间差异无统计学意义(χ²=0.058, P＞0.05);左、右侧髂静脉压迫的面积、狭窄率比较,差异无统计学意义(P值均＞0.05);正交断面上左、右侧髂总静脉最大压迫部位短径分别为(6.0±2.6)、(8.3±2.8)mm,压迫范围分别为(11.2±2.1)、(10.0±2.4)mm,同侧髂总静脉与下腔静脉延长线的夹角分别为38.8°(20.2°)、17.7°(9.2°),差异均有统计学意义(P值均＜0.01)。(2)在＜65岁和≥65岁年龄段者的女性的左、右侧髂总静脉受压面积均小于男性,差异均有统计学意义(P值均＜0.05),而狭窄率差异均无统计学意义(P值均＞0.05)。(3)左、右侧髂总静脉狭窄程度≥25%和≥50%时,男女性别构成差异均无统计学意义(P＞0.05)。(4)髂静脉压迫分型:Ⅰ型,左髂总静脉单一压迫占20.5%(41/200);Ⅱ型,左髂总静脉双重压迫,占36.5%(73/200);Ⅲ型,左右髂总静脉双侧压迫,占23.5%(47/200)、Ⅳ型,其他压迫类型,占19.5%(39/200)。各型间年龄、性别、狭窄率构成比较,差异均无统计学意义(P值均＞0.05),压迫点个数比较差异有统计学意义(P＜0.01)。结论 无下肢症状的髂静脉受压人群MSCT多平面重建显示髂静脉受压部位不固定,左侧髂总静脉受压发生率最高,其次是右侧髂总静脉受压,可将髂静脉受压情况分为四种类型(Ⅰ~Ⅳ型),其中以Ⅱ型左髂总静脉双重压迫最为常见。     

Anomalous veins of the retroperitoneum: clinical considerations

A case of complex anomalies (variations) of the veins of the retroperitoneum in a 57 year old male cadaver is presented. The anomaly involved a double inferior vena cava, with the left suprarenal v. draining into the left vena cava and the right testicular v. drained into the right renal v.. There was also no left common iliac v., with the left external iliac v. draining into the left vena cava and the left internal iliac v. into the right common iliac v.. Although duplication of the inferior vena cava has previously been reported the present case is interesting because of the complexity of the associated anomalies.     

Anomalous veins of the retroperitoneum: clinical considerations

Abstract: A case of complex anomalies (variations) of the veins of the retroperitoneum in a 57 year old male cadaver is presented. The anomaly involved a double inferior vena cava, with the left suprarenal v. draining into the left vena cava and the right testicular v. drained into the right renal v., There was also no left common iliac v., with the left external iliac v. draining into the left vena cava and the left internal iliac v. into the right common iliac v.. Although duplication of the inferior vena cava has previously been reported the present case is interesting because of the complexity of the associated anomalies.     

Sectional anatomy of the adrenal gland in the coronal plane

To provide practical anatomic data for the imaging diagnosis and surgical treatment of adrenal disease, we investigated the anatomy of the adrenal gland and its relationships to regional structures using 31 sets of serial coronal sections of upper abdomen of Chinese adult cadavers and correlated coronal magnetic resonance (MR) images of ten upper abdomens of adult healthy volunteers and coronal reconstructed multislice spiral computed tomography (MSCT) images of five patients without lesions in the adrenal gland. The adrenal glands were visualized mainly on the successive coronal sections between 18 mm anterior to the posterior margin of inferior vena cava and 24 mm posterior to the posterior margin of inferior vena cava. In general, the left adrenal gland was visualized two sections earlier than the right adrenal gland. On the plane through the anterior parts of bilateral renal hili (A₁₈), the appearance rate of bilateral adrenal glands was 100%, and the maximal measurements of bilateral adrenal glands were visualized. The length, width, thickness of right adrenal body, thickness of medial limb and lateral limb were, respectively, 34.02 ± 2.12 mm, 10.91 ± 0.89 mm, 5.82 ± 0.26 mm, 2.78 ± 0.08 mm, 2.62 ± 0.06 mm, whereas the measurements of left adrenal gland were 28.31 ± 2.46 mm, 18.40 ± 1.06 mm, 6.84 ± 0.24 mm, 3.02 ± 0.08 mm, 2.86 ± 0.07 mm, respectively. The coronal plane has superior advantage in showing the bilateral adrenal glands. The shapes of adrenal glands are various, whereas the range of adrenal thickness is quite narrow. The thickness of adrenal medial and lateral limbs, especially the thickness of lateral limb are useful for the diagnosis of the bilateral adrenocortical disease.     

The hepatic veins: Anatomy and classification on single slice spiral CT in North Indian population

AimsTo find out the normal pattern of hepatic veins in the North Indian population and to categorize them.MethodsThe present study was conducted on 100 patients whose spiral CT abdomen was performed for various medical conditions in the department of radiodiagnosis.ResultsFour categories were recognized. Category-1, when right hepatic vein drains independently into the inferior vena cava whereas middle and left hepatic veins join together to form a common trunk before draining into the inferior vena cava. It was observed in 74% patients. Category-2 was observed in 2% patients, where right & middle hepatic veins join to form a common trunk and left hepatic vein drain independently into the inferior vena cava. Category-3 was observed in 21% patients, where all the three major hepatic veins drain independently into the inferior vena cava. Category-4 was observed in 3% patients, where all the three major hepatic veins join together to form a common trunk before draining into the inferior vena cava.ConclusionsCategory-1 is the most common pattern of major hepatic vein drainage found in the North Indian population. The present study also concluded that single right, middle and left hepatic vein is the most common pattern of hepatic veins present in the North Indian population. Caudate lobe is drained by more than one vein in majority of North Indians. Also superomedial vein, right accessory vein and inferior right hepatic vein are the most common accessory veins present in the North Indian population.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

下腔静脉滤器回收后血管形态改变的CT静脉造影研究

目的 探讨下腔静脉滤器回收后肾下段下腔静脉CT静脉造影(CTV)血管壁形态的改变,并分析相关影响因素。方法 回顾性研究。纳入2015年1月-2018年2月在北京积水潭医院血管外科下腔静脉滤器回收后规范抗凝治疗70例患者的下腔静脉CTV图像为滤器组,男34例、女36例,年龄17~79(48.11±13.86)岁;在北京积水潭医院下腔静脉CTV数据库中随机抽取40例非血栓性疾病患者为对照组,男23例、女17例,年龄18~70(46.70±12.16)岁。在下腔静脉CTV图像上测量并比较两组下腔静脉最小直径和肾静脉开口下方1 cm平面参考直径的差异;观察滤器组肾下段下腔静脉壁有无增厚,应用logistic回归分析其影响因素。结果 两组患者的性别、年龄差异均无统计学意义(P值均＞0.05)。滤器组和对照组下腔静脉参考直径分别为(16.0±2.6)、(20.2±2.4) mm,最小直径分别为(13.0±3.6)、(19.3±2.3)mm,差异均有统计学意义(t=8.267、10.032,P值均＜0.01)。滤器组35.7%(25/70)的患者血管壁局限性或环状增厚,下腔静脉最小直径为(10.3±3.6)mm; 64.3%(45/70)患者没有血管壁增厚,下腔静脉最小直径为(14.5±2.5)mm,差异有统计学意义(t=5.330, P＜0.01)。血管壁增厚患者与无增厚患者的下腔静脉血栓形成、下腔静脉参考直径差异均有统计学意义(χ²=6.459, t=3.794, P值均＜0.05);logistic多因素分析显示,下腔静脉血栓形成和下腔静脉参考直径是下腔静脉壁增厚的独立影响因素(OR=5.410、1.500,P值均＜0.01)。结论 滤器回收后下腔静脉会出现不同程度的狭窄和血管壁增厚,下腔静脉血栓形成和较小的下腔静脉参考直径明显增加下腔静脉壁增厚的风险。