多支肝管1例

<正>在解剖一成年女性尸体时,见其有4支肝管汇合成肝总管,报道如下:这4支肝管从左至右,分别是:①肝左管,外径6.0mm,长0.8cm。②左副肝管,外径3.0mm,长0.5cm。左     

新生儿肝外胆道的测量及其临床应用

对50具经常规固定的新生儿尸体的肝左、右管、肝总管、胆囊管及胆总管的长度、管腔的内、外径及相关的角度作了系统的测量和统计,并讨论了有关临床应用和注意事项。新生儿胆汁淤滞症发病较多,据临床诊断70～80％的新生儿患有先性胆道闭锁或肝炎综合症。多数患者需行肝胆手术,但为新生儿胆道治疗提供的形态学资料尚少,相差较大且不系统,尤其对各段胆道的内径迄无报道。为此我们选用50例新生儿尸体对胆道的长度、内、外直径及相关的角度等进行了系统的观察和测量提供临床参考。     

左肝管全程剖开胆肠吻合术的应用解剖学研究

左肝管全程剖开手术,必须熟悉左肝管与邻近血管的局部解剖关系.为此我们用 ABS 丙酮溶液灌注塑型了6具新鲜成人尸肝脏,解剖40例(成人30,儿童10)肝脏标本,测量了左肝管长度和管径,左肝管与肝总管夹角。全程剖开左肝管与右肝管,并观察左肝管与右肝管、左肝动脉、门静脉左干和肝圆韧带的关系,提出了右肝管全程剖开手术方法和注意事项。     

胆囊下肝管的解剖及其临床意义

对135例屍体中出现的15例胆囊下肝管进行了研究,其出现率为11.1%,全部均为单支,位于胆囊窝右侧。胆囊下肝管最大外径5mm,最长5cm,与肝外胆道汇合的形式有三种,分别注入右肝管及肝总管内。本文针对胆囊下肝管来源于肝右前叶胆囊窝内的浅层肝管,提出临床上剥离胆囊时应注意的要点。     

肝右管变异1例

在解剖一具约 60岁左右的男性尸体标本时 ,见其右肝管为 3支型变异 ,现报道如下 :在肝门下方右肝管 3支型 (分别辊称为上、中、下支 ,附图 )。上支肝右管为肝右管主干 ,长 11.9ｍｍ ,外径为 5.9ｍｍ ,与肝左管汇合成肝总管 ;中支肝右管长为 19.8ｍｍ ,外径为 3.0ｍｍ ,注入到肝总管中段 ;下支肝右管长为 2 5.5ｍｍ ,外径为 3.4ｍｍ ,注入到肝总管下段。胆囊管长为 17.8ｍｍ ,外径为 3.9ｍｍ。肝总管长为 33.5ｍｍ(从右上肝管与左肝管汇合处到肝总管与【作者简介】王鹏 (1 975 - ) ,女 (回族 ) ,天津人 ,助教 ,学士 ,主要从事解剖学的教学及…     

第一肝门的腹腔镜肝脏手术入路解剖学研究

目的:为腹腔镜肝脏外科提供第一肝门的应用解剖及手术入路设计。方法:成人尸体肝脏标本30例结合临床手术入路设计,研究肝门静脉主干及其属支的管径、汇合形式及分支直径、长度(从分叉至进入肝实质),横沟的长度、门静脉分叉点与肝方叶尖、尾状叶尖的距离。观察肝门静脉左、右支在横沟内与左、右肝动脉及肝左、右管的伴行关系。结果:①肝门静脉在胰颈或胰体之后由肠系膜上静脉、脾静脉[直径分别为(11.42±2.85)mm、(7.91±3.06)mm]汇合而成。其汇合类型分为3型;②横沟呈槽状,长度为(4.19±0.36)cm;③肝门静脉左支长为(1.45±0.17)cm,直径为(11.97±1.65)mm;④门静脉右支长为(1.57±0.05)cm,直径为(11.75±0.98)mm。结论:腹腔镜下解剖分离第一肝门是可行的;肝门阻断入路操作简单,效果切实;还可以进行手术区域的肝门管道预处理及肝门静脉保护。     

肝外胆道的临床应用解剖学观测

目的观测肝外胆道解剖结构，为临床肝外胆道手术提供形态学依据。方法解剖30具甲醛固定的成人尸体．观察肝外胆道的形态，测量肝外胆道的外径、长度及各管道之间的夹角。结果肝左管细、直、略短，与肝总管延长线夹角较小；肝右管粗、斜、略长，与肝总管延长线夹角较大；肝左、右管汇合点距肝门较近；副肝管出现率高，胆囊下肝管较少见；胆囊管、肝总管汇合方式多为角形或平行型。在横断面上，胆囊纵轴与过脊柱椎体中心的水平线夹角约为45°。结论肝外胆道变异较多，手术者只有熟悉掌握肝外胆道手术正常解剖结构并了解可能出现的变异，才能减少术中胆道损伤。     

腹腔干及其分支变异1例

解剖1具老年男尸,发现其腹腔干及其分支变异,对腹腔干及其各级分支的起点、长度及管径作了观测,为积累解剖学资料和上腹部外科手术提供参考. 胃左动脉从腹腔干前壁发出后分为两支,分别从上方、左侧行向胃小弯,分布至胃壁;在胃左动脉起点的右侧,左副肝动脉[1,2]从腹腔干直接发出,紧贴腹后壁及肝左叶后部进入肝实质,长度62 mm,管径1.8mm(图1).在胃左动脉起点下方1mm右侧,肝总动脉直接起自腹腔干前壁,向肝门走行过程中,分为右副肝动脉和肝固有动脉两个分支,右副肝动脉长55mm,管径1.7 mm,在胆囊管和肝总管的后方入肝门,并穿入肝实质;肝固有动脉长18 mm,分为左、右两支,其中右支发出胆囊动脉.肝固有动脉左、右支及胆囊动脉均在门静脉和肝总管前方入肝门(图2).     

肝总管、胆总管扩张增粗1例

笔者在带领学员局部解剖操作过程中,发现1具男尸肝总管、胆总管扩张增粗。此类标本较为少见,现报道如下。 此具尸体男性,年龄约75岁,身长175cm。外形较完整,无明显畸形。解剖观察腹腔,可见明显的肝总管、胆总管扩张增粗,经游标卡尺测量：左肝管自然外径12．8mm;右肝管自然外径12．1mm;肝总管自然外径32．1mm;胆囊管自然外径7．6mm;胆总管自然外径33．8mm（图1）。     

腹腔干分支变异一例

笔者在解剖1具成年男性尸体时,发现其腹腔干分支有较大变异,为积累资料及为临床提供参考,报道如下. 腹腔干外径5.63 mm,长2.50 cm,在第12胸椎体前方由腹主动脉前壁发出,分为脾动脉、胃左动脉、肝总动脉和变异肝固有动脉右支.其中脾动脉外径4.51 mm,胃左动脉外径3.06 mm,两者走行、分布与正常无异.变异肝固有动脉右支外径2.81 mm,从腹腔干发出后于肝门静脉和胆总管后面向右上方走行,在胆囊管与肝总管汇合处进入胆囊三角,然后沿肝总管右侧向上走行,经肝门右侧进入肝内.该动脉在距肝门1.00 cm处发出胆囊动脉,外径1.58mm.     

Anatomical Variations in the Extra Hepatic Biliary Ductal System

The aim of the study was to study the various anatomical variations occurring in the extra hepatic biliary ductal tract. The study material consisted of 40 adult specimens of liver, gallbladder with duodenum collected enmass from the forensic department. Out of the 40 specimens dissected we came across accessory hepatic ducts all arising from the right lobe of liver. These accessory right hepatic ducts drained into the common hepatic duct at different levels. Knowledge of these accessory ducts confirmed by various intra operative cholangiographic procedures is necessary for avoiding any serious complications during surgery. Hence we conclude that this study will be a useful guideline for the operating Surgeons and Radiologist working in that area.     

Calot三角的应用解剖学

本对50例成年尸体Calot三角的形状，内容和位置关系作了调查，并进行了讨论，尤其是对于胆囊动脉在Calot三角内的有关情况作了探讨。     

肝左管行程定位与临床应用

目的 确定肝管的行程,为显露肝左管及肝方叶切除提供应用解剖学基础。方法 本文对64例成人肝标本中肝左管的长度及毗邻关系进行测量。结果 肝左管位于肝方叶后1/3范围,相当于肝门左半内横行或斜行。其起始部大多贴近肝圆韧带裂,占84.37×10~(-2);其余向右偏离该裂一段距离,距肝方叶脏面0.83士0.52cm(0.～1.6).距肝方叶后面0.39±0.29cm(0～0.1)。结论 肝左管位于肝方叶的后1/3,较恒定,是肝左管行程定位的基础,可作为手术显露肝左管及肝方叶切除的参考。     

经瘘管胆道纤维镜取石或造影的应用解剖

为胆道纤维镜取石或造影插管提供有关解剖数据,在20个肝脏铸型标本和20个成人肝脏标本上,对各级胆道进行了观测。     

复杂性肝胆管结石及狭窄的外科手术分析

目的探讨复杂性肝胆管结石及狭窄的手术治疗方法。方法回顾性分析我院2005年1月至2010年1月60例接受手术治疗的复杂性肝胆管结石及狭窄患者的病例,观察术后并发症及使用消炎利胆片或中医中药后结石复发情况。结果 60例患者手术均成功,术后经B超、T管照影以及CT检查发现有11例有结石残余,经T管窦道用胆道镜取结石3~8次后11例患者结石均取尽;手术后胆道出血1例,伤口感染1例,经药物保守治疗后均治愈。离院后随访,有1例在术后1年内复发,其余未复发且经B超检查未发现异常。结论外科手术是治疗复杂性肝胆管结石及狭窄的有效方法。     

肝尾状叶脉管构筑的应用解剖

应用55例成人肝剥离标本及45例胎儿、新生儿肝管道铸型,研究了肝尾状叶的鞘系及静脉回流。尾状叶有两个恒定的蒂、接受左、右侧鞘系的双重供应,以左侧为主;而尾状突主要由右后叶鞘系分布。15例肝铸型标本的尾状叶左、右侧动脉形成吻合弓。尾状叶动脉供应形式可分为三种,静脉可分为三型并直接汇入下腔静脉。由于血管吻合的存在,在病理状态下,尾状叶也应是沟通门一腔静脉的桥梁。     

Apoptosis of bile duct epithelial cells in hepatic allograft rejection

Liver biopsy remains the 'gold standard' for monitoring rejection in liver transplant patients. Portal inflammation, bile duct damage and endothelialitis are recognized features of hepatic allograft rejection. The pathogenesis of the bile duct injury during rejection, however, remains unclear. To define the mechanism of bile duct damage, we studied the light- and electronmicroscopic appearance of hepatic tissue from selected patients in whom allograft failure was solely due to rejection. Of the 25 orthotopic liver transplant rejection cases examined, 17 were mild, seven were moderate and one was severe rejection. Light microscopy examination of the damaged bile duct epithelium revealed evidence of apoptosis which was confirmed by electronmicroscopy. Furthermore, there appeared to be a positive correlation between the grade of rejection and the number of apoptotic cells. Also included in the study were 13 cases of chronic active hepatitis and 10 normal livers which showed the least apoptotic cells. We conclude that the identification of apoptotic cells in damaged bile ducts in allograft biopsies might be helpful in the diagnosis of rejection and in assessment of the severity of rejection.     

带血管蒂肝圆韧带瓣转位修复胆管缺损的应用解剖

观察30例成人肝圆韧带标本,肝圆韧带呈纤维条索样,内含少许不规则残腔。肝圆韧带的血液供养主要来自肝右动脉的分支及伴行的附脐静脉。由于肝圆韧带近端紧邻胆管,远端易于游离,提出了带血管蒂的肝圆韧带瓣作为自体生物材料来修复肝外胆管的缺损,并讨论了该术式有关的应用解剖要点。     

A Study on the Anomalies of Gallbladder and Associated Structures

The gallbladder is a piriform structure on the undersurface of liver. It collects bile from the liver to concentrate it and to store it. The gallbladder has a cystic duct which joins the common bile duct and through these ducts bile passes into the duodenum. There is usually a single gallbladder (arising from the cystic bud of hepatic diverticulum) with one cystic duct supplied by a cystic artery taking origin from the right hepatic artery. But in few persons there are double gallbladder or double cystic ducts or different variations in the origin and course of cystic arteries. A study was undertaken in 2006 to detect the anomalies of these structures among the people Kolkata (a metropolis of eastern part of India), by dissection of cadavers. This study was conducted from the year 2006 to 2009 in the Department of Anatomy of Calcutta National Medical College and in other medical colleges of Kolkata. Three cases of double gallbladder and few other variations like double cystic duct were found in this study. These findings will help the clinicians (specially the surgeons, radiologists of the eastern part of India) to undertake any investigative or surgical procedure in the region of extra hepatic biliary apparatus. This study will enhance our knowledge not only surgical Anatomy, but also in embryology and in gross anatomy.