肝静脉与门静脉的解剖及其在经颈静脉肝内门体分流术中的应用

目的：探讨肝静脉与门静脉的解剖及在经颈静脉肝内门体分流术（TIPS）中的应用。方法：在PUBMED、CNKI及维普等数据库中，查阅近年来国内外有关肝静脉、门静脉的正常解剖与变异及其在TIPS中应用的文献，进行分析总结。结果：肝静脉系统主要由肝右静脉、肝中静脉、肝左静脉3支组成，肝左静脉发生变异最多，肝中、右静脉变异相对少见。门静脉在肝门处进入肝脏，以分为左支和右支两主干这一类型居多，其解剖形态因地区、种族等因素而有差异。肝静脉和门静脉呈向后向上与向前向下的空间关系，经典TIPS是从肝右静脉距下腔静脉入口约2cm处向门静脉分叉部或右支内穿刺建立分流道。结论：肝静脉、门静脉的正常解剖与变异及其空间关系对顺利完成TIPS的操作至关重要。熟悉肝静脉、门静脉正常解剖和变异可提高TIPS的成功率，减少和避免并发症的发生。

Anatomy of Hepatic Venous and Portal Venous and Its Application in Transjugular Intrahepatic Porto- systemic Shunt

Objective：To study the anatomies and space structures of the hepatic vein and portal veinas well as its application in Transjugular intrahepatic portosystemie shunting （TIPS）. Methods ：To search the litera tures concerning normal anatomy and variation of hepatic vein and portal vein at home and abroad in recent years in the PubMed, Cnki and VIP database, to analyze and summarize them. Results：Hepatic venous system was composed of the right hepatic vein, middle hepatic vein and the left hepatic vein. The variation happened mostly in the left he patic vein, and relatively rare in the right hepatic vein and middle hepatic vein. Portal vein entered the liver at the hepatic hilum, and mostly type was divided into the left branch and the right branch from the trunk, which varied from region, race and other factors. The spatial relationship of hepatic and portal veins was forward down. Classic TIPS was punctured from 2 cm away from the opening of the right hepatic vein to the bifurcation or the right branch of the portal vein. Conclusions ： Anatomies and spatial relationship of the hepatic vein and portal vein is essential to per form TIPS successfully. Being familiar with anatomy and variations of hepatic vein and portal vein can improve the success rate of TIPS technique, with reducing and avoiding the related complications.