胎肝血管的解剖及其移植应用

目的观察胎肝的血管特点,探讨在临床带血管的胎肝移植的血管吻合的选择性。方法6～10个月胎龄的死胎33例于手术放大镜下原位解剖胎肝的附属血管,用直尺、卡尺和分割规测量附属血管的外径和长度。结果6～10个月胎龄的胎肝脐静脉的外径为(3.68±0.48)mm～(5.61±0.87)mm,长度为(36.12±4.58)mm～(50.97±7.68)mm;门静脉的外径为(2.31±0.43)mm～(4.16±0.65)mm,长度为(15.62±2.68)mm～(29.03±4.87)mm;肝固有动脉的外径为(1.67±0.82)mm～(2.32±0.98)mm,长度为(14.96±3.03)mm～(25.58±3.85)mm。脐静脉的外径较门静脉的外径粗(P<0.05);门静脉的外径较肝固有动脉的外径粗(P<0.05)。结论在胎肝移植前先结扎静脉导管,以脐静脉替代门静脉吻合,门静脉替代肝固有动脉吻合,更有利于吻合技术操作和供肝的双重血供,更有利于供肝发挥正常的功能。

Anatomic features of vessels of fetal liver and its application in transplantation

Objective To observe the anatomy of fetal liver blood vessel for studying the choice of blood vessels inosculated with fetal liver in the clinical transplantation application. Methods The accessory blood vessel of 33 fetal liver was anatomized at normal position under the operating loupe, then, its length and external diameter measured by a ruler, caliper ruler and compasses. Results In 6～10 months fetal liver, the length of umbilical veins, portal veins and proper hepatic arteries was(36.12±4.58)mm～(50.97±7.68)mm,(15.62±2.68)mm～(29.03±4.87)mm and(14.96±3.03)mm～(25.58±3.85)mm respectively; and the external diameter of them was 3.68±0.48 mm～(5.61±0.87)mm,(2.31±0.43)mm～(4.16±0.65)mm and (1.67±0.82)mm～(2.32±0.98)mm respectively. The external diameter of umbilical veins is more advantageous than that of portal veins (P<0.05). The external diameter of portal veins is larger than that of proper hepatic arteries(P<0.05). Conclusion It is more advantageous to inosculating operation and to the double blood supply of the transplanted fetal liver, and to give full play for the transplanted liver that the vein pipe of the fetal liver is tied before it is transplanted,the portal veins is replaced by the umbilical veins and the proper hepatic arteries is replaced by the portal veins.