成人再通肝圆韧带与自体门静脉及肠系膜上静脉长度及管径对比研究

目的将成人再通肝圆韧带（LTH）长度及管径与自体门静脉及肠系膜上静脉进行对比分析,研究其用于自体门静脉（PV）及肠系膜上静脉（SMV）节段性替代的可行性。方法随机选取25例成人上腹部手术患者,术前行强化CT检查,运用血管重建技术重建门静脉及肠系膜上静脉,在重建图像上测量其长度,并自近肝端向远肝端,于每厘米中部依次测量其管径。术中切取其肝圆韧带并进行扩张再通,30cmH2O压力下测量再通后肝圆韧带的长度及其每厘米管径。将两者的长度及对应部位的管径进行对比分析。结果门静脉与肠系膜上静脉的长度之和为7.32～11.1（9.40±1.32）cm,门静脉最大平均直径为8.8～13.9（11.83±1.56）mm,肠系膜上静脉最小平均直径为5.0～8.1（7.18±0.92）mm。再通肝圆韧带的长度为7.6～10.8（9.01±0.97）cm,最大平均内径为10.0～16.1（12.55±1.81）mm,最小平均内径为5.6～7.5（6.47±0.80）mm。70%以上的病例其肝圆韧带与自体门静脉及肠系膜上静脉管径的差值波动范围在30%以下。再通肝圆韧带长度及对应测量位置管径与门静脉或肠系膜上静脉无统计学差异。结论肝圆韧带可扩张再通,再通肝圆韧带具有与门静脉及肠系膜上静脉相匹配的长度及管径,具备了用于门静脉及肠系膜上静脉节段性修复重建的解剖学基础。

Comparative study of the length and diameter in recanalized adult ligamentum teres hepatic and their auto-portal vein and superior mesenteric vein

Objective To investigate the length and inner diameter of the Ligamentum Teres Hepatic(LTH) compared with auto-portal/superior mesenteric vein, to provide evidences of using the Ligamentum Teres Hepatic as vascular graft to reconstruct the portal vein and superior mesenteric vein. Methods Twenty-five patients suffering from laparotomy were selected randomly, all of them had been done strengthen CT examination before laparotomy. With the method of 3D reconstruction of blood vessels in computer, the portal veins and superior mesenteric veins’ length was measured, and every centimeter’s diameter of the veins was measured from the proximal end of liver to the distal end. The Ligamentum Teres Hepatic of the 25 patients were excised, and the LTH were dilated with the mechanical method combined water-filling. The length of dilated part and every centimeter’s inner diameter of the LHT were measured at the pressure of 30 cm H2O. Then we compared the length and inner diameters of LTH with portal-superior mesenteric vein. Results At the pressure of 30 cm H2O, the mean length of the dilated Hepatic Ligamentum Teres was 7.6-10.8(9.01 ± 0.97) cm, the mean of the cranial inner diameter was 10.0-16.1(12.55 ± 1.81) mm, the caudal inner diameter was 5.6-7.5(6.47 ± 0.80) mm. The mean length of the potal vein and superior mesenteric vein was 7.3-11.1(9.40 ± 1.32) cm, the mean of the potal veins’ maximal diameter was 8.8-13.9(11.83 ± 1.56) mm, the mean of the superior mesenteric veins’ minimal diameter inner diameter was 5.0-8.1(7.18 ± 0.92) mm. Conclusions The Ligamentum Teres Hepatic can be recanalized, the length and diameter of the recanalized HTL are similar as portal-superior mesenteric vein. Therefore, the recanalized HTL can be used as a vascular graft to reconstruct the potal/superior mesenteric vein.