肝后下腔静脉间隙和肝外血管在半肝切除术中的临床解剖及应用研究

目的探讨肝后下腔静脉(RHIVC)前间隙和肝外进、出肝血管在半肝切除术中的临床解剖学意义。方法对21例通过RHIVC前间隙解剖与选择肿瘤侧半肝进、出血管解剖阻断技术(slective hepatic vascul exclusi,SHVE)和22例Pringle阻断法的半肝切除术,同时对半肝切除一侧RHIVC的肝短静脉(shorthepatic veins SHVs)数目和分布情况进行分析。结果在SHVE组患者解剖RHIVC前间隙和将肿瘤侧肝动脉、肝门静脉、肝静脉解剖分离予以结扎或置阻断带过程顺利,无发生RHIVC或肝静脉损伤。在本组43例半肝切除术中,SHVs数量3～4支44.2%,6～8支55.8%,其中SHVs位于RHIVC前壁中轴线占11.6%。结论由于RHIVC前间隙无/或潜在少,且细小的SHVs,通过RHIVC前间隙解剖与SHVE技术,对于巨大肝肿瘤的半肝切除术具有重要的临床实用意义。

Applied anatomy of retrohepatic inferior vena cava and extrahepatic vessels in hemibepatectomy

Objective　To explore anatomic data of the anterior lacune between the retrohepatic inferior vena cava (RHIVC) and the liver and extrahepatic vessels, and provide clinical reference for the procedure of hemibepatectomy.　Methods　43 patients were divided into 2 groups. 21 patients underwent selective hepatic vascular exclusion (SHVE) by dissecting the lacune between the RHIVC and the liver, while 22 patients underwent Pringle's hepatic vascular occlusion for hemihepatectomy. Meanwhile, the RHIVC distribution and the number of short hepatic veins (SHVs) were also analyzed during the operation.　Results　For patients of group SHVE, the exploration of the lacune, the isolation and ligation of hepatic artery, hepatic vein, and hepatic portal vein of tumor involved side were smoothly during the process, with no injury of RHIVC or hepatic veins. For all patients who underwent hemihepatectomy, there were 3 to 4 branches of SHVs(44.2%), or 6 to 8(55.6%). For 11.6% patients, the SHVs located at the medial axis of the anterior wall of the lacune between the RHIVC and the liver.　Conclusions　Since there is a potential nonvascular zone at the longitudinal axis of the lacune between the RHIVC and the liver, it is important to anatomize the lacune between the RHIVC and the liver and apply the SHVE technique in giant hepatic carcinoma resection.