胆囊床内血管的应用解剖

目的：为腹腔镜胆囊切除手术提供形态学基础.方法：对128例肝脏标本进行解剖,观察胆囊床内血管的位置、行程,测量其在胆囊床内的长度和直径.结果：胆囊床内血管有：（1）胆囊动脉深支及分支,占71.1%（91例）;（2）肝中静脉及其属支,占12.5%（16例）,其突入形式分①肝中静脉主干,②右前叶支、或左内叶支、或两者一起突出,③右前叶支属支、左内叶支属支、或两者一起突出3种类型;（3）肝门静脉右支及其分支,分主干和分支两类,主干占39.8%（51例）,肝门静脉右支的分支占14.8%（19例）;（4）肝门静脉左支的分支,占2.34%（3例）;（5）胆囊静脉,在胆囊附着面有小静脉与肝中静脉、肝门静脉左、右支的分支相连.结论：切除胆囊时应注意胆囊床左、右缘,以及具有肝门右切迹的病例,保护突入胆囊床内的肝中静脉及其属支,以防止出血.

Applied anatomy of the inner blood vessel of the gallbladder bed

Objective:To providem orphologicaldata forlaparoscopic cholecystectom y.M ethods:To m akean anatomic observation on 128 liver specimens, observe the location of the blood vessel and its course, andmeasure its length and diameter in the gallbladder bed. Results: The blood vessels in the gallbladder bedincluded: (1) the deep branch of the cystic artery, making up 71.1% (91 cases); (2) the intermediate hepatic veinand its branches with three intruding types, 12.5% (16 cases);(3) the right branch of the hepatic portal vein andits branches, 39.8%(51 cases) and 14.8%(19 cases) respectively;(4) branches of the left branch of the hepaticportal vein, 2.34%(3 cases);(5) the cystic vein, connected with the intermediate hepatic vein and the branchesof the right and left branches of hepatic portal vein at the adhesive surface of the gallbladder. Conclusions:Attention should be paid to the left and right edge of the gallbladder bed and those cases with right notch, whileprotection during cholecystectomy should be provided for the middle hepatic vein and its branch projected intothe gallbladder bed in order to avoid bleeding.