64-MSCT重建肝门静脉左支的临床解剖学研究
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摘要
目的:64-MSCT重建肝门静脉左支,观测肝内门静脉左支的形态特征和分支分布规律,以及左半肝的分叶分段,为诊断和治疗肝脏疾病提供更为详尽的形态学资料。方法:100例无肝脏疾病的成人64-MSCT增强扫描肝门静脉数据,重建肝门静脉左支,观察肝门静脉左支的形态结构,测量其主干及主要分支的相关数据并进行统计学分析。结果:肝门静脉左支横部的长和中点内径分别为(29.50±6.51) mm、(7.70±1.55)mm,矢状部的长度和中点内径分别为(18.74±4.22)mm、(6.98±1.41)mm;角部角度为(118.16±13.73)°。左外叶上段支长为(36.31±16.87)mm,其1/2处的内径为(2.93±0.87)mm;左外叶下段支长(28.46±13.56)mm,其1/2处的内径为(3.21±0.87)mm。左内叶支形态变化较大。结论:肝内门静脉主干左支的长度、内径和角部的角度变动范围较大,除供应左半肝外,还可发出分支至右前叶。其分支分布直接影响到左半肝分叶分段,具体定界应结合实际情况而定。
Objective :To observe the morphological characteristics and branch distribution of the left branch of the portal vein, and the left hepatic lobe segmentation, and to provide more detailed morphological data for the diagnosis and treatment of liver diseases. Methods :100 adult cases without liver disease by 64-MSCT enhanced scan in the hepatic portal vein, the morphological structure of the left branch of the portal vein were observed, and the data of the trunk and the main branch were measured and analyzed statistically. Results :The length and midpoint diameter of pars transverses on the left stems were(29.50±6.51) mm and(7.70±1.55) mm; the length and midpoint diameter of pars sagitalis on the left stems were(18.74±4.22) mm,(6.98±1.41) mm; the pars angularis was(118.16±13.73)°. The length of left lat. superior segmental branch was(36.31±16.87) mm, the diameter of midpoint was(2.93±0.87) mm.The length of left lat. inferior segmental branch was(28.46±13.56) mm, and the diameter of midpoint was(3.21±0.87)mm. The shape of the endite branch of left changed greatly. Conclusion : The scope of change in diameter, length and angle of the left branch of the portal vein is large in that it can not only supply the left hemiliver but also issue the branch to the right anterior. The branching directly affects the left lobectomy and segmentectomy. The location of the branches should be based on the specific condition.
Objective :To observe the morphological characteristics and branch distribution of the left branch of the portal vein, and the left hepatic lobe segmentation, and to provide more detailed morphological data for the diagnosis and treatment of liver diseases. Methods :100 adult cases without liver disease by 64-MSCT enhanced scan in the hepatic portal vein, the morphological structure of the left branch of the portal vein were observed, and the data of the trunk and the main branch were measured and analyzed statistically. Results :The length and midpoint diameter of pars transverses on the left stems were(29.50±6.51) mm and(7.70±1.55) mm; the length and midpoint diameter of pars sagitalis on the left stems were(18.74±4.22) mm,(6.98±1.41) mm; the pars angularis was(118.16±13.73)°. The length of left lat. superior segmental branch was(36.31±16.87) mm, the diameter of midpoint was(2.93±0.87) mm.The length of left lat. inferior segmental branch was(28.46±13.56) mm, and the diameter of midpoint was(3.21±0.87)mm. The shape of the endite branch of left changed greatly. Conclusion : The scope of change in diameter, length and angle of the left branch of the portal vein is large in that it can not only supply the left hemiliver but also issue the branch to the right anterior. The branching directly affects the left lobectomy and segmentectomy. The location of the branches should be based on the specific condition.
引文
[1]Strong R W,Lynch S V,Ong T H,et al.Successful liver transplantation from a living donor to her son[J].N Engl J Med,1990,322(21):1505-1507.
[2]刘文国,初国良,何宏文,等.肝门静脉肝内分支的形态观测及临床意义[J].中国局解手术学杂志,2005,14(4):225-226.
[3]李建军,杨维竹,江娜,等.经导管选择性门静脉栓塞治疗肝癌的临床应用[J].世界华人消化杂志,2004,12(10):2291-2294.
[4]徐礼治,汪继勇,汪益民,等.肝尾状叶切除术的研究进展[J].肝胆胰外科杂志,2015,27(1):82-83.
[5]郭俊武,秦伟,戴勇.肝尾状叶应用解剖学研究进展[J].临床肝胆病杂志,2011,27(11):1229-1232.
[6]汪坤菊,秦将钧,黄海伟,等.尾状叶门静脉的应用解剖学[J].解剖学杂志,2009,32(2):254-256.
[7]张慧,周庭永,钱学华,等.肝门静脉左支的临床解剖学[J].解剖学杂志,2011,34(1):95-97.
[8]韩永坚.临床解剖学丛书(腹,盆部分册)[M].北京:人民卫生出版社,1992:6.
[9]王丹,夏仁品,杨世昆,等.“2步分层法”腹腔镜左外叶肝切除的解剖学基础和临床应用[J].中国临床解剖学杂志,2018,36(1):82-85.
[10]蒲淼水,钟世镇,李忠华,等.左外叶活体肝移植的解剖学研究[J].中国临床解剖学杂志,2003,21(2):143-147.
[11]仇毓东,周建新,冯伟,等.精准肝蒂离断技术在肝细胞肝癌解剖性肝段切除患者中的应用[J].中华肝脏外科手术学电子杂志,2013,2(4):224-229.
[12]谭新华,张文兴,刘鹏,等.腹腔镜下Glisson蒂横断式解剖性肝切除的应用价值[J].中国内镜杂志,2018,24(2):90-93.
[13]段伟东.解剖性肝切除手术切面的确定[J].中国实用外科杂志,2018,38(4):356-360.
[14]何新卫,赵辉,文军,等.解剖式肝段切除术在左肝胆管结石中的应用研究[J].局部手术学杂志,2016,25(6):416-419.
[15]陈海敏,高夫生,方路,等.肝叶血流阻断在右肝解剖性肝切除中的应用:附12例报告[J].中国普通外科杂志2018,27(1):15-21.
[2]刘文国,初国良,何宏文,等.肝门静脉肝内分支的形态观测及临床意义[J].中国局解手术学杂志,2005,14(4):225-226.
[3]李建军,杨维竹,江娜,等.经导管选择性门静脉栓塞治疗肝癌的临床应用[J].世界华人消化杂志,2004,12(10):2291-2294.
[4]徐礼治,汪继勇,汪益民,等.肝尾状叶切除术的研究进展[J].肝胆胰外科杂志,2015,27(1):82-83.
[5]郭俊武,秦伟,戴勇.肝尾状叶应用解剖学研究进展[J].临床肝胆病杂志,2011,27(11):1229-1232.
[6]汪坤菊,秦将钧,黄海伟,等.尾状叶门静脉的应用解剖学[J].解剖学杂志,2009,32(2):254-256.
[7]张慧,周庭永,钱学华,等.肝门静脉左支的临床解剖学[J].解剖学杂志,2011,34(1):95-97.
[8]韩永坚.临床解剖学丛书(腹,盆部分册)[M].北京:人民卫生出版社,1992:6.
[9]王丹,夏仁品,杨世昆,等.“2步分层法”腹腔镜左外叶肝切除的解剖学基础和临床应用[J].中国临床解剖学杂志,2018,36(1):82-85.
[10]蒲淼水,钟世镇,李忠华,等.左外叶活体肝移植的解剖学研究[J].中国临床解剖学杂志,2003,21(2):143-147.
[11]仇毓东,周建新,冯伟,等.精准肝蒂离断技术在肝细胞肝癌解剖性肝段切除患者中的应用[J].中华肝脏外科手术学电子杂志,2013,2(4):224-229.
[12]谭新华,张文兴,刘鹏,等.腹腔镜下Glisson蒂横断式解剖性肝切除的应用价值[J].中国内镜杂志,2018,24(2):90-93.
[13]段伟东.解剖性肝切除手术切面的确定[J].中国实用外科杂志,2018,38(4):356-360.
[14]何新卫,赵辉,文军,等.解剖式肝段切除术在左肝胆管结石中的应用研究[J].局部手术学杂志,2016,25(6):416-419.
[15]陈海敏,高夫生,方路,等.肝叶血流阻断在右肝解剖性肝切除中的应用:附12例报告[J].中国普通外科杂志2018,27(1):15-21.