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观察34个正常人离体肝脏标本的肝、门静脉主支的立体空间关系,为建立肝、门静脉内支架分流提供解剖学依据。材料与方法:34个新鲜离体肝脏标本(剥制标本30个、铸型4个),并与10例肝硬化的肝、门静脉DSA影像学资料进行对照分析。结果:肝硬化的门静脉长度缩短、管内径变小,平均右支长度较正常缩短7.5mm、管内径变小2.3mm、左支长度缩短3.4mm、管内径变小0.9mm;肝、门静脉间距缩小、角度加大,平均肝右静脉至门静脉右支(RHV—RPV)间距缩小4.5mm、角度加大21.6,肝中静脉至门静脉左支(MHV—LPV)间距缩小7.0mm、角度加大26.9°。结论:TIPS与治疗的理想穿刺路径是RHV—RPV,其次为MHV—LPV。门静脉分叉部位于肝实质内23例(占69.1％)、肝实质外11例(占30.9％)、且下壁裸露,位于肝动脉前上方,应避免在门脉分叉部穿刺,以防损伤肝动脉或肝外门静脉引起腹腔内出血。
Observe the spatial relationship between the main branch of liver and portal vein in 34 normal human liver specimens to provide anatomical basis for the establishment of hepatic and portal vein shunt. MATERIALS AND METHODS: Thirty-four freshly isolated liver specimens (30 stripped specimens and 4 casts) were compared with DSA imaging data of 10 patients with liver cirrhosis and portal vein. Results: The length of the portal vein of cirrhosis was shortened, the diameter of the tube was reduced, the average right branch length was shortened by 7.5mm, the diameter of the tube was reduced by 2.3mm, the length of the left branch was reduced by 3.4mm, the diameter of the tube was reduced by 0.9mm, the distance between liver and portal vein was reduced (RHV-RPV) was reduced by 4.5mm and the angle was increased by 21.6. The distance between the MHV-LPV and the MHV-LPV was reduced by 7.0mm and 26.9 ° respectively . Conclusion: The ideal route of TIPS and treatment is RHV-RPV, followed by MHV-LPV. Portal vein bifurcation in the liver parenchyma in 23 cases (69.1%), 11 cases of extrahepatic plexus (30.9%), and the lower wall exposed, located in the anterior hepatic artery, should avoid puncturing the portal vein to prevent Damage to the hepatic artery or extrahepatic portal vein caused by intra-abdominal bleeding.