CAJ | 학술논문

目的探讨绕肝提拉法肝后隧道建立的临床解剖学依据.方法解剖20具成人尸体肝后下腔静脉标本,收集15例晚期肝炎后肝硬化行背驮式肝移植患者病肝切除后肝后下腔静脉的临床资料,制订肝后隧道路径标准,统计汇入肝后下腔静脉及肝后隧道路径上肝短静脉总数.结果肝短静脉主要从左右两侧汇入肝后下腔静脉,汇入肝后下腔静脉的肝短静脉多集中于中、下1/3段(F=9.188,P＜0.01).在肝后隧道路径上,汇入肝后下腔静脉的肝短静脉主要集中在下1/3段前方,而其他两段分布较少(x2=48.524,P＜0.01).肝硬化组汇入肝后下腔静脉的肝短静脉数与尸检组相比差异无统计学意义(t =0.405,P＞0.05),但肝硬化组肝后隧道常发生解剖结构变异.结论肝后下腔静脉前间隙是一潜在性腔隙,具有独特的解剖学特点,是安全建立肝后隧道的解剖依据.但在晚期肝炎后肝硬化患者手术中应慎用肝后隧道.
목적 탐토요간제랍법간후수도건립적림상해부학의거.방법 해부20구성인시체간후하강정맥표본,수집15례만기간염후간경화행배타식간이식환자병간절제후간후하강정맥적림상자료,제정간후수도로경표준,통계회입간후하강정맥급간후수도로경상간단정맥총수.결과 간단정맥주요종좌우량측회입간후하강정맥,회입간후하강정맥적간단정맥다집중우중、하1/3단(F=9.188,P＜0.01).재간후수도로경상,회입간후하강정맥적간단정맥주요집중재하1/3단전방,이기타량단분포교소(x2=48.524,P＜0.01).간경화조회입간후하강정맥적간단정맥수여시검조상비차이무통계학의의(t =0.405,P＞0.05),단간경화조간후수도상발생해부결구변이.결론 간후하강정맥전간극시일잠재성강극,구유독특적해부학특점,시안전건립간후수도적해부의거.단재만기간염후간경화환자수술중응신용간후수도.
Objective To evaluate the anatomical basis of retrohepatic tunnel used for liver hanging maneuver.Methods The anatomy of inferior vena cava ( IVC ) was studied in 20 healthy adult cadavers and 15 patients with advanced cirrhosis who underwent piggyback liver transplantation to confirm the existence of the path of retrohepatic tunnel and count the number of short hepatic veins draining into retrohepatic IVC.Results Short hepatic veins mainly drain into the IVC on its left and right sides.The number of short hepatic veins that drain into the upper or middle portion of the IVC was significantly more than that into the lower portion ( x2 =48.524,P ＜ 0.01 ).On the path of retrohepatic tunnel,most short hepatic veins that drain into the IVC are located on the front side ( F =9.188,P ＜ 0.01 ).There was no significant difference in the number of short hepatic vein between the groups of liver cirrhosis and that of healthy adults ( t =0.405,P ＞ 0.05 ),but anatomic variation of post-hepatic tunnel is common in liver cirrhotics.Conclusions Retrohepatic tunnel was a potential space and had a unique anatomical feature.The establishment of retrohepatic tunnel by liver hanging maneuver is safe in noncirrhotics.However,in advanced posthepatitic cirrhosis,retrohepatic tunnel should be used with caution.