中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2012年
13期
136-139
,共4页
朱文涛%陈强谱%张兴元%张帆%管清海%张长习%王海涛
硃文濤%陳彊譜%張興元%張帆%管清海%張長習%王海濤
주문도%진강보%장흥원%장범%관청해%장장습%왕해도
圆韧带%解剖学%组织学%静脉重建
圓韌帶%解剖學%組織學%靜脈重建
원인대%해부학%조직학%정맥중건
Round ligament%Anatomy%Histology%Vein reconstruction
目的 研究成人肝圆韧带的再通方法,并对其再通后的解剖学及组织学进行观察,为其临床应用提供依据.方法 成人上腹部手术患者100例,术中切取其肝圆韧带,对其进行扩张再通,测量肝圆韧带的可再通长度,在30 cm H20压力下测量其外径、内径及管壁厚度.随机选取10条再通后的肝圆韧带标本分段取材,进行HE及Verhoeff染色,光镜下观察组织学结构,测定管壁中弹力纤维、胶原纤维及平滑肌含量,并与门静脉及肠系膜上静脉标本进行比较.结果 采用机械与流体静压相结合的方式可使肝圆韧带扩张再通.100条肝圆韧带中,97条扩张再通成功,其平均再通长度(96.61±14.70) mm(70 ～ 130 mm);30 cm H2O压力下,其近肝侧外径平均值为(12.78±1.35) mm(10.90 ～ 17.2 mm),近脐侧为(7.04±1.98)mm(3 ～ 12.1 mm);近肝侧内径平均值为(12.21±1.63) mm(9.9～16.1mm),近脐侧为(5.72±1.32)mm(4.2～7.5mm)；近肝侧壁厚平均值为(0.52 ±0.02)mm(0.48 ～0.55 mm)；近脐侧为(0.20±0.0l) mm(0.19～0.22 mm).HE染色光镜下可见肝圆韧带管壁分内膜、中膜及外膜三层,管腔内面有完整的内皮细胞覆盖,Verhoeff染色可见再通肝圆韧带管壁富含弹力纤维(EF)、胶原纤维(CF)及平滑肌(SM).三种成分含量与正常门静脉及肠系膜上静脉相比无显著性差异.结论 采用机械与流体静压相结合的方式可使成人肝圆韧带再通,再通后可获得长度为96.61 mm,直径为7.04～12.78 mm的管状结构.其管壁组织学结构与正常门静脉及肠系膜上静脉相似.再通后的肝圆韧带具备作为血管移植材料的解剖学和组织学基础.
目的 研究成人肝圓韌帶的再通方法,併對其再通後的解剖學及組織學進行觀察,為其臨床應用提供依據.方法 成人上腹部手術患者100例,術中切取其肝圓韌帶,對其進行擴張再通,測量肝圓韌帶的可再通長度,在30 cm H20壓力下測量其外徑、內徑及管壁厚度.隨機選取10條再通後的肝圓韌帶標本分段取材,進行HE及Verhoeff染色,光鏡下觀察組織學結構,測定管壁中彈力纖維、膠原纖維及平滑肌含量,併與門靜脈及腸繫膜上靜脈標本進行比較.結果 採用機械與流體靜壓相結閤的方式可使肝圓韌帶擴張再通.100條肝圓韌帶中,97條擴張再通成功,其平均再通長度(96.61±14.70) mm(70 ～ 130 mm);30 cm H2O壓力下,其近肝側外徑平均值為(12.78±1.35) mm(10.90 ～ 17.2 mm),近臍側為(7.04±1.98)mm(3 ～ 12.1 mm);近肝側內徑平均值為(12.21±1.63) mm(9.9～16.1mm),近臍側為(5.72±1.32)mm(4.2～7.5mm)；近肝側壁厚平均值為(0.52 ±0.02)mm(0.48 ～0.55 mm)；近臍側為(0.20±0.0l) mm(0.19～0.22 mm).HE染色光鏡下可見肝圓韌帶管壁分內膜、中膜及外膜三層,管腔內麵有完整的內皮細胞覆蓋,Verhoeff染色可見再通肝圓韌帶管壁富含彈力纖維(EF)、膠原纖維(CF)及平滑肌(SM).三種成分含量與正常門靜脈及腸繫膜上靜脈相比無顯著性差異.結論 採用機械與流體靜壓相結閤的方式可使成人肝圓韌帶再通,再通後可穫得長度為96.61 mm,直徑為7.04～12.78 mm的管狀結構.其管壁組織學結構與正常門靜脈及腸繫膜上靜脈相似.再通後的肝圓韌帶具備作為血管移植材料的解剖學和組織學基礎.
목적 연구성인간원인대적재통방법,병대기재통후적해부학급조직학진행관찰,위기림상응용제공의거.방법 성인상복부수술환자100례,술중절취기간원인대,대기진행확장재통,측량간원인대적가재통장도,재30 cm H20압력하측량기외경、내경급관벽후도.수궤선취10조재통후적간원인대표본분단취재,진행HE급Verhoeff염색,광경하관찰조직학결구,측정관벽중탄력섬유、효원섬유급평활기함량,병여문정맥급장계막상정맥표본진행비교.결과 채용궤계여류체정압상결합적방식가사간원인대확장재통.100조간원인대중,97조확장재통성공,기평균재통장도(96.61±14.70) mm(70 ～ 130 mm);30 cm H2O압력하,기근간측외경평균치위(12.78±1.35) mm(10.90 ～ 17.2 mm),근제측위(7.04±1.98)mm(3 ～ 12.1 mm);근간측내경평균치위(12.21±1.63) mm(9.9～16.1mm),근제측위(5.72±1.32)mm(4.2～7.5mm)；근간측벽후평균치위(0.52 ±0.02)mm(0.48 ～0.55 mm)；근제측위(0.20±0.0l) mm(0.19～0.22 mm).HE염색광경하가견간원인대관벽분내막、중막급외막삼층,관강내면유완정적내피세포복개,Verhoeff염색가견재통간원인대관벽부함탄력섬유(EF)、효원섬유(CF)급평활기(SM).삼충성분함량여정상문정맥급장계막상정맥상비무현저성차이.결론 채용궤계여류체정압상결합적방식가사성인간원인대재통,재통후가획득장도위96.61 mm,직경위7.04～12.78 mm적관상결구.기관벽조직학결구여정상문정맥급장계막상정맥상사.재통후적간원인대구비작위혈관이식재료적해부학화조직학기출.
Objective To investigate the method of dilating the adult hepatic ligamentum tetes (HLT),and comprehend the anatomical characteristics and histological structures for its clinical application.Methods 100 adlut patients who underwent laparotomy enter the study,and their HLT were excised.The HLT were dilated with the mechanical method combined water-filling.A conoid-like tube was gained after being dilated.The length,the outside diameter,the wall thickness,and the inside diameter of the tube were measured at the pressure of 30 cm H20.10 of the 97 recanalized HLT were selected randomly as experimental group,then we selected 6 portal veins and 4 superior mesenteric veins as control group.In order to investigate the histological structures,we stained the specimens with the HE and Verhoeff dyeing method.The histological structures of the sections were observed by microscope,and the elastic fibers,collagen and smooth muscle of the tube wall were analysed with the stereological method by medical image analysis software of Motic( MMD 6.0A).Results 97 of the 100 HLT can be dilated successfully with the mechanical method combined water-filling.A conoid-like tube was gained after being dilated.The mean length of the tube was(96.61 ± 14.70) mm (70-130 mm).The diameter of the lumen in the cranial and middle segments was larger than that of the caudal segment.At the pressure of 30 cm H20,the mean of the cranial out diameter was( 12.78± 1.35)mm(10.9-17.2 mm),the caudal out diameter was(7.04 ± 1.98) mm(3-12.1 mm).The mean of the cranial inner diameter was(12.21 ± 1.63) mm(9.9-16.1 mm),the caudal inner diameter was(5.72 ± 1.32) mm(4.2-7.5 mm).The mean of the cranial wall thickniss was ( 0.52 ± 0.02 ) mm ( 0.48-0.55 mm),the caudal wall thickniss was (0.20 ± 0.01 ) mm(0.19-0.22 mm).After being dyed with the HE dyeing method,we find that the wall of dilated HLT was composed by intima,media and adventitia.The intima of the dilated HLT was covered with endothelial cells.After being dyed with the Verhoeff dyeing method,we find that the wall of dilated HLT in rich of elastic fibers,oollagen and smooth muscle.There was no statistical difference of the above three components between experimental and control groups.Conclusions HLT can be dilated with the mechanical method combined waterfilling.After being dilated,the HLT can become vessel-like tube with 96.61 mm in length and 7.04-12.78 mm in diameter.Its histological structures is similar as major abdominal veins.Therefore,the recanalized HTL possessing the anatomical and histological characteristics of veins,can be used as a vascular graft.
