中国普外基础与临床杂志

中国普外基础与临床杂志

肝右后下静脉在肝脏外科中的临床应用进展

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目的 了解目前肝右后下静脉(IRHV)在肝脏外科中的临床应用进展并为其在临床应用提供依据。 方法 复习近年来关于 IRHV 在肝脏外科中临床应用进展的相关文献并加以综述。 结果 IRHV 作为肝短静脉的一种,直接注入下腔静脉,常与Ⅵ段门静脉伴行;其并不存在于所有个体中,尸体解剖出现率为 80%~90%,影像学检测出现率为 10%~30%;口径为 0.22~0.95 cm,其口径与肝右静脉口径呈负相关性;IRHV 对布加综合征分型及治疗方法有着重要意义;IRHV 主要引流 Couinaud 肝脏分段法的第Ⅵ段肝实质静脉血,IRHV 的存在扩大了肝切除术的适应证范围,在肝移植术中重建 IRHV 既能保留供肝的功能,又能在其他主肝静脉发生急性闭塞时代偿性地引流相应肝脏区域。 结论 IRHV 在肝脏外科中具有重要的临床意义,充分研究其走行特点及毗邻关系有重要作用,不仅可在手术中避免对其损伤,同时可为相关肝脏外科疾病提供新的治疗思路。

Objective To summarize clinical applications of inferior right hepatic vein (IRHV) in liver surgery and to provide basis for clinical applications of IRHV. Method The relevant literatures about clinical applications of IRHV in recent years were reviewed. Results As a kind of short hepatic veins, the IRHV directly injected into the inferior vena cava, often accompanied by the portal vein of the segment Ⅵ. The cadaver incidence of IRHV was about 80%–90%, while the imaging incidence was about 10%–30%. The caliber of IRHV was about 0.22–0.95 cm, and its caliber was negatively correlated with the caliber of right hepatic vein. The IRHV played a great role in the classification and treatment of the Budd-Chiari syndrome. According to the Couinaud liver classification method, the IRHV mainly drained the blood of segment Ⅵ. The existence of IRHV expanded the indications of hepatectomy. The reconstruction of IRHV in the liver transplantation could not only reserve the function of donor liver, but could drain the corresponding liver areas compensatory when the acute occlusion of other major hepatic veins happens. Conclusions IRHV has important clinical significances in liver surgery. Fully studying its walking characteristics and adjacent relationship can not only avoid injury during surgery, but also provide new treatment ideas for related liver surgical diseases.

关键词: 肝右后下静脉; 肝脏外科; 临床应用; 肝切除术; 肝移植; 布加综合征; 综述

Key words: liver right posterior inferior vein; Liver surgery; clinical application; hepatectomy; liver transplantation; Budd-Chiari syndrome; review

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