摘要
目的:为腹腔镜胆囊切除术保护胆囊床内血管提供形态学基础;探讨术前彩色多普勒超声探查肝中静脉的意义。方法:(1)对30例正常成人肝标本在超声影像下观察胆囊床血管的位置、大小及与胆囊床的毗邻关系;(2)对30例超声观察后的肝标本进行解剖,观察胆囊床内超声显示的血管的位置、来源,测量其长度和直径,比较超声下血管与解剖观察血管的形态和走行;(3)对20例肝铸型标本胆囊床血管进行观察;(4)采用彩色多普勒超声对168例正常成人活体肝脏进行观测,记录胆囊床血管的直径、位置及毗邻关系,并与解剖观察结果比较。结果:30例成人肝标本胆囊床超声影像下观察到5例直径大于2mm,长度大于2cm的变异血管;解剖证实,这些血管均为肝中静脉起始部或其属支,距胆囊床表面0～3mm,其中位于胆囊床正中的2例,位于左、右缘的分别为1例和2例,均与胆囊床长轴平行。胆囊床血管彩色多普勒超声影像检查,距胆囊床0～3mm范围内内径超过2mm的肝中静脉或其属支有29例,肝门静脉分支1例。结论:直径超过2mm,距胆囊床表面0～3mm的胆囊床变异血管为肝中静脉起始段或其属支,出现率为17.3%。腹腔镜胆囊切除术术前进行彩色多普勒超声检查,能明确胆囊床内肝中静脉或其属支及肝门静脉分支的位置及与胆囊床的关系。
Objective： To provide morphological data for protecting the inner blood vessels of the gallbladder bed on laparoscopic cholecystectomy. Methods： Ultrasonography and anatomic observation on 30 liver specimens were performed, the location of the blood vessels was observed and its diameter and length on the gallbladder bed were measured. Color Doppler ultrasound was used to examine the anatomic relationship between the gallbladder bed and the blood vessels of the gallbladder bed in 168 patients. Results： For 5 cases, the diameter of blood vessels exceeded 2mm and the distance was about 0-3mm between the closest point of the blood vessel and the gallbladder bed in all specimens. Anatomic observation confirmed that the variant vessels were the middle hepatic vein or its tributaries. Color Doppler ultrasound found that 29 cases had the middle hepatic vein or its tributaries and 1 branches of hepatic portal vein. its diameter exceeded 2mm and the distance was about 0-3mm between the closest point of the blood vessel and the gallbladder bed in the 168 cases. Conclusions： The blood vessels of the gallbladder bed mainly arise from the middle hepatic vein or its tributaries, which located upon the left, right rim or the center of the gallbladder bed. If the variant middle hepatic vein or its tributaries and branch of hepatic portal vein closing to the gallbladder bed, the risk of hemorrhage during laparoscopic cholecystectomy may be increased obviously, however, that can be prevented by identifing it preoperatively with ultrasound.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2006年第3期263-267,共5页
Chinese Journal of Clinical Anatomy
关键词
胆囊床
血管
超声观测
腹腔镜胆囊切除术
应用解剖
gallbladder bed
blood vessel
ultrasonography
laparoscopic cholecystectomy
applied anatomy
