| Objective: through the liver specimens of anatomy,understanding and analysis of hepatic vein(MHV,middle hepatic vein and hepatic vein)within the liver parenchyma contorts,and its distribution characteristics in the cross section of the branch in the liver,summarizes the hepatic vein and its branches in the spatial distribution within the liver,the liver surface and qualitative symbol structure,the relationship between clinical surgery.Method: nine liver specimens were provided by the anatomic teaching and research laboratory of wannan medical college,and the liver with inferior vena cava(IVC,inferior vena cava)was removed.From the hepatic phrenic hepatic vein to the inferior vena cava,from the side to the side of the liver,the surface of the liver was dissected,from the superficial to the deep,to determine the location of the hepatic diaphragmatic surface of the MHV.Subsequently,1cm was opened on the left and right side of the MHV tangent,and the MHV was dissected from the surface of the liver,and the Angle of the MHV branch was measured.Mark left hepatic cross section plane for L1,R1 is on the right and then to L1,R1 plane as a benchmark,respectively from the liver to the left and right sections 1 cm,2 cm operated by slicing machine combining sharpness for L2,L3,R2,R3 plane.The length and diameter of the MHV trunk and its branches are recorded,and the main branch of the MHV is inserted into the Angle of IVC,the Angle of the main branch of the falciform ligament,the number of main branches of MHV,and the Angle of the MHV main branch.(2)in L1,2,3,R1,2,3,plane,a record of 3 mmor the number of MHV branch blood vessels,and the three-dimensional positioning data within the liver parenchyma,the cross section of blood vessels to hepatic anterior/posterior diaphragmatic surface,edge or half liver resection MHV branch blood vessels in the vertical distance(3)record section below,the spatial relationship between distance between said.(4)records and right Glisson MHV sheath in cross section,overlaps the anatomic relations are in right Glisson sheath,MHV intersect points or into the distance,said record overlap distance between right Glisson sheath and MHV.All measurements of the length of the unit in millimeter(mm),said Angle in degrees(°)said.Results:For all 11 bodies anatomy of the liver,with an average of 4 to 8 genera MHV,collect IVa and IVb,V,VIII period of blood of liver tissue,MHV trunk 7.16 ±1.10 cm long,with sickle ligament between 35 ° to 65 ° Angle,an average of 51.45 ±8.00 degrees,with IVC between 46-75 ° Angle,an average of 59.27 ±9.54 degrees;The angles of the MHV branch into the main stem were: IVa 50.91 plus or minus 12.47 degrees,IVb 49.36 plus or minus 11.03 degrees,V 48.82 ±9.98 degrees,VIII 51.63±12.89 degrees,IVa,IVb,V,VIII,the diameter of which was 5.00±0.69 mm,4.71±0.67,5.87 + 0.63,5.05 + 0.59.The vertical distance of the MHV distance into IVC1,3,5,and6 cm was: 12.53 plus or minus 4.53,33.56 ±4.26,42.21±5.12,47.12 ±5.68 mm.The number of blood vessels at the bottom of the MHV trunk was 0.27±0.47.The average blood vessels of MHV branches in L1,L2,L3,R1,R2 and R3 were IVa1.36,1.36,0.18,IVb2.18,1.45,and 0.55.V1.73,0.91,0.36,VIII2.45,1.55,0.82.From the left to the right of the six planes,the distance between the vascular distance and the diaphragmatic surface,in the IVb and V segments,respectively(i.e.,L3...In the order of R3):31.23±2.62,20.86±7.26,17.67±5.09,23.09±5.46,21.88±6.58,22.52±2.41 mm,the minimum value of the left blade is 9.8mm,which is located in the L1 plane,and the minimum value of the right lobe is 14.8mm,which is located in the R1 plane.In IVa and VIII,they were:--,34.83±6.24,37.32±7.91,plus or minus 7.91,29.53 plus or minus8.27,29.46 plus or minus 6.55,25.44 plus or minus 8.11,and the minimum value of the left lobe was 21.8mm,which was located in the L2 plane,and the minimum value of the right lobe was 12.6mm,which was located in the R1 plane.From left to right in the plane of the six IVb,V section on blood vessel of liver front distance are: 33.18±6.95?22.29±5.51?23.59±6.90?28.00±8.85?33.50±7.94?36.78±4.43 mm,the minimum 12.5mm,the left lobe in R2 plane,the right lobe minimum 11.6 mm,located in R1,R3 plane.In IVa and VIII,the distance from the posterior margin of the blood vessel was:--,25.45± 5.31?24.84±5.63 ?31.92±8.38?33.50±7.94?36.78±4.43 mm,the minimum value of the left lobe was 24.5mm,located in the L2 plane,and the minimum value of the right lobe was 17.3mm,located in the R1 plane.The distance between the MHV trunk and the right Glisson sheath was between 6.5 and 15.1mm,with an average of10.34 plus or minus 2.43 mm.Conclusion:At the time of partial hepatectomy,the line was connected to the IVC at the midpoint of the gallbladder to the right from 2 to 3cm to the IVC.The MHV trunk was passed through the liver parenchyma,and the initial ministry divided the proportion of the liver above 3 to 1,to the IVC,and the liver was divided by 1:1,and the upper liver tissue was slightly more than the lower part.In the process of breaking the liver,it should be gradually separated from the surface.Liver beneath the surface of about 1 cm belongs to the safety area,there are few coarser blood vessels,1-2 cm away from broken liver tissue of the region need to pay attention to the possible existence of larger blood vessels,high-risk areas of liver surface 2-3.5 cm,there 3 mm or more vessels,and is close to MHV backbone.IVb and V segment of the liver were slightly more than IVa and VIII.The former vessels were more superficial than the latter.At the bottom of the MHV main plane,1cm left at the bottom of the MHV starting point is the right Glisson sheath bifurcation.There is no obvious blood vessel between the two.And the right Glisson sheath bifurcated to the MHV trunk of the second hepatic portal and there was almost no major blood vessel in the liver parenchyma.Therefore,during the operation oflaparoscopic hemihepatectomy,the safe areas in the process of hepatotomy were: I and liver tissue within 1cm of the liver surface.II.Right Glisson sheath bifurcated to the MHV trunk at the second liver portal.Relative safe area: the hepatic tissue between the MHV main plane and the right Glisson sheath bifurcation plane.Danger zone: liver parenchyma 2-3.5cm from the liver surface. |
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