Applied Anatomy Of The Right Adrenal Vein In Operation Of Naked Hepatic Region

Objectives:To study the right adrenal vein morphology and the way to enter and type.Measuring the distance between the three that the beginning of the right adrenal vein and the right adrenal vein into the inferior vena cava and the lowest position of the short hepatic veins.The lowest position of the short hepatic veins was used as anatomical landmark.To study the method of finding the right adrenal vein during hepatectomy by hepatectomy for hepatic resection of the hepatic artery and to provide the anatomical basis for avoiding injury to the right adrenal vein during surgery.Methods:Selected to deal with by conventional anti-corrosion teaching adult autopsy specimens 34(31male,3female)of all specimens from the Department of Human Anatomy,Kunming Medical University.Observation:1.Observed the right adrenal morphological features and adjacent relationships.2.Observe the location of the right adrenal vein at the beginning and classify the right adrenal vein according to its normal and variant infusion patterns.3.Observation and measurement from the right adrenal vein to its center point where it enters the inferior vena cava(IVC),and the angle of the right adrenal vein into the inferior vena cava.4.Measure the distance from the center point of the right adrenal vein starting point to the lowest edge of the lowest short hepatic veins in the third hepatic portal.5.The distance from the center point of the right adrenal vein to the inferior vena cava to the lowest edge of the lowest r hepatic vein in the third hepatic portal was measured.Results:Anatomical observations and measurements show:1.The right adrenal gland is located on the right side of the spine.The height of the right adrenal gland at the 11th thoracic vertebra.The shape of the right adrenal gland is irregular like a tetrahedron,an approximate conical or irregular triangle.The medial limb is short and the long axis is pointing to the right lateral and the lateral limb is slightly longer,Lateral oblique curvature greater than the medial limb.The right adrenal gland in front of the longitudinal crest is divided into lateral and medial surface,the lateral surface:the right posterior lobe liver bare area,is a Couinaud ?-?segment,with its direct of thin layer of fat connective tissue separated;Medial surface:the inferior vena cava right posterior wall,the middle layer of thin connective tissue separated by fat;bottom:a little concave in the right kidney on the pole;behind:with the diaphragm relative to the foot.2.The right adrenal vein was divided into normal type and variant type:Normal type(26/34):the right adrenal vein regardless of the exit position,directly into the inferior vena cava.According to different export position,the upper edge of the export to the top pole,the lower edge of the distance to the bottom of the bottom are divided into four different morphogenesis types:Type A(3/26):The starting point of the right adrenal vein is located on the upper pole of the right adrenal gland and goes up to the right posterior wall of the inferior vena cava at an acute angle.Type B(20/26):The venous origin is located on the upper right adrenal gland.The range of vein diameter is about 2.2-7.6mm.The average diameter is 4.0mm.There are 3 cases of this subtype vein fine branch and 4 cases of thick branch.In this subtype,regardless of the fine branches,the veins will go upwards after leaving the right adrenal gland and enter the right or right side of the inferior vena cava at an acute angle.This subtype belongs to the classic type,accounting for the majority.Type C(2/26):The venous origin is located in the middle of the right adrenal gland,and it merged into the right side of the inferior vena cava at an acute angle.Type D(1/26):The venous origin is located in the lower right adrenal gland,and it enters the right side of the inferior vena cava at a right angle.Variant type(8/34):There are multi-branch right adrenal vein or not directly into the inferior vena cava.According to multiple branches of the right adrenal vein or direct import at dinfferent,they are divided into there subtypes:type A,type B and type C.type A(3/8):There are two right adrenal veins of this type.A total of 3 cases,including 2 cases of two right renal afferent veins near the beginning.The two veins are of different diameters,and the right upper branch merges into the right lower hepatic vein and is co-dried with the right lower hepatic vein and then merges into the right posterior wall of the inferior vena cava.the diameter of the left lower branch is greater than that of the upper right one,and it travels upwards and finally merges into the right posterior wall of the inferior vena cava.In another case,the diameters of the two branches were basically equal,and the starting position was a long distance away.After the two Expenditures,the right adrenal gland traveled upwards and the other went downwards,all directly into the inferior vena cava.Type B(3/8):There is Only one right adrenal vein,but the right adrenal vein left the right adrenal gland and travel upwards and merged into the right lower hepatic vein.After the two were dry,they merged into the right side of the inferior vena cava.TypeC(2/8):There is Only one right adrenal vein,the initial part of which is located on the upper right adrenal gland and goes up and down,and finally enters the short hepatic vein.3.The distance from the right adrenal vein to the center point of the inferior vena cava is 7.5+4.5 mm,Coronal into the inferior vena cava side,side behind,behind the proportion of it respectively 58%?38%?4%;Angle of import:acute angle 23 cases,accounting for 88.5%;right angle in 2 cases,accounting for 7.7%;obtuse angle in 1 cases,accounting for 3.8%.4.The distance from the center point of the right adrenal vein starting point to the lowest edge of the lowest hepatic vein in the third portal hepatic is 11.4 ± 6.5 mm.5.The distance from the center of the right adrenal vein to the inferior vena cava to the lowest edge of the lowest hepatic portal vein in the third portal hepatic is 9.5±2.3mm.Conclusions:In this study,the right adrenal vein was typed by anatomical measurement of the right adrenal vein.The anatomical features and relative safe approach sites of each subtype were studied and analyzed.The range of finding the right adrenal vein under the standard pathway of the posterior hepatic tunnel was pointed out when using the"reverse hepatectomy for hepatectomy ".These measurements provide anatomical support for the surgeon to avoid injury to the right adrenal vein when hepatectomy is performed.