• 1.云南省第一人民醫(yī)院肝膽外科(昆明650032);;
  • 2.昆明醫(yī)學(xué)院解剖教研室(昆明650000);;
  • 3.云南省高等醫(yī)學(xué)?？茖W(xué)校解剖教研室(昆明650000);

目的　 通過解剖學(xué)的研究，探討繞肝提拉法手術(shù)的臨床解剖學(xué)依據(jù)。
方法 　選用解剖教學(xué)的21例成人尸體的肝后下腔靜脈，從腔內(nèi)觀察尸肝組匯入肝后下腔靜脈的肝短靜脈開口情況，按不同繞肝提拉法的路徑和不同肝后隧道寬度（10 mm、6 mm）統(tǒng)計(jì)可能遇到的肝短靜脈數(shù)。
結(jié)果 　繞肝提拉法在肝后隧道寬度6 mm時(shí)標(biāo)準(zhǔn)路徑遇到肝短靜脈0～3（中位數(shù)＝1）支，標(biāo)準(zhǔn)右上方路徑（EM路徑，肝后下腔靜脈右緣距肝下緣1 cm）遇到肝短靜脈0～2（中位數(shù)＝0）支，后者小于前者，差異有統(tǒng)計(jì)學(xué)意義（P=0.003）。
結(jié)論 　繞肝提拉法手術(shù)建立肝后隧道是可行且安全的。

引用本文： 王峻峰,莫一我,王彥坤,孫志為,李興國,范煒,王曉云,金焰,張新俊,徐敬,劉俊. 繞肝提拉法肝后隧道的應(yīng)用解剖學(xué)研究. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(5): 569-572. doi: 復(fù)制

1. 　Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization [J]. J Am Coll Surg, 2001; 193(1)∶109.
2. 　Kokudo N, Sugawara Y, Imamura H, et al. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique [J]. Transplantation, 2003; 76(5)∶803.
3. 　Ettorre GM, Vennarecci G, Lonardo MT, et al. The modified “hanging maneuver” during orthotopic liver transplantation using a technique for conserving the inferior vena cava [J]. Tumori, 2003; 89(4 Suppl)∶63.
4. 　彭淑牖， 曹利平， 李江濤， 等. 肝后隧道的建立與繞肝帶的使用在高難度肝切除術(shù)中的作用 [J]. 中華醫(yī)學(xué)雜志, 2003; 83(19)∶1644.
5. 　Lai EC, Fan ST, Lo CM, et al. Anterior approach for difficult major right hepatectomy [J]. World J Surg, 1996; 20(3)∶314.
6. 　吳孟超. 肝癌外科治療的近期進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(2)∶125.
7. 　王魯， 孫惠川， 欽倫秀， 等. 肝癌解剖性肝切除的初步經(jīng)驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶39.
8. 　王學(xué)浩, 姜超. 活體肝移植的現(xiàn)狀和發(fā)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(2)∶100.
9. 　彭淑牖, 牟一平. 肝中裂分離高位膽管狹窄修復(fù)術(shù) [A]. 黃志強(qiáng)主編. 腹部外科手術(shù)學(xué) [M]. 第1版. 長沙: 湖南科技出版社, 2001∶974~977.
10. 　鐘世鎮(zhèn)主編. 臨床解剖學(xué) [M]. 北京: 人民軍醫(yī)出版社, 1998∶355～356.
11. 　Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet， 1981; 152(1)∶43.
12. 　Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection [J]. Surg Gynecol Obstet, 1957; 105(3)∶310.
13. 　張我華， 孫善全. 肝靜脈口和下腔靜脈肝后段的應(yīng)用解剖研究 [J]. 中華外科雜志， 1984； 22（9）∶563.
14. 　Fong Y, Blumgart LH. Useful stapling techniques in liver surgery [J]. J Am Coll Surg, 1997; 185(1)∶93.
15. 　Mehran R, Schneider R, Franchebois P. The minor hepatic veins: anatomy and classification[J]. Clin Anat, 2000; 13(6)∶416.
16. 　Cheng YF, Huang TL, Chen CL, et al. Variations of the middle and inferior right hepatic vein: application in hepatectomy [J]. J Clin Ultrasound, 1997; 25(4)∶175.
17. 　Meng WC, Shao CX, Mak KL, et al. Anatomical justification of Belghiti’s ‘liver hanging manoeuvre’ in right hepatectomy with anterior approach [J]. ANZ J Surg, 2003; 73(6)∶407.
18. 　Sato TJ, Hirai I, Murakami G, et al. An anatomical study of short hepatic veins, with special reference to delineation of the caudate lobe for hanging maneuver of the liver without the usual mobilization [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1)∶55.
19. 　Hirai I, Murakami G, Kimura W, et al. How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study [J]. Clin Anat, 2003; 16(3)∶224.
  1. 1. 　Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization [J]. J Am Coll Surg, 2001; 193(1)∶109.
  2. 2. 　Kokudo N, Sugawara Y, Imamura H, et al. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique [J]. Transplantation, 2003; 76(5)∶803.
  3. 3. 　Ettorre GM, Vennarecci G, Lonardo MT, et al. The modified “hanging maneuver” during orthotopic liver transplantation using a technique for conserving the inferior vena cava [J]. Tumori, 2003; 89(4 Suppl)∶63.
  4. 4. 　彭淑牖， 曹利平， 李江濤， 等. 肝后隧道的建立與繞肝帶的使用在高難度肝切除術(shù)中的作用 [J]. 中華醫(yī)學(xué)雜志, 2003; 83(19)∶1644.
  5. 5. 　Lai EC, Fan ST, Lo CM, et al. Anterior approach for difficult major right hepatectomy [J]. World J Surg, 1996; 20(3)∶314.
  6. 6. 　吳孟超. 肝癌外科治療的近期進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(2)∶125.
  7. 7. 　王魯， 孫惠川， 欽倫秀， 等. 肝癌解剖性肝切除的初步經(jīng)驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶39.
  8. 8. 　王學(xué)浩, 姜超. 活體肝移植的現(xiàn)狀和發(fā)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(2)∶100.
  9. 9. 　彭淑牖, 牟一平. 肝中裂分離高位膽管狹窄修復(fù)術(shù) [A]. 黃志強(qiáng)主編. 腹部外科手術(shù)學(xué) [M]. 第1版. 長沙: 湖南科技出版社, 2001∶974~977.
  10. 10. 　鐘世鎮(zhèn)主編. 臨床解剖學(xué) [M]. 北京: 人民軍醫(yī)出版社, 1998∶355～356.
  11. 11. 　Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet， 1981; 152(1)∶43.
  12. 12. 　Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection [J]. Surg Gynecol Obstet, 1957; 105(3)∶310.
  13. 13. 　張我華， 孫善全. 肝靜脈口和下腔靜脈肝后段的應(yīng)用解剖研究 [J]. 中華外科雜志， 1984； 22（9）∶563.
  14. 14. 　Fong Y, Blumgart LH. Useful stapling techniques in liver surgery [J]. J Am Coll Surg, 1997; 185(1)∶93.
  15. 15. 　Mehran R, Schneider R, Franchebois P. The minor hepatic veins: anatomy and classification[J]. Clin Anat, 2000; 13(6)∶416.
  16. 16. 　Cheng YF, Huang TL, Chen CL, et al. Variations of the middle and inferior right hepatic vein: application in hepatectomy [J]. J Clin Ultrasound, 1997; 25(4)∶175.
  17. 17. 　Meng WC, Shao CX, Mak KL, et al. Anatomical justification of Belghiti’s ‘liver hanging manoeuvre’ in right hepatectomy with anterior approach [J]. ANZ J Surg, 2003; 73(6)∶407.
  18. 18. 　Sato TJ, Hirai I, Murakami G, et al. An anatomical study of short hepatic veins, with special reference to delineation of the caudate lobe for hanging maneuver of the liver without the usual mobilization [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1)∶55.
  19. 19. 　Hirai I, Murakami G, Kimura W, et al. How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study [J]. Clin Anat, 2003; 16(3)∶224.