变异肝动脉的解剖学特点及其临床意义
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摘要
目的观察变异肝动脉的解剖学特点,为临床相关血管影像学检查、手术及介入治疗等提供形态学资料。方法按常规方法解剖25例成人尸体标本,沿肝总动脉追踪、寻找肝固有动脉的分支并观察分布情况。结果本组肝固有动脉及其分支变异率为28%。其中有2例属Hitta分型外的变异肝动脉,肝固有动脉右侧壁未见胃右动脉,而是在左侧壁发出1支动脉主干,远端分支分布于肝和胃,本文称为"肝胃动脉(HGA)";其中标本2从HGA主干后壁发出1分支,远端也分布于肝和胃,本文称为"肝胃副动脉"。结论本组2例起于肝固有动脉左侧壁的HGA,是胃小弯右侧的主要动脉来源,并有分支营养肝和胃的其他部位。此种变异补充了变异肝动脉的形态学资料,对临床有一定的指导价值。
Objective To investigate the anatomical features of variant hepatic artery so as to provide morphological data for clinical operation, such as related vascular imaging examination, surgery and interventional therapy. Methods Twenty-five adult corpses were dissected in the routine method. The branches of the proper hepatic artery and their distributions were traced along the common hepatic artery, and the distributions were studied. Results The variant rate of proper hepatic artery and its branches was 28%.Some variant branches beyond the Hitta classification were found in 2 cases, in which the right gastric artery was not found as expected on the right wall of the proper hepatic artery;it originated from the left wall and was distributed in the liver and stomach, and was called "hepatogastric artery(HGA)" in the literature. In one of the two specimens, a branch was found originating from the posterior wall of HGA and also distributed in the liver and stomach, which was thus called "hepatogastric accessory artery". Conclusion HGA originates from the left wall of the proper hepatic artery in two of the specimens, and is the main arterial source of the right side of the lesser curvature of the stomach, and has branches to nourish the liver and other parts of the stomach as well. This research contributes to the morphological data of the variant hepatic artery, and may give some guide to the related clinic operation.
Objective To investigate the anatomical features of variant hepatic artery so as to provide morphological data for clinical operation, such as related vascular imaging examination, surgery and interventional therapy. Methods Twenty-five adult corpses were dissected in the routine method. The branches of the proper hepatic artery and their distributions were traced along the common hepatic artery, and the distributions were studied. Results The variant rate of proper hepatic artery and its branches was 28%.Some variant branches beyond the Hitta classification were found in 2 cases, in which the right gastric artery was not found as expected on the right wall of the proper hepatic artery;it originated from the left wall and was distributed in the liver and stomach, and was called "hepatogastric artery(HGA)" in the literature. In one of the two specimens, a branch was found originating from the posterior wall of HGA and also distributed in the liver and stomach, which was thus called "hepatogastric accessory artery". Conclusion HGA originates from the left wall of the proper hepatic artery in two of the specimens, and is the main arterial source of the right side of the lesser curvature of the stomach, and has branches to nourish the liver and other parts of the stomach as well. This research contributes to the morphological data of the variant hepatic artery, and may give some guide to the related clinic operation.
引文
[1]鲍光进,李树平,孙静,等.肝动脉解剖变异的640层容积CT血管成像研究[J].中国医学计算机成像杂志,2014,20(6):555-560.
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[10]谢伦利,易一平,杨佩峰,等.双源性肝固有动脉分支伴胆囊动脉起点变异1例[J].中南医学科学杂志,2013,41(1):94.
[11]于青云,马建军,谢赛同,等.双肝中动脉及肝动脉多分支变异1例[J].中国临床解剖学杂志,2015,33(1):50.
[12]Saeed M,Murshid KR,Rufai AA,et al.Coexistence of multipleanomalies in the calia-mesenterric arterial system[J].Clin Anat,2002,16:30-36.
[13]卢川,刘作勤.肝动脉解剖变异影像学研究[J].中国介入影像与治疗学,2006,2:84-87.
[14]魏祯杰,晏玉洁,何璐,等.肝左动脉变异合并肝固有动脉、胃右动脉缺如一例[J].四川解剖学杂志,2016,24(3):65.
[15]路俊英,郭志军,郭海云,等.应用64排螺旋CT血管造影技术观察肝动脉解剖变异类型[J].肝脏,2018,23(9):812-815.
[16]涂植涛,郭璐,聂世鑫,等.胃小弯侧动脉的应用解剖[J].局部手术学杂志,2013,22(2):131-133.
[17]李家开,张金山.肝胃动脉在肝癌TACE中的意义:胃肠道合并症的原因探讨[J].实用放射学杂志,2002,18(6):498-502.
[2]Michels NA.Newer anatomy of the liver and its variant blood supply and collateral circulation[J].Am J Surg,1966,112(3):337-347.
[3]Hitta JR,Gabbay J,Busuttil RW.Surgical anatomy of the hepatic arteries in 1000 cases[J].Ann Surg,1994,220(1):50-52.
[4]虞桦,张佳林,张城硕,等.合并供肝动脉变异肝移植肝动脉重建42例临床分析[J].中国医科大学学报,2016,45(4):352-360.
[5]李中辉,陈华,孙备.胰十二脂肠切除术中变异肝动脉识别与处理[J].中国实用外科杂志,2017,37(9):1050-1053.
[6]孙鹏,孙义馨,张柏秋,等.MDCTA对肝动脉解剖变异的应用价值[J].中国实验诊断学,2016,20(10):1768-1770.
[7]苏耀,吴莹怡,沈慧香,等.肝固有动脉分支及吻合变异1例[J].中国临床解剖学杂志,2013,31(1):99.
[8]张庆颜,刘芳,陈筱羽,等.副肝右动脉起自腹腔干1例[J].中国临床解剖学杂志,2015,33(4):438.
[9]叶莹鹏,姚潇潇,蒋盼若,等.肝动脉来源伴腹腔干多分支变异一例[J].解剖学杂志,2018,41(6):710.
[10]谢伦利,易一平,杨佩峰,等.双源性肝固有动脉分支伴胆囊动脉起点变异1例[J].中南医学科学杂志,2013,41(1):94.
[11]于青云,马建军,谢赛同,等.双肝中动脉及肝动脉多分支变异1例[J].中国临床解剖学杂志,2015,33(1):50.
[12]Saeed M,Murshid KR,Rufai AA,et al.Coexistence of multipleanomalies in the calia-mesenterric arterial system[J].Clin Anat,2002,16:30-36.
[13]卢川,刘作勤.肝动脉解剖变异影像学研究[J].中国介入影像与治疗学,2006,2:84-87.
[14]魏祯杰,晏玉洁,何璐,等.肝左动脉变异合并肝固有动脉、胃右动脉缺如一例[J].四川解剖学杂志,2016,24(3):65.
[15]路俊英,郭志军,郭海云,等.应用64排螺旋CT血管造影技术观察肝动脉解剖变异类型[J].肝脏,2018,23(9):812-815.
[16]涂植涛,郭璐,聂世鑫,等.胃小弯侧动脉的应用解剖[J].局部手术学杂志,2013,22(2):131-133.
[17]李家开,张金山.肝胃动脉在肝癌TACE中的意义:胃肠道合并症的原因探讨[J].实用放射学杂志,2002,18(6):498-502.
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