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An analysis about the anatomy of portal veins in 88 portal venograms
Abstract Purpose: To study the anatomy and variation of portal vein in terms of site of origind, course orientation, length, width, bifurcation site and angle, hepatic branches and variation in shapes on the basis of portal venogram for the application in TIPSS procedure.Materials and methods: Portal venogram was performed in 88 patients. Superior mesenteric arterial portography
was done in 43 cases with portal hypertension. Celiac or splenic arterial portography or intra-operative portography was done in 45 cases without portal hypertension as the control group. The targetfilm distance was 100cm.Results and conclusion: Most of the portal veins originated at the right border of T12and L1, while in a few cases at the level of T11and L2. The average length was 7.8cm. Theaverage width was 1.8cm in portal hypertensive groups as compared with 1.21cm in the controlgroup. The width of the branches was wider in the portal hypertensive group than that in the control group. The left branches were about 0.43cm wider than the normal and the right branches about 0.50cm wider. 90% of the portal vein in the liver divided into two branches, the left and the right branches. 10% of the portal vein divided into three branches, left, middle and right. Most of the bifurcation sites of the portal veins were at the level of T10in the portal hypertensive group and T11in the control group.
Key words Portal vein Variation Diagnostic imaging
经颈静脉肝内门腔静脉分流术(TIPS)治肝硬化门静脉高压并胃底、食管静脉曲张破大出血,近几年在国内已广泛开展,因此熟悉静脉的造影解剖对提高TIPS的成功率,减和避免并发症是必要的。现将我院造影资料完整的88例进行分析,重点观察门静脉起始位置、走行方向、分叉位置、角度、肝内分支形态,并结合我们开展TIPS的体会进行讨论。
材料和方法
我院自1993年8月~1995年6月共做门静脉造影100例,造影资料完整的有88例。其中男58例,女30例;年龄21~70岁,平均43.9岁。88例中43例(门脉高压组)为肝硬化门脉高压,其中1例为酒精性肝硬化,4例曾行脾肾分流术后再发出血。45例(非门脉高压组)为肝、胰、脾病变做腹腔动脉造影所显示的门静脉,以及胃癌或结肠癌手术切除时为了解门脉有无癌栓做的术中门脉造影。经肠系膜上动脉或腹腔动脉门脉造影70例(简称动脉性门脉造影)。采用Seldinger法,经股动脉穿刺插管,使用Cook公司生产的6F选择性肠系膜上动脉或腹腔动脉造影导管,日本岛津1 250mA单C臂心血管造影机。经肠系膜上动脉门脉造影,造影时正侧位各注入76%泛影葡胺50ml,注入速率每秒8ml,注入7秒后开始摄片。摄片程序为每秒1张,连续摄5秒;每2秒1张,连续摄5秒。造影前自导管内推注血管扩张药前列腺素E 10mg。经腹腔动脉门脉造影的造影剂用量为76%泛影葡胺45ml,注入速率每秒8ml。摄片程序为每秒2张,摄4秒;每秒1张,摄2秒;每3秒1张,摄5秒。术中门脉造影将7F造影导管插入肠系膜上静脉,手推76%泛影葡胺35ml造影。术中门脉造影使用50mA可移动式X线机摄片,经腹腔动脉门脉造影和术中门脉造影均仅摄正位片,摄片管-片距为100cm。
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