猕猴肝门静脉系统和肝静脉系统的观察

以铸型方法及实体解剖观察了猕猴(Macaca mulatta) 肝的门静脉分支和肝静脉分支。猕猴肝门静脉与人、猪、兔、牛、羊等相似, 同样可将全肝分成二叶四段, 即左叶、右叶; 左外侧段、左内侧段、右内侧段、右外侧段。尾状叶的左、右部可分别隶属于左叶和右叶。猕猴肝大静脉有左外侧叶肝静脉、左内侧叶肝静脉、肝中静脉、肝右静脉及尾状叶肝静脉。此外, 作者对哺乳动物门静脉分支的规律性, 猕猴肝大静脉的命名及吻合作了讨论。     

Intrahepatic Vascular Anatomy in Rats and Mice—Variations and Surgical Implications

Introduction

The intra-hepatic vascular anatomy in rodents, its variations and corresponding supplying and draining territories in respect to the lobar structure of the liver have not been described. We performed a detailed anatomical imaging study in rats and mice to allow for further refinement of experimental surgical approaches.

Methods

LEWIS-Rats and C57Bl/6N-Mice were subjected to ex-vivo imaging using μCT. The image data were used for semi-automated segmentation to extract the hepatic vascular tree as prerequisite for 3D visualization. The underlying vascular anatomy was reconstructed, analysed and used for determining hepatic vascular territories.

Results

The four major liver lobes have their own lobar portal supply and hepatic drainage territories. In contrast, the paracaval liver is supplied by various small branches from right and caudate portal veins and drains directly into the vena cava. Variations in hepatic vascular anatomy were observed in terms of branching pattern and distance of branches to each other. The portal vein anatomy is more variable than the hepatic vein anatomy. Surgically relevant variations were primarily observed in portal venous supply.

Conclusions

For the first time the key variations of intrahepatic vascular anatomy in mice and rats and their surgical implications were described. We showed that lobar borders of the liver do not always match vascular territorial borders. These findings are of importance for the design of new surgical procedures and for understanding eventual complications following hepatic surgery.     

Dependence of the topography of the hepatic veins on the external shape of the liver, its size and on age

Hepatic preparations obtained from 186 newborns, children and mature persons have been studied. In newborns and babies the size of the right and left hepatic lobes are nearly the same. Beginning from an early age, the right hepatic lobe begins to grow, and the oblongatal or oval form of the liver changes into a triangle one. With changes in its size and form, the topography of the hepatic veins changes, too. In children younger than 1 year of age having the oblongatal or oval form of their liver, the diameters of the right, middle and left hepatic veins are nearly equal. In mature persons having the triangle form of the liver, the right hepatic vein is the largest and its diameter is twice as large as that of the left hepatic vein. Additional hepatic veins flowing into the inferior vena cava, are mainly formed by the branches participating in drainage of the right hepatic lobe. In 25 cases there are additional large hepatic veins; they are observed in cases when the right hepatic vein is poorly developed.     

Intrahepatic ramification of the portal vein in the right and caudate lobes of the liver

We defined the subsegmental divisions and the ramification patterns of the portal vein in the right and caudate lobes using 25 human liver casts. The ramifications of the portal vein and the subdivisions of the liver were classified based on the major portal veins with the largest diameter and those having a diameter of not less than two thirds of the largest vein in each subsegment. The following results were obtained. (1) The portal trunk showed three ramification patterns and the basic pattern was bifurcation (80%). (2) The anterior portal vein first ramified into several anterior-inferior portal veins (P5) and ran toward the superior direction to bifurcate into 2 major portal veins in the anterior-superior subsegment (S8). (3) There were three types of ramification patterns of the portal veins in S8: bifurcation (84%), trifurcation and one-pedicle type. (4) There were also three branching types of the largest vein (P5-max) in P5: ramification from the anterior portal vein, P8-anterior vein supplying the anterior region of S8 and P8-posterior vein supplying the posterior region of S8. (5) The posterior portal vein showed two ramification patterns of the bifurcation (36%) and nonbifurcation type. (6) The major portal veins in the caudate subsegment ramified at various sites such as the portal trunk, left, right and/or other portal veins.     

The bronchial tree and blood vessels of the Japanese monkey lung

The author injected various colored celluloid solutions into the bronchial tree and blood vessels of the lungs of five adult Japanese monkeys (Macaca fuscata) in order to prepare cast specimens. These specimens were investigated from the comparative anatomical viewpoint to determine whether the bronchial ramification theory of the mammalian lung (Nakakuki, 1975, 1980) can be applied to the Japanese monkey lung or not. The bronchioles are arranged stereotaxically like those of other mammalian lungs. The four bronchiole systems, dorsal, ventral, medial, and lateral, arise from both bronchi, respectively, although some bronchioles are lacking. In the right lung, the bronchioles form the upper, middle, accessory, and lower lobes, while in the left lung, the upper and accessory lobes are lacking and bi-lobed middle and lower lobes are formed. In the right lung, the upper lobe is formed by the first branch of the dorsal bronchiole system. The middle lobe is the first branch of the lateral bronchiole system. The accessory lobe is the first branch of the ventral bronchiole system. The lower lobe is formed by the remaining bronchioles of the four bronchiole systems. In the left lung, the middle lobe is formed by the first branch of the lateral bronchiole system. The lower lobe is formed by the remaining bronchioles. Thus, the bronchial ramification theory of the mammalian lung applied well to the Japanese monkey lung. The right pulmonary artery runs across the ventral side of the right upper lobe bronchiole. It then runs along the dorso-lateral side of the right bronchus between the dorsal bronchiole system and the lateral bronchiole system. On its way, it gives off branches of the pulmonary artery which run along the dorsal or lateral side of each bronchiole except in the ventral bronchiole system. In the ventral bronchiole system, the branches run along the ventral side of the bronchioles. The distributions of the pulmonary artery in the left lung are the same as those in the right lung. The pulmonary veins do not always run along the bronchioles. Most of them run on the medial or ventral side of the bronchioles. Some of them run between the pulmonary segments. In the right lung, these pulmonary veins finally form the right upper lobe vein, right middle lobe vein and the right lower lobe pulmonary venous trunk before entering the left atrium. However, the right accessory lobe vein runs on the dorsal side of the bronchiole and pours into the right lower lobe pulmonary venous trunk. In four cases out of the five examples, part of the right lower lobe veins pour into the right middle lobe vein, while the others enter the right lower lobe pulmonary venous trunk. In the left lung, the branches of the pulmonary veins finally form the left middle lobe vein and the left lower lobe pulmonary venous trunk.     

肝硬化患者肝脏门静脉血流与肝叶萎缩之间关系的研究

目的：探讨肝硬化患者肝脏右叶、左叶体积变化,检测肝硬化患者门静脉血流情况,分析二者之间的关系,以及门静脉血流与肝功能之间关系。方法：本研究纳入54例肝硬化患者和40例正常人,采用超声多普勒方法分析这些受试者的肝脏体积和门静脉主干及左右分支的内径、血流速、流量数据,并通过静脉血检测白蛋白、胆红素、胆碱酯酶水平等评估患者肝功能水平。结果：肝硬化组平均年龄46.3岁,男性32例,其中childA级患者16例,childB级患者27例,childC级患者11例;正常对照组平均年龄41．8岁,男性24例。肝硬化组患者右左肝叶之比明显低于正常对照组（p〈0．05）,门静脉内径和血流量明显高于正常对照组（p〈0．05）．随着child分级升高,门静脉血流量也明显升高。肝硬化组门静脉右支血流量明显低于左支血流量（p〈0．05）;此外肝硬化患者门静脉右支和左支血流量之比明显低于正常人群门静脉右左支之比（p〈0．05）;而且肝硬化患者门静脉右左支血流量之比与右左肝叶具有明显的相关性与右左肝叶之比具有明显的相关性（r=0．64,p〈0．05）。结论：评估肝硬化病人门静脉血流情况,对于判断肝脏病理变化程度,评价治疗效果,以及选择治疗方案方面都具有重要的临床价值     

一雄性灰鹤胃的血液供应

用血管铸型法对一只因伤致死的雄性灰鹤胃的血供进行铸型观察,结果显示,灰鹤的胃动脉均由腹腔动脉分出,腺胃由腺胃背侧动脉和腺胃腹侧动脉供应营养,肌胃由胃左动脉、胃右动脉和肌胃背侧动脉供应营养。腺胃的静脉有腺胃腹侧静脉、胃凹腹侧静脉和腺胃背侧静脉,分别经左（腺胃腹侧静脉和胃凹腹侧静脉）、右（腺胃背侧静脉）肝门静脉回流;肌胃的静脉有胃左静脉、胃右静脉和胃背侧静脉,分别经左（胃左静脉）、右（胃右静脉和肌胃背侧静脉）肝门静脉回流。此外本文将灰鹤胃的血供与其它动物的进行了比较。     

环颈雉胃的血供

用血管铸型法和大体解剖学方法对环颈雉胃动脉的起源、分布及胃静脉的回流情况进行了解剖学研究。结果表明,环颈雉的胃动脉均由腹腔动脉分出;腺胃由腺胃背侧动脉和腺胃腹侧动脉营养,腺胃背侧动脉直接起自腹腔动态的左侧,腺胃腹侧动脉起自腹腔动脉左支。腺胃血液的静脉有腺胃前静脉和腺胃后静脉,分别汇入后腔静脉和左肝门静脉。肌胃由肌胃左动脉、肌胃右动脉和肌胃背侧动脉营养,肌胃左动脉起自腹腔动脉的左支;肌胃右动脉起自腹腔动脉的右支;肌胃背侧动脉从腺胃背动脉分支而来。回流肌胃血液的静脉有胃右静脉、胃左静脉和胃腹侧静脉;胃右静脉汇入右肝门静脉,胃左静脉和胃腹侧静脉汇入左肝门静脉。另外腺胃和肌胃的表面缺乏主干动脉间的吻合。     

The lobular division,bronchial tree and blood vessels of the squirrel monkey lung

The lobular division, bronchial tree, and blood vessels in lungs of seven squirrel monkeys (Saimiri sciureus) were examined from the viewpoint of comparative anatomy. The right lung of the squirrel monkey consists of the upper, middle, lower, and accessory lobes, whereas the left lung consists of the upper, middle, and lower lobes. These lobes are completely separated by interlobular fissures. In three of seven examples examined the left middle lobe was lacking. The squirrel monkey lung has four bronchiole systems, i.e. dorsal, lateral, ventral, and medial, on both sides. The upper lobes are formed by the first branches of the dorsal bronchiole systems. The middle lobes are formed by the first branches of the lateral bronchiole systems. The remaining bronchioles constitute the lower lobes. In addition to the above lobes, in the right lung, the accessory lobe is present, being formed by the first branch of the ventral bronchiole system. The right pulmonary artery runs across the ventral side of the right upper lobe bronchiole, and then across the dorsal side of the right middle lobe bronchiole. Thereafter, it runs between the dorsal bronchiole and lateral bronchiole systems along the dorso-lateral side of the right bronchus. During its course, the right pulmonary artery gives off the arterial branches which run along each bronchiole. These branches run mainly along the dorsal or lateral side of the bronchioles. In the left lung, the pulmonary artery and its branches run the same course as in the right lung. The pulmonary veins run mainly the ventral or medial side of the bronchioles, and between the bronchioles.     

Umbilical vein variations: review of the literature and a case report of a persistent right umbilical vein

A case of a ligamentum teres formed from an obliterated right umbilical vein is described. It passed to the right branch of the portal vein. The quadrate and left lobes of the liver were not separated by the usual fissure. Very few cases of anomalous umbilical veins or persistent right umbilical veins have been recorded. Of these, several have been recorded only in the umbilical cord, while in others the persistent right umbilical vein has been found intra-abdominally, in an extrahepatic position, and passing directly to the right atrium or to the inferior vena cava. Its presence is generally associated with severe congenital abnormalities, in contrast with the present case. In view of the high incidence of congenital defects associated with aberrant or accessory umbilical veins, when these are detected either in the umbilical cord or in the abdomen by umbilical phlebography, it is suggested that the patient should be carefully investigated for other congenital abnormalities.     

Typical from and basic variants of the structure of the intrahepatic portion of the portal vein]

The structure of the portal vein was studied in 210 preparations of the liver. The structure of the main trunk of the portal vein and its lobe branches was estimated orienting by the typical shape and the main variations of the structure. Two variants of the structure of the right and left portal veins (after the type of a "pine branch" and the variant of the "minimum length" of the lobe vein) were common for both veins. The structure of the "snail" type was found only in the left portal vein of the "whisk" type -- only in the right one. The sources of the segment blood supply changed depending on the structure of the main trunk and lobe veins. They can be supplied by terminal or lateral branches of the lobe veins, vascular branches of the main trunk of the portal vein and of the vessels of neighbouring segments. Estimation of the angioarchitectonics of the liver operated on should be approached individually in each case. It is expedient to take into account the above typical shape and the main variants of the intrahepatic portion of the portal vein.     

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

We wished to study the efficacy and safety of the retrograde ligation of short hepatic veins (SHVs) and the right hepatic vein (HV) through the retrohepatic tunnel in patients who underwent hemihepatectomy due to large hepatic carcinoma in the right lobe of the liver. Right hemihepatectomy was performed in 23 patients with tumors larger than 8 cm in diameter. The liver was separated at the secondary porta, and the interspace between right HVs and middle HVs was expanded. The right hepatic portal vein and hepatic artery were freed and ligated, followed by the retrograde dissection of SHVs and the right HV along the right retrohepatic space anterior to the inferior vena cava. A blocking belt was set at the left side of the midline, after which the right liver was cut off. The procedure was successfully completed in all patients. The average amount of intraoperative blood loss was 640 ml. The change in hepatic function was observed on the third postoperative day. Twenty-two patients exhibited satisfactory results; one patient died from postoperative hepatic failure. In conclusion, this procedure can be safely performed in most hemihepatectomy patients with liver tumors.     

Aberrant course of the left gastric vein in the human. Possibility of a persistent left portal vein

Two livers with an aberrant course of the left gastric vein were found in 245 Japanese cadavers. The left gastric vein collects branches from the lesser curvature of the stomach, enters the left side of the hepatogastric ligament from the cardiac region and runs towards the left side of hepatic hilus. The vein enters the liver at the left side and joins an intrahepatic branch ramified from the portal vein.     

Contribution of the umbilical and portal veins to the hepatic blood supply of guinea pig fetuses--an angiographic study.

The interlobular distribution of the umbilical and portal venous blood flow within the liver was examined in 35 guinea pig fetuses between 59 and 65 days of gestation. Contrast medium was injected into the umbilical or vitelline vein, and its passage through the liver was monitored by serial angiography. In four experiments, injections were made into both the umbilical and vitelline veins of the same fetus. To ease interpretation of the angiograms obtained in vivo, we also made a postmortem examination of livers in which the venous system had been filled with an aqueous suspension of barium sulphate in gelatin. These combined experiments demonstrated no passage of contrast medium from the placenta to the inferior vena cava, which is in accordance with independent evidence that the term guinea pig fetus lacks a functional ductus venosus. The area supplied by the umbilical and portal veins was clearly and consistently delineated. The umbilical vein supplied the left lobe and the left sublobe of the quadrate lobe. The portal vein supplied the right lobe, the smaller caudate lobe, and all or most of the right sublobe of the quadrate lobe. This pattern of distribution appears to be determined by flow and pressure gradients within the hepatic circulation.     

猫儿山小鲵肝的组织结构

通过常规石蜡切片技术对2例猫儿山小鲵(Hynobius maoershanens)肝进行组织学观察。结果显示,猫儿山小鲵肝分为两叶,右叶稍大于左叶。肝组织结构主要由被膜、中央静脉、门管区和肝细胞组成。门管区的小叶间静脉和小叶间胆管清晰可见,但小叶间动脉不易观察。肝内结缔组织少,肝小叶之间界限不清。肝细胞索围绕中央静脉呈放射状排列,但放射状不明显。肝实质中含有大量清晰可见的棕黑色色素团,可能与此物种对低氧环境的适应有关。     

Distribution of the pulmonary artery and vein in the lung of the crab-eating monkey (Macaca fascicularis)

In the lung of the crab-eating monkey (Macaca fascicularis), the right pulmonary artery runs across the ventral side of the right upper lobe bronchiole and the dorsal side of the right middle lobe bronchiole. Thereafter, it courses along the dorso-lateral side of the right bronchus, between the dorsal and lateral bronchiole systems. During this course, the right pulmonary artery gives off arterial branches running mainly along the dorsal or lateral side of each bronchiole. The left pulmonary artery runs across the dorsal side of the left middle lobe bronchiole, and is then distributed as in the right lower lobe. The pulmonary veins run mainly along the ventral or medial side of the bronchiole in the upper and middle lobes whereas, in the lower lobe, they run ventrally, and between the bronchioles. Finally they enter the left atrium as four large veins.     

Vascularization of liver metastases: a corrosion cast study

22 livers with multiple metastases from different primaries were injected with acrylate resin and examined stereoscopically. All metastases had developed an individual pattern of vascularization. The metastases of 8 out of 12 livers injected via the portal vein showed a distinct blood supply by the portal vessels. In all 16 livers with arterial hypervascularized metastases the development of pathological tumor vessels could be demonstrated. All metastases of the same liver showed an identical pattern of vascularization. Larger branches of the hepatic vein always were displaced by the growing tumor. It was impossible however to infer from the vascularization pattern of the metastases to the primaries. The clinical relevance of these anatomical findings will be discussed.     

Preferential expression of connexin37 and connexin40 in the endothelium of the portal veins during mouse liver development

Hepatic blood vessels consist of the hepatic artery and three types of venous channels (the portal veins, the sinusoids, and the hepatic veins). This study was undertaken to analyze, by immunohistochemistry, connexin expression throughout the vascular development of the fetal mouse liver with special attention being given to portal vein development. In the adult liver, connexin37 and connexin40 were expressed in the endothelium of the portal vein and hepatic artery, but not in those of the hepatic vein and sinusoids. Connexin43 was expressed in mesothelial cells and smooth muscle cells of the portal veins. The preferential expression of connexin37 and connexin40 in portal veins was seen throughout liver development, including its primordium formation stage (10.5-day or 11.5-day stage), although connexin37 expression was transiently seen in free nonparenchymal cells in fetal stages. The differentiation of each blood vessel in the hepatic vascular system may occur in early developmental stages, soon after hepatic primordium formation. This work was supported by Special Coordination Funds for Promoting Science and Technology from the Ministry of Education, Culture, Sports, Science and Technology, Japan.     

Thromboxane A2 analogue contracts predominantly the hepatic veins in isolated canine liver

Thromboxane A₂ (TxA₂) is a potent vasoconstrictor and has been implicated as a mediator of liver diseases such as ischemic-reperfusion injury. We determined the effects of TxA₂ and the well-known hepatic venoconstrictor histamine, on the vascular resistance distribution and liver weight in isolated canine livers perfused with blood via the portal vein. The stable TxA₂ (STA₂; 20 μg, n=5) and histamine (5 μg, n=6) similarly increased the hepatic total vascular resistance, 2.5- and 2.4-fold, respectively. The increase in the hepatic venous resistance was significantly greater than that of the portal resistance (threefold vs. 1.9-fold for STA2; threefold vs. 1.8-fold for histamine). Predominant hepatic venoconstriction induced by both agents was confirmed in livers perfused in a reverse direction from the hepatic vein to the portal vein, as shown by marked precapillary vasoconstriction. STA2 transiently increased liver weight loss (−3.6 g/100g liver weight), followed by a gradual weight gain (9.0 g/100 g). Histamine caused a progressive weight gain (9.1 g/100 g). In conclusion, similar to histamine, TxA₂ constricts predominantly the hepatic vein in isolated canine livers.