目的 探讨胆囊静脉的回流模式和注入部位，为了解胆囊癌血管转移途径和腹腔镜胆囊切除术提供解剖学基础。 方法 新鲜成人肝和胆囊标本32例，制成肝门静脉和胆囊静脉铸型标本。计数胆囊静脉属支和分支的数目，测量其直径。观察胆囊静脉的回流模式和注入肝门静脉的部位。 结果 胆囊有胆囊静脉2～4支，长1.6 cm (1.1~2.1 cm)，中部直径3.1 mm（2.4~4.1 mm）。胆囊静脉属支有3支（2~5支）, 末端直径1.6 mm（0.8~2.8 mm）；胆囊静脉分支有4支（3~5支），起始处直径1.5 mm（0.8~2.2 mm）。胆囊静脉左、右侧各1支的有10例，各2支的有8例；左侧1支、右侧2支的有6例，左侧2支、右侧1支的有7例，左侧3支、右侧1支的有1例。在胆囊体和底部起始的细小静脉与胆囊动脉分支伴行，向胆囊两侧走行，汇合成2~5支胆囊静脉属支，在近胆囊床边缘处汇合为胆囊静脉。而后胆囊静脉分出3~5支分支，走行5~8 mm后与肝门静脉右支的第3~5级分支吻合。胆囊床底部有3~5支细小胆囊静脉直接与肝门静脉右支的细小分支吻合。胆囊颈部和胆囊管的静脉与胆总管静脉或肝总管静脉汇合，上行注入肝门静脉左支或右支。 结论 胆囊体和底部的静脉以胆囊门静脉的模式与肝门静脉右支的分支吻合，即首先以胆囊毛细血管静脉端汇合为小静脉，各属支进而汇合为数支胆囊静脉，而后胆囊静脉分出数支分支，与肝门静脉右支的第3~5级分支吻合。
Abstract
Objective To observe the reflux mode of cholecystic vein and the exact locations of venous confluence, so as to provide an anatomical understanding of the hematogenous metastasis in gallbladder carcinoma and surgical operation in laparoscopic cholecystectomy. Methods Thirty-two cases of fresh adult liver and gallbladder specimens were made into section specimens, in which the number of branches and tributaries of cholecystic vein were counted and the diameter of these vessels were measured. The patterns of reflux and the and the various locations of venous confluence were observed. Results Normally, there were 2-4 chloeytic veins from the gallbladder. The average longitude the veins was about 1.6 (1.1-2.1) mm The average diameter of middle location was about 3.1(2.4-4.1) cm. The cholecystic vein had 3 (2-5) branches with a terminal diameter of 1.6 (0.8-2.8) mm. There were 4 (3-5) branches of the cholecystic vein, with a diameter of 1.5 (0.8-2.2) mm at the beginning. About the various locations of cholecystic veins, it was observed in 10 cases that there was one single branch on both left and right side. Two branches on both sides were found in 6 cases, one branch on left side with two branches on right side were found in 7 cases, three branches on left side with one branch on right side in one single case. The small tributaries of the cholecystic vein which arose from the body and fundus of the gallbladder were accompanied by the branches of the cholecystic artery, then went to both sides of the gallbladder, and formed 2-5 tributaries through 2-3 tiers of arcades, and merged into the cholecystic vein near the edge of the gallbladder bed. Further, the cholecystic vein g sent out 3-5 branches, ran 5~8 mm and anastomosed with the third to fifth tiers of the right branch of hepatic portal vein. At the bottom of the gallbladder bed, 3-5 small cholecystic veins anastomosed directly with the small branches of the right branch of the hepatic portal vein. Gallbladder jugular vein and the cholecystic duct met with the veins from the common bile duct or the hepatic duct, and went upward to flow into the right or left branch of the hepatic portal vein. Conclusions The veins from the body and fundus of the gallbladder anastomose with the right branch of the hepatic portal vein in the gallbladder portal vein pattern, that is, at first, the ends of the gallbladder capillary veins converges into venules, then each tributary merge into couple of cholecystic veins, and the cholecystic vein branches are divided into several tiers branches, which are anastomosed with the third to fifth tiers of the right hepatic portal vein.
关键词
胆囊静脉回流； /
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胆囊门静脉； /
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临床解剖学； /
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血管铸型； /
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胆囊癌血管转移
Key words
Venous reflux of cholecystic vein; /
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Cholecystic portal vein; /
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Clinical anatomy; /
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Vascular cast; /
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Vascular metastasis of gallbladder carcinoma
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