Yu Shen-ping, Chu Guo-liang, Yang Jian-yong, He Li, Wang Hua-qiao
Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Surg Radiol Anat. 2009 Jun;31(5):325-9. doi: 10.1007/s00276-008-0446-y. Epub 2008 Dec 16.
DIPS is to create a portosystemic shunt directly between the portal vein and the retrohepatic inferior vena cava (RIVC) without passing through the hepatic vein. It has been recommended that the DIPS could be applied when routine TIPS is unsuccessful or the patient has anatomical variations of the hepatic vein. The aim of this study was to identify the safe area of the RIVC where the DIPS can be safely established.
The lengths of the safe and unsafe areas of the RIVC were measured. The tributaries of the RIVC were examined. The diameter of these tributaries was measured and their incidence and relation to the safe area of the RIVC were observed. The puncture distances of DIPS and TIPS were measured and compared.
The liver together with the RIVC was collected from 31 adult cadavers (age 32-65 years; M/F 25/6). 1. The safe and unsafe areas of the RIVC: the total length of the RIVC was 70.1 +/- 13.0 mm (33.1-92.0 mm), whereas the length of the safe area of the RIVC was 54.3 +/- 12.3 mm (20.2-71.1 mm), which was about over 70% of the total length. The length of the unsafe area at the upper end was 5.9 +/- 1.8 mm (3.0-10.2 mm), and at the lower end was 8.9 +/- 2.9 mm (3.1-20.0 mm). 2. The tributaries of the RIVC: In about 90% of the cadavers (90.3%; 28 out of 31), the LHV and MHV had the common trunk. The other three cadavers (9.7%; 3 out of 31) had independent RHV, MHV and LHV. There were 217 of small hepatic veins draining into the lower segment of the RIVC. Over 70% of the small hepatic veins were smaller than 5 mm in diameter and distributed on the anterior and left wall of the lower RIVC. 3. Puncture distances of the DIPS and TIPS: The distances from the bifurcation of the portal vein to the RIVC, to the right and to middle hepatic veins were 31.2 +/- 7.9 mm (15.0-47.2 mm), 38.6 +/- 8.1 mm (17.2-59.0 mm), and 46.6 +/- 8.2 mm (34.0-68.1 mm), respectively. Thus, the puncture distances via the RIVC, RHV and LHV were significantly different (P < 0.001). The puncture distance of the DIPS was shortest.
Anatomically, DIPS is a feasible interventional procedure to make a intrahepatic shunt between IVC and portal vein directly, and has its anatomical advantages compared to TIPS.
经颈静脉肝内门体分流术（DIPS）是在门静脉和肝后下腔静脉（RIVC）之间直接建立门体分流，不经过肝静脉。有人建议，当常规经颈静脉肝内门体分流术（TIPS）不成功或患者存在肝静脉解剖变异时，可应用DIPS。本研究的目的是确定RIVC中可安全建立DIPS的安全区域。
测量RIVC安全区和非安全区的长度。检查RIVC的属支。测量这些属支的直径，观察其发生率以及与RIVC安全区的关系。测量并比较DIPS和TIPS的穿刺距离。
从31具成年尸体（年龄32 - 65岁；男/女25/6）上采集肝脏及RIVC。1. RIVC的安全区和非安全区：RIVC的总长度为70.1±13.0mm（33.1 - 92.0mm），而RIVC安全区的长度为54.3±12.3mm（20.2 - 71.1mm）约占总长度的70%以上。上端非安全区的长度为5.9±1.8mm（3.0 - 10.2mm），下端为8.9±2.9mm（3.1 - 20.0mm）。2. RIVC的属支：约90%的尸体（90.3%；31具中的28具），左肝静脉（LHV）和中肝静脉（MHV）有共同主干。另外3具尸体（9.7%；31具中的3具）有独立的右肝静脉（RHV）、MHV和LHV。有217条小肝静脉汇入RIVC下段。超过70%的小肝静脉直径小于5mm，分布在RIVC下段的前壁和左侧壁上。3. DIPS和TIPS的穿刺距离：门静脉分叉处到RIVC、右肝静脉和中肝静脉的距离分别为31.2±7.9mm（15.0 - 47.2mm）、38.6±8.1mm（17.2 - 59.0mm）和46.6±8.2mm（34.0 - 68.1mm）。因此，经RIVC、RHV和LHV的穿刺距离有显著差异（P < 0.001）。DIPS的穿刺距离最短。
从解剖学角度看，DIPS是一种可行的介入手术，可直接在腔静脉和门静脉之间建立肝内分流，与TIPS相比具有解剖学优势。
