目的应用多种医学影像学及解剖学方法，研究与经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）密切相关的解剖学改变，以提高操作的成功率、可靠性及安全性，并探索新的导向方式及分流途径。材料与方法采用ＭＲＩ、ＣＴ、血管造影、肝脏血管铸型等手段，研究肝动脉、胆管和门静脉的伴行情况及相互空间关系，估计各种穿刺途径对其损伤的可能性。分析肝段下腔静脉与门静脉的空间关系。结果胆管和肝动脉主要位于门静脉分叉及主干的前方、前上方；在右干分叉部及左干角部、矢状部分布不规则，可位于其后上或左右方。肝动脉，特别是肝右动脉和门静脉关系密切，可作为穿刺导向。肝段下腔静脉距门静脉分叉及左右干均较近，穿刺有较大的安全范围，可作为新的分流途径。结论熟悉肝脏血管解剖、应用有效导向、避免胆道和肝动脉损伤可提高ＴＩＰＳＳ疗效 Objective To investigate the anatomical changes associated with transjugular intrahepatic portal stent shunt (TIPSS) using a variety of medical imaging and anatomic methods to improve the success rate, reliability and safety of the operation and Explore new ways to guide and diversion. MATERIALS AND METHODS MRI, CT, angiography, and hepatic vessels were used to study the companion and mutual relations of hepatic artery, bile duct and portal vein and to estimate the possibility of various punctures. Analysis of the spatial relationship between hepatic inferior vena cava and portal vein. Results The bile duct and hepatic artery were mainly located in front of the portal vein bifurcation and the trunk, anteriorly and upwardly; in the right stem and the left corner, the sagittal section was irregular and could be located on the posterior or left and right sides. Hepatic arteries, especially the right hepatic artery and portal vein, are closely related to each other and can be used as a puncture guide. Hepatic inferior vena cava portal vein bifurcation and the left and right stem are close, puncture a larger safety margin, as a new shunt pathway. Conclusions Familiarity with hepatic vascular anatomy and effective guidance to avoid the biliary and hepatic artery injury can improve the therapeutic effect of TIPSS