Objective To describe the CT features of the right hepatic portal vein and hepatic vein by upper abdominal angiography with 256-slice spiral CT, and to explore the anatomical relationship and the redefinition of liver segmentation, so as to explore its clinical significance. Methods One hundred cases who were randomly collected were examined with plain CT scanning and three-phase enhanced CT scanning. The distribution of right hepatic portal vein and the branches, hepatic vein and the branches after 3D reconstruction were observed, and the relevant data were statistically analyzed. Results The distribution of portal vein: S5 segment could be divided into 4 types. There were 66 cases of A type, 10 cases of B type, 8 cases of C type, and 16 cases of D type. S6 segment could be divided into 6 types, A type 56 cases, B type 15 cases, C type 4 cases, D type 17 cases, E type 4 cases, F type 4 cases . S7 segment could be divided into 3 types, A type 73 cases, B type 23 cases, C type 4 cases. S8 segment could be divided into 5 types, A type 67 cases, B type 3 cases, C type 2 cases, D type 8 cases, E type 20 cases. The distribution of hepatic vein: 45 cases of LHV, MHV and RHV were imported into IVC respectively. Fifty-five cases of LHV and MHV formed common trunk and were imported into IVC. IRHV was found in 36 cases, 11 cases of RHV were small with compensatory blood supply to the right liver by developed MHV. The main MHV trunk was located above the main bifurcation of the portal vein in 15 cases, and the MHV was located right of the Rex-Cantlie line in 41 cases. In this paper, the spatial position relationship between hepatic vein and portal vein was divided into four types. Type A has the most (accounting for 64%) and type D has the least (accounting for 3%). Conclusions The anatomical features of the hepatic vein and portal vein in the right part of the liver is complex and diverse. The spatial distribution of hepatic vein and portal vein also change when the main portal vein is mutated. It has imaging guiding significance for the smooth implementation of individualized liver surgery.
Key words
Right liver; /
3D reconstruction; /
Hepatic portal vein; /
Hepatic veins; /
Anatomy relationship
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References
[1] 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13. DOI: 10.12151/JMCM.2021.02-01.
[2] 杨明, 黄缘, 魏来. 肝硬化终末期患者的治疗和管理[J]. 临床肝胆病杂志, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007.
[3] 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南[J]. 中华肝脏病杂志, 2019, 27(8): 582-593. DOI: 10.3760/cma.j.issn.1007-3418.2019.08.002.
[4] 陈超, 黄尔炯, 吴伟. 经颈静脉肝内门体分流术在门脉高压性疾病治疗中的应用[J]. 肝胆胰外科杂志, 2019, 31(8): 459-463. DOI: 10.11952/j.issn.1007-1954.2019.08.004.
[5] 孟岩, 张健飞, 于胜波, 等. 肝段解剖及肝脏外科研究进展[J]. 中国医师进修杂志, 2011, 34(z1): 108-109. DOI: 10.3760/cma.j.issn.1673-4904.2011.z1.069.
[6] Soyer P, DA Bluemke, Choti MA, et al. Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography[J]. Ajr Am J Roentgenol, 1995, 164(1): 103-108. DOI: 10.2214/ajr.164.1.7998521.
[7] Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US[J]. Radiology, 1992, 184(1): 157. DOI: 10.1148/radiology.184.1.1609075.
[8] 范应方, 向飞, 蔡伟, 等. 基于三维可视化技术的右半肝门静脉3D分型及分段[J]. 南方医科大学学报, 2016, 36(1): 26-31. DOI: 10.3969/j.issn.1673-4254.2016.01.05.
[9] 魏卿. 肝脏右后段门静脉和肝静脉的分支类型及其变异[D]. 大连: 大连医科大学, 2012.
[10] 王岐本, 曾志成. 国人肝静脉[J]. 中国现代医学杂志, 2006, 16(17): 2619-2622. DOI: 10.3969/j.issn.1005-8982.2006.17.016.
[11] 张琳. 肝中静脉解剖及影像三维重建在活体肝移植中的应用[D]. 重庆: 重庆医科大学, 2009. DOI: 10.7666/d.Y1546464.
[12] 杨文哲. 数字医学技术在闭合性肝外伤诊治中的应用研究[D]. 广州: 南方医科大学, 2015. DOI: 10.7666/d.Y2910686.
[13] 王海彪, 胡元达, 俞海蛟, 等. 腹腔镜下肝门解剖技术在精准左肝叶切除术的应用[J]. 中华外科杂志, 2014, 52(1): 68-69. DOI: 10.3760/cma.j.issn.0529-5815.2014.01.017.
[14] 王莉, 薛雁山, 胡齐, 等. 肝右后下静脉的CT影像解剖学研究及其临床意义[J]. 中国医学影像学杂志, 2009, 17(1): 28-31. DOI: 10.3969/j.issn.1005-5185.2009.01.009.
[15] 唐敏, 杨尚文, 马一鸣, 等. 64排螺旋CT扫描数据基础上的门静脉和肝静脉三维解读及其解剖变异分析[J]. 中国临床医学影像杂志, 2013,24(5): 338-340, 356. DOI: 10.3969/j.issn.1008-1062. 2013. 05.009.
[16] 孙谊, 王崑, 包全, 等. 肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除手术的安全性探讨[J]. 中华普通外科杂志, 2014, 29(3): 181-184. DOI: 10.3760/cma.j.issn.1007-631X.2014.03.006.
[17] 谭孝华, 杜成友, 杨祖奎. 肝中静脉在活体肝移植中的作用[J]. 国外医学外科学分册, 2005, 32(4): 267-270. DOI: 10.3760/cma.j.issn.1673-4203.2005.04.008.
[18] 吴军, 闫雪华. 肝硬化门脉高压症介入治疗进展[J]. 甘肃医药, 2011, 30(8): 474-476. DOI: 10.3969/j.issn.1004-2725.2011.08.009.
[19] 赵洪伟, 齐瑞兆, 岳振东, 等. 3367例经颈静脉肝内门体分流术的技术难点分析[J]. 中华消化外科杂志, 2016, 15(7): 689-695. DOI: 10.3760/cma.j.issn.1673-9752.2016.07.010.
[20] 沈柏用, 施源. 肝脏分段解剖的新认识[J]. 世界华人消化杂志, 2008, 16(9): 913-918. DOI: 10.3969/j.issn.1009-3079.2008.09.001.
[21] Healey JE. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts[J]. Arch Surg, 1953, 66(5): 599. DOI: 10.1001/archsurg.1953.01260030616008.
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