Branching Patterns and Drainage Territories of the Middle Hepatic Vein in Computer‐Simulated Right Living‐Donor Hepatectomies
Branching Patterns and Drainage Territories of the Middle Hepatic Vein in Computer‐Simulated Right Living‐Donor Hepatectomies
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计算机模拟右活体肝切除术中肝中静脉的分支模式和引流区域
DOI：
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发表时间：
2006
影响因子：
8.8
通讯作者：
P. Schemmer
中科院分区：
文献类型：
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作者：
J. Neumann;J. Neumann;M. Thorn;L. Fischer;Max Schöbinger;T. Heimann;B. Radeleff;Jan Schmidt;H. Meinzer;M. Büchler;P. Schemmer
全右肝移植最常用于成人对成人活体肝移植（LDLT）。主要问题之一是第 5 段和第 8 段的静脉引流。因此，本研究旨在为手术计划提供右肝叶静脉引流的信息。使用肝脏手术计划系统对来自常规临床成像的 56 个 CT 数据集进行了回顾性评估。我们定义并分析了静脉引流段以及肝中静脉 (MHV) 解剖变化对第 5 段和第 8 段静脉流出的影响。MHV 变化导致第 5 段引流在中肝静脉和右肝静脉之间发生显着变化。在具有最常见 MHV 分支模式的病例 (n = 33) 中，虚拟肝切除术紧邻 MHV 相交的引流血管，为 30% 的潜在移植物提供引流，而不考虑潜在的静脉-静脉分流。在 MHV 分支延伸至第 5 段和第 6 段的个体中 (n = 10)，存在静脉引流受损风险的移植物总体积增加了 5% (p < 0.001)。如果这一点在临床试验中得到证实并与术中发现相关，那么使用肝脏手术计划系统将有利于改善右叶 LDLT 后的总体结果。
Full right hepatic grafts are most frequently used for adult‐to‐adult living donor liver transplantation (LDLT). One of the major problems is venous drainage of segments 5 and 8. Thus, this study was designed to provide information on venous drainage of right liver lobes for operation‐planning. Fifty‐six CT data sets from routine clinical imaging were evaluated retrospectively using a liver operation‐planning system. We defined and analyzed venous drainage segments and the impact of anatomic variations of the middle hepatic vein (MHV) on venous outflow from segments 5 and 8. MHV variations led to significant shifts of segment 5 drainage between the middle and right hepatic vein. In cases with the most frequent MHV branching pattern (n = 33), a virtual hepatectomy closely right to the MHV intersected drainage vessels that provided drainage for 30% of the potential graft, not taking into account potential veno‐venous shunts. In individuals with inferior MHV branches that extend far into segments 5 and 6 (n = 10), the overall graft volume at risk of impaired venous drainage increased by 5% (p < 0.001). If this is confirmed in clinical trials and correlated with intraoperative findings, the use of liver operation‐planning systems would be beneficial to improve overall outcome after right lobe LDLT.