基于计算机辅助手术系统的肝静脉分型及其对肝脏外科的临床意义

A classification of types of hepatic vein based on data obtained from a computer-assisted surgery sys- tem and its clinical implications in liver surgery

目的基于计算机辅助手术系统对主肝静脉及各肝静脉分支的分型进行大数据分析，测量肝静脉相应的回流体积，为实施精准肝切除术提供理论依据。方法应用海信计算机辅助手术系统（CAS）将570例国人上腹部增强CT进行肝脏及血管三维重建，大数据分析主肝静脉及其分支的医学影像变异并分型，测量各肝静脉主干回流区域体积。结果主肝静脉分型：I型270例（47．4％），Ⅱ型294例（51．6％），Ⅲ型6例（1．0％）。肝左静脉分型：I型190例（33．3％），Ⅱ型79例（13．9％），Ⅲ型301例（52．8％）。肝中静脉分型：I型313例（54．9％），Ⅱ型174例（30．5％），Ⅲ型83例（14．6％）。肝右静脉分型：I型456例（80．0％），Ⅱ型79例（13．9％），Ⅲ型35例（6．1％）；I型又分为四个亚型，A亚型26例（5．7％），B亚型404例（88．6％），C亚型20例（4．4％），D亚型6例（1．3％）。其中131例，肝左静脉回流体积（25．0±6．6）％，肝中静脉回流体积（34．8±9．5）％。63例伴有右后下静脉的患者，肝右静脉回流体积（25．1±11．6）％，右后下静脉及肝短属支回流体积（14．7±7．4）％。68例不伴有右后下静脉的患者，肝右静脉回流体积（40．7±8．6）％。结论肝静脉解剖变异复杂多样，各分支回流肝体积差异较大。海信CAS能准确立体显示肝内血管走行及肿瘤与脏器的毗邻关系，对精准肝切除术的实施具有重要意义。

Objective To classify the types of hepatic vein and to measure their corresponding liver venous drainage volumes based on analysis of data obtained from a computer-assisted surgery system with an aim to provide an anatomical basis on individualized anatomical hepatectomy. Methods Thin-layer compu- ted tomography （CT） imaging on 570 patients were reconstructed using the Hisense CAS. The types of hepatic vein were classified according to their anatomical variations. The margins of the hemilivers or sectors and their corresponding hepatic venous drainage volumes were displayed. Results The major hepatic veins were classified into three types： Type I （270/570, 47.4% ）, type Ⅱ （294/570, 51.6% ）, and type m （6/570, 1.0% ）. The left hepatic vein （LHV） was classified as type I in 190/570 （33.3%）, type Ⅱ in 79/570 （13.9%）, and type m in 301/570 （52.8%）. The middle hepatic vein （MHV） was classified as type I in 313/570 （54.9%）, type Ⅱ in 174/570 （30.5%）, and type Ⅲ in 83/570 （14.6%）. The right hepatic vein （RHV） was classified as type I in 456/570 （80.0%）, type Ⅱ in 79/570 （13.9%）, and type Ⅲ in 35/570 （6.1%）. Type I was further classified into four subtypes of A （26/456, 5.7% ）, B （404/456, 88.6%）, C （20/456, 4.4%）, and D （6/456, 1.3%）. The LHV volume was （25.0 ± 6. 6） % , the MHV volume was （ 34. 8 ± 9.5 ） % and the RHV volume was （25. 1 ± 11.6） % in 63 patients with inferior right hepatic veins （IRHV）. The IRHV and other branches volumes were （14.7 ± 7.4）%.The RHV volume was （40.7±8.6）% in 68 patients without IRHV. Conclusions Hepatic venous variations are complex. Significant differences existed in the hepatic venous drainage volumes. The Hisense CAS clearly delineated the relationship between the intrahepatic vascular structures and the liver carcinoma which hopefully can lead to improvement in the success rate of complex hepatectomy.