肝右静脉分支的分布规律及其对循肝静脉解剖性肝切除术的临床意义

Distribution patterns of the right hepatic vein branches and their clinical significance in hepatic vein-guided anatomical hepatectomy

目的通过分析肝脏CT三维重建后的影像信息,总结肝右静脉的空间分布规律,以期为解剖性肝切除术的手术规划提供指导。方法回顾性分析2018年9月至2021年10月于哈尔滨医科大学附属第二医院行肝脏CT检查的77例受检者的临床资料,其中男性42例,女性35例,年龄(50.2±12.8)岁。收集受检查的CT原始医学数字成像和通信数据,利用三维重建软件将二维影像数据重建为三维模型,通过分析肝右静脉的分支数量和汇入主干的空间位置,对其特征和分型进行分析。结果 77例受检者的肝脏CT三维重建模型中,观测到645条肝右静脉分支:268条(41.6%)右侧支,240条(37.2%)背侧支,70条(10.9%)左侧支,67条(10.3%)腹侧支。每支肝右静脉拥有的右侧分支数为3(3,4),背侧分支数为3(3,4),左侧分支数为1(0,1),腹侧分支数为1(0,1)。多组间比较显示四个方位的分支数差异有统计学意义(H=175.89,P<0.001)。两组间比较显示,右侧分支数分别多于左侧(χ^(2)=136.87)和腹侧(χ^(2)=140.07)分支数,背侧分支数分别多于左侧(χ^(2)=-123.36)和腹侧(χ^(2)=126.57)分支数,差异均具有统计学意义(均P<0.001)。腹侧与左侧分支数比较、背侧与右侧分支数比较,差异均无统计学意义(均P>0.05)。结论肝右静脉分支的腹侧支和左侧支较少,术中从腹侧或左侧解剖分离肝右静脉相对安全,涉及中肝或Ⅷ段肝切除时,循肝右静脉断肝具有一定的合理性。

Objective To elucidate the spatial distribution patterns of the right hepatic vein by analyzing the image information obtained after CT three-dimension reconstruction of liver to provide guidance in surgical planning of anatomical hepatectomy.Methods A retrospective analysis was performed on the clinical data of 77 subjects who underwent CT examination of the liver at the Second Affiliated Hospital of Harbin Medical University from September 2018 to October 2021.There were 42 males and 35 females,aged(50.2±12.8)years old.CT DICOM data of the patients were collected,and the two-dimensional image data were reconstructed into a three-dimensional model by using the 3D reconstruction software.The characteristics and typing were studied by analyzing the number of branches of the right hepatic vein and the spatial location of the main trunk.Results Of 77 subjects,645 branches of the right hepatic vein were observed in the liver CT 3D reconstruction model,including 268(41.6%)right-sided branches,240(37.2%)dorsal branches,70(10.9%)left-sided branches,and 67(10.3%)ventral branches.Each right hepatic vein possessed 3(3,4)right-sided branches,3(3,4)dorsal branches,1(0,1)left-sided branch,and 1(0,1)ventral branch.The numbers of branches in the four directions were significantly different(H=175.89,P<0.001).Comparison showed that the number of right-sided branches was significantly more than that of the left-sided(χ^(2)=136.86)and ventral(χ^(2)=140.07),respectively.The number of dorsal branches was more than that of left-sided(χ^(2)=-123.36)and ventral(χ^(2)=126.57)branches,respectively.The differences were significant(P<0.001).There were no significant differences between the number of ventral and left-sided branches,and between the dorsal and right-sided branches(all P>0.05).Conclusion The right hepatic vein had fewer ventral and left-sided branches.It is relatively safe to dissect the right hepatic vein from the ventral or the left side during surgery.For resection of the central liver segments or segment VIII of the liver,it is reasonable to transect the liver along the left border of the right hepatic vein.