Clinical studies on inferior right hepatic veins

BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm. occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES: A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS: The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segment VII, and the medial right hepatic vein drains the middle part of segment VII. A thicker IRHV mainly drains segment VI and the inferior part of segment VII and a thinner IRHV drains the inferior part of segment V. CONCLUSIONS: The clinical significance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy of VII and VIII with right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and difficulty in exposure. (4) It is very helpful to decide therapeutic modalities for Budd-Chiari syndrome.

Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe

BACKGROUND: Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufficient remnant liver function and/or postoperative septic complications, is the major cause of hospital mortality. This study was undertaken to evaluate hepatic segmentectomy combined with major hepatic vein (MHV) resection for preserving the remnant liver lobe in the treatment of resectable primary liver cancer. METHODS: From 1997 to 2007, six patients with primary liver cancer underwent hepatic segmentectomy with MHV resection, and three patients with hepatic vein injury had ligation of the MHV. The remnant liver lobe was preserved after hepatic segmentectomy combined with MHV resection or ligation. RESULTS: The preserved liver lobe with normal structure could maintain hepatic function and showed no evidence of atrophy or swelling after hepatic segmentectomy combined with MHV resection or ligation. CONCLUSIONS: After the right inferior hepatic vein is confirmed, and the MHV is occluded experimentally before hepatic segmentectomy combined with MHV resection, progressively deteriorating congestion does not occur in the preserved segment. Ligation or resection of the two MHVs must be avoided in patients with hepatic cirrhosis who have to undergo hepatic segmentectomy combined with MHV resection. Ligation of the MHV in patients with juxtahepatic vein injury is a simple and effective therapeutic modality.