Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

成人间右半肝活体肝移植的肝动脉重建

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.     

成人间右半肝活体肝移植的肝动脉重建

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.     

Hepatic flow optimization in full right split liver transplantation

Split liver transplantation for two adults offers a valuable opportunity to expand the donor pool for adult recipients.However,its application is mainly hampered by the physiological limits of these partial grafts.Small for size syndrome is a major concern during transplantation with partial graft and different techniques have been developed in living donor liver transplantation to prevent the graft dysfunction.Herein,we report the first application of synergic approaches to optimise the hepatic hemodynamic in a split liver graft for two adults. A Caucasian woman underwent liver transplantation for alcoholic cirrhosis(MELD 21)with a full right liver graft (S5-S8)without middle hepatic vein.Minor and accessory inferior hepatic veins were preserved by splitting the vena cava;V5 and V8 were anastomosed with a donor venous iliac patch.After implantation,a 16G catheter was advanced in the main portal trunk.Inflow modulation was achieved by splenic artery ligation.Intraportal infusion of PGE1 was started intraoperatively and discontinued after 5 d.Graft function was immediate withnormalization of liver test after 7 d.Nineteen months after transplantation,liver function is normal and graft volume is 110%of the recipient standard liver volume. Optimisation of the venous outflow,inflow modulation and intraportal infusion of PGE1 may represent a valuable synergic strategy to prevent the graft dysfunction and it may increase the safety of split liver graft for two adults.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

目的 评价术中胆道数字成像技术在活体肝移植(living donor liver transplantation,LDLT)肝内胆道解剖分型和胆道切面确定中的作用及临床价值.方法 66例LDLT供者,通过术中胆道数字减影了解胆道分型及变异,结合金属标志物准确选择胆道离断位置,与手术结果比较,分析其在LDLT供者术中胆道解剖描述及切面确定中的作用.结果 所有供者均采用胆道数字成像技术对肝内胆道解剖进行分型,Ⅰ型(经典型)45例(68.2%),Ⅱ型(三叉型,胆总管由右前肝管、右后肝管、左肝管汇合而成)7例(10.6%),Ⅲ型(无右肝管主干,右后肝管汇入肝总管)13例(19.7%),Ⅳ型(无右肝管主干,右后肝管汇入左肝管)1例(1.5%),Ⅴ型(复杂分型)0例(0%).Ⅰ型所有供者均形成单一吻合口;Ⅱ型7例供者中4例形成2个吻合口,3例经成形或非成形后形成1个吻合口;Ⅲ型13例供者中9例形成2个吻合口,4例经成形后形成1个吻合口;Ⅳ型1例供者,2个胆道吻合口.所有供者都完成活体右半肝切取术.结论 术中胆道数字减影结合金属标志物可以精确显示肝内胆道解剖及变异并准确定位肝管切面,减少胆道吻合口数目,有助于供肝的安全获取和移植.

Abstract：

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

A NEW LIVER TRANSPLANTATION MODEL: POSTSPLENECTOMIC ECTOPIC AUXILIARY LIVER TRANSPLANTATION IN PIGS

Objcctive:To inquire into the possibility and reliability of newly estab-lished liver transplantation model-postsplenectomic ectopic auxiliary liver transplantationin pigs.Methiods:Thirty-six male domestic pigs were used(the recipients and donorseach 18).Donor liver was removed and cold Collins solution perfused.In the recipient pig,the portal vein was constricted by 1/3 original diameter,then the spleen resected.Afterthat,the donor liver was transplanted on the splenic bed.The anastomotic procedure wasdone as following:hepatic artery-splenic artery anastomosis(HA-SA), hepatic vein-left re-nal vein anastomosis(HV-RV),and portal vein-splenic vein anastomosis(PV-SV).Commonbile duct was intubated and bile was collected with an extracorporeal bag.Pre-and Post-operative determinations were carried out,including serum biochemistry,hepatic patho-logical examination(microscopy and electroscopy),and anastomotic stoma pressure,etc.Results:Of the 18 recipient pigs,four died during operation(22.2%).Postoperative ob     

医学图像三维可视化系统在精准肝切除中的应用价值

目的 探讨医学图像三维可视化系统(MI-3DVS)在精准肝切除中的指导作用.方法 2008年6月至2010年9月南方医科大学珠江医院利用自行研发的MI-3DVS在术前对45例肝癌患者肝脏的CT薄层图像数据进行三维重建.根据肝内门静脉和肝静脉走行划分肝段,确定肿瘤所在位置,测算切除的功能性肝脏体积并计算剩余肝脏体积百分比.术前评估可切除性,制订个体化的手术方案,然后进行仿真手术演练,指导临床手术.结果 45例肝癌患者根据肝内肝静脉和门静脉的走行分布分为7种类型:常见型21例,与Couinaud分段相同;未分型6例;肝右叶未分型11例;肝左叶未分型4例;肝右静脉型1例;肝中静脉双支型1例;右后下静脉型1例.39例患者行开腹肝癌切除术,平均剩余肝脏体积百分比为74%±17%,术后病理检查均为肝细胞癌;6例患者行TACE治疗.所有患者术后未发生急性肝功能衰竭、出血、胆汁漏等严重并发症.出院后随访6个月,患者无瘤或带瘤生存.结论 用MI-3DVS进行术前评估和指导临床手术,符合肝脏解剖与生理特点,对精准肝切除有重要的指导作用.

Abstract：

Objective To investigate the guiding significance of medical image three-dimensional visualization system (MI-3DVS) in precise hepatectomy. Methods The clinical data of 45 patients with hepatic neoplasms who were admitted to the Zhujiang Hospital from June 2008 to September 2010 were prospectively analyzed. The preoperative image data of the liver were three-dimensionally reconstructed by MI-3DVS. According to the distribution of the intrahepatic portal veins and hepatic veins, the liver was divided into different sections,and then tumors can be located within these hepatic segments. The volume percentage of residual liver and volume of liver resected were detected. Evaluation of surgical resectability and surgery simulation were done before operation. Results According to the distribution of the intrahepatic portal veins and hepatic veins, all patients were divided into seven types: 21 patients were with normal type which was the same as Couinaud type, six with nondivided type, 11 with non-divided right liver type, four with non-divided left liver type, one with right hepatic vein type, one with double middle hepatic vein type and one with right posterior vein type. Thirty-nine patients received open hepatectomy, and the volume percentage of the residual liver was 74% ± 17%. Postoperative pathological examination confirmed that all the 39 patients were with hepatocellular carcinoma. Six patients received transcatheter arterial chemoembolization. No severe complications such as acute hepatic failure, bleeding, bile leakage were detected. All patients were followed up for six months, and they survived with or without tumor. Conclusion MI-3DVS has guiding significance in preoperative assessment and perioperative guidance for precise hepatectomy.     

肝脏右后下静脉的临床解剖学研究

目的 观测肝脏右后下静脉(inferior right hepatic veins,IRHV)的解剖学结构.方法 60具成人尸体肝脏标本,根据肝右后静脉汇入下腔静脉肝后段上、中、下1/3的部位分为上、中、下三组.观察测量IRHV的出现率、数目、口径、肝外行程及其与肝右静脉的关系.结果 IRHV出现率为83.33%,口径为2.62～18.46(14.32±1.21)mm,肝外长度为3.26～47.65(10.78±7.81)mm.IRHV直径与其数量呈负相关.IRHV直径与肝右静脉直径呈负相关,IRHV数量与肝右静脉直径呈正相关.结论 IRHV口径粗大,出现率高,有肝外行程,和肝右静脉呈彼消此长关系.在肝切除术中应注意避免损伤,活体肝移植时应施行IRHV的修复重建.

Abstract：

Objective To observe the anatomy of the inferior right hepatic veins (IRHV).Methods The IRHVs were divided into 3 groups according to the location where they entered into the retrohepatic inferior vena cava at: the upper 1/3, middle or lower 1/3. The incidence, number, caliber, extrahepatic length and the relationship between the major hepatic veins (the right, middle and the left hepatic veins) and the IRHV were observed and measured in 60 adult cadavers. Results The incidence of IRHV was 83.33% with an average diameter of 2.62-18.46(14.32±1.21)mm. Its extrahepatic length was 3.26-47.65 (10.78±7.81)mm. There was a marked negative correlation between the diameter of the IRHV and its number, a marked negative correlation between the diameter of the IRHV and the diameter of the right hepatic vein and a marked positive correlation between the number of the IRHV and the diameter of the right hepatic vein. Conclusions There were high variations in the incidence and anatomy of the IRHV which were related to the diameter of the right hepatic vein. The IRHV was not to be torn during liver resection and should be reconstructed in right liver grafts.     

Clinical and imaging study on hepatic venous congestion of Ⅴ, Ⅷ segments in living donor liver transplantation

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.     

Clinical and imaging study on hepatic venous congestion of Ⅴ, Ⅷ segments in living donor liver transplantation

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.