| Liver transplantation is an effective therapy for the end-stage disease of hepatopathy . Partial right lobe liver transplantation is a good way to enlarge source of supplied liver. Because of the complex of the construction within livers, it was limited in some district to perform partial right lobe liver transplantation in the world, especially to perform partial right lobe liver transplantation with living donor. Partial right lobe liver transplantation deals with followed as: evaluating quality of donors' liver,calculating volume or weight of grafts , anatomy,separation,cutting and reconstruction of the branches of hepatic arteries, bile ducts ,portal veins. Each of the procedurs is the key factor which is dued to good quality of life to receiptors.The donor giving partial right lobe liver not only suffers operation ,but also experience baptism that he or shi carries out duty of family and society,endurs a lot of mind stress ,realizes his or her in individual worthiness.China is a area where hepatic diseases are prevalent. Many patients need to receive liver transplantation because of end-stage hepatic diseases whereas there are not enough donors providing livers. The aim of this study is to provide the applied anatomy for surgical treatment of living-related liver transplantation combined with some specific partial right lobe liver transplantation with observing the rule of construction of the inner liver and out.Materials and methods 1. The gross anatomic construction of the arteries, bile ducts, portal veins andhepatic veins were studied in 41 fresh adult livers, 43 formalin-fixed adult cadaver livers and 91 adult liver casts.2. In 41 fresh adult livers and 43 formalin-fixed adult cadaver livers, the followed items were studied:(l).The number of branches , maximum diameter ,the whole length ,the length outside livers, the courser , confluence, the diameter in the wall of IVC,the spots where hepatic veins inpour ,the angles between IVC and hepatic veins ,the angles between falciform ligaments and hepatic veins, the distance between the diaphragm muscle and hepatic veins; The number and diameter of right-retro-infra short hepatic veins, the number of superior border hepatic veins on the right and the left of livers, the diameter and the length of retro-IVC, intra-IVC, the diameter and the length of the branches of middle hepatic veins entering cholecystic bed, the shortest distance of the branches of middle hepatic veins entering cholecystic bed and cholecystic wall, the excursioning degree of middle hepatic veins from middle hepatic fissura,the distance between right hepatic veins and middle hepatic veins.(2).The length, diameter .number and courser of portal veins' main branch,right branch,right anterior branch, right anterior superior branch, right anterior inferior branch, right posterior branch, right posterior inferior branch, right posterior inferior branch,the angle between the right branch of portal vein and the left branch of portal vein,the distance between the liver and the place where the right branch of portal vein and the left branch of portal vein forms confluence.(3).The length, diameter and courser of common hepatic artery, right branch of hepatic artery, proper hepatic artery ,right posterior branch,the confluence type of the right branch and the left branch, the angle between the right branch of hepatic artery and the left branch of hepatic artery ,the distance between the liver and the place where the right branch of hepatic artery and the left branch of hepatic artery forms confluence.(4).The length, diameter and courser of common bile duct, common hepatic duct, right branch of bile duct, right posterior branch,the confluence tipe of the right branch and the left branch, the angle between the right branch of bile duct and the leftbranch of bile duct ,the distance between the liver and the place where the right branch of bile duct and the left branch of bile duct forms confluence.3.The name ,number,diameter, the place of ducts on planes were calculated in 8 formalin-fixed adult cadaver livers that were choosed from 43 formalin-fixed adult cadaver livers after the livers were cutted down according to the operation way of amplificated right semi-liver transplantation, right semi-liver transplantation, right posterior lobe liver transplantation respectively.4.The calculating methods: electron slide gaud, stainless steel rule, compasses were used to calculate the diameter,the length and angle .5.The statistics' methods:All datas were analyzed with SPSS 11.5. The measurement data from different liver sources which were fitted for the condition of variance check was analyzed with One Way ANOVA .Otherwise, the measurement data,as well as enumeration data was analyzed with K Indpendent Samples Test. Comparison of rate of two indpendent samples was analyzed with 2 Independent Samples Test, Comparison of rate of samples and population was analyzed with Binomial. Correlation analysis was used for analyse of the relation of two index by Spearman or Pearson Correlation.Resultsl.The results of hepatic veins from 133 liver specimens were followed as:(l).The results of types of hepatic veins :In type A,there was a larger right hepatic vein and small accessory hepatic veins (59.4% of all specimens), In type B.there was a larger right hepatic vein and small accessory hepatic veins (27.8% of all specimens). In type C,there was a larger right hepatic vein and small accessory hepatic veins (12.8% of all specimens).There was more specimens in type A of this study than that reported in literature (P=0.000) while There was less specimens in type A of this study than that reported in literature (P<0.05).(2).The middle and left hepatic veins formed a common trunk in 60.3 percent of specimens, There was less specimens forming a common trunk of this study than that reported in literature (P=0.000). The middle and left hepatic veins did not form a common trunk in 33.8 percent of specimens, The middle and left hepatic veins did notform a common trunk but formed a common opening in 5.9 percent of specimens.(3).The length of the common trunk was 1.12±0.62cm,while the diameter of the common trunk was 1.29±0.40cm.(4).There were no common kinds of converge of hepatic veins of which the veins' branches drained blood from IV segment (Couinaud's classification) and should enter middle hepatic vein ,but entered left hepatic vein(13% of all specimens ),and of which the veins'branches drained blood from III segment ( Couinaud's classification) and should enter left hepatic vein ,but entered middle hepatic vein(3/l 33).There were more specimen which drained blood from III segment (Couinaud's classification) and should enter left hepatic vein ,but entered middle hepatic vein (3%of all specimens), P=0.002.(5).The diameter of left hepatic vein , middle hepatic vein and right hepatic vein was 0.91±0.27cm,1.01±0.29cm, 1.38±0.35cm respectively.(6).There was a negative correlation between the diameter of right hepatic veins and accessory right hepatic veins(r=-0.265? P=0.022); There was positive correlation between the diameter of left hepatic veins and the number of short right hepatic veins( r=0.254 , p=0.027 ); There was positive correlation between the diameter of middle hepatic veins and the number of a short right hepatic veins( r=0.278, p= 0.015).(7).The number of right-retro-middle hepatic vein, right-retro-infra hepatic vein, short hepatic veins was 0.26±0.44, 0.30 ±0.46, 16.16±0.87 respectively, The diameter of largest short hepatic veins was 0.61 ±0.27cm.(8).There were right-retro-middle hepatic vein(29.5%of all specimens) and right-retro-infra hepatic vein (26.0% specimens).(9).The distance of two spots was 1.47±0.42cm where middle hepatic vein and right hepatic vein connected with IVC respectively. The distance from the first branch of right hepatic vein, middle hepatic vein and left hepatic vein to IVC was 0.82±0.81 cm,1.40±0.03 cm and 0.96±0.62cm respectively.(10).The diameter and the length of retro-IVC and intra-IVC which represented that more than 50% of IVC was circled by liver parenchyma 2.29±0.40cm,6.81±1.24cm, 1.89±0.39cm,4.59±0.89cm.(ll).The right excursioning degree of middle hepatic veins from middle hepatic fissura was 14.11±12.645° in 75 cases of 78 cases,while the right excursioning degree of that was in only 3 cases of all cases .(12).The length and the diameter of the branch of middle hepatic vein was which entered liver constitution near cholecystic bed was 2.85±0.55cm,0.31±0.04cm and the stortest distance from the branch to the cholecystic wall was 0.26±0.22cm.2. The results about bile duct were followed as:(l)The results about type of bile duct in 133 cases were followed as:?In type A (76.6% of all cases) right hepatic duct from common hepatic duct was made of anterior right hepatic duct and posterior right hepatic duct. ?In type B (8.3% of all cases) there was no right hepatic duct and common hepatic duct was made of anterior right hepatic duct .posterior right hepatic duct and left hepatic duct. (§)In type Cl (3% of all cases) posterior right hepatic duct entered common hepatic duct. In type C2(1.5% of all cases) anterior right hepatic duct entered common hepatic duct.@In type Dl (1.5% of all cases) posterior right hepatic duct entered left hepatic duct. In type C2 (4.5% of all cases) anterior right hepatic duct entered left hepatic duct. ?In type E ( no cases of all cases) many of branches of bile duct from left lobe entered posterior right hepatic duct or anterior right hepatic duct.(6)In type F (0.8% of all cases) posterior right hepatic duct receiveing cystic duct entered common hepatic duct which was made of anterior right hepatic duct and left hepatic duct. ?In singular type (3.8% of all cases).There were more cases in type A in this study than that reported in literature (57% of all), p<0.01. There was less cases in type E,C in this study than that reported in literature ( 3%, 20%of all), p<0.01.There was no different cases in typeF,B,D in this study from that in literature.(2).The diameter of common bile duct ,common hepatic duct, left hepatic duct, right hepatic duct,anterior right hepatic duct,and posterior right hepatic duct was 0.67±0.18cm, 0.62±0.18cm, 0.41±0.14cm, 0.46±0.15cm, 0.32±0.11cm, and 0.31±0.12cm.(3). The length of common bile duct ,common hepatic duct , left hepatic duct, right hepatic duct,anterior right hepatic duct,and posterior right hepatic duct was 3.98±2.14cm, 2.27±0.81cm, 1.07±0.61cm,1.70±0.54cmand0.90±0.29cm.(4).The angle between left hepatic duct and right hepatic duct was 112.78±34.78°.The distance from the confluence of left hepatic duct and right hepatic duct to livers was 0.94±0.63cm.3. The results about hepatic artery were followed as:(1 )The results about type of hepatic artery in 119 cases were followed as:(D.In common type (89.2% of all cases) intrinsic hepatic artery sent out left hepatic artery and right hepatic artery.(2).In this type ( 5% of all cases) accessory left hepatic artery was came from left gastri artery. ?. In this type ( 2.5% of all cases) replaced right hepatic artery came from the superior mesenteric artery. ?. In this type ( 0.8% of all cases) there were accessory left hepatic artery and replaced right hepatic artery.?. In this type ( 0.8% of all cases) accessory right hepatic artery came from the superior mesenteric artery.(§)In this type ( 0.8% of all cases) replaced left hepatic artery came from left gastric artery.There was more cases in common type in this study than that reported in literature(55% of all), p=0.000.(2).The diameter of common hepatic artery, intrinsic hepatic artery .middle hepatic artery,right hepatic artery, anterior right hepatic artery ,and posterior right hepatic artery was 0.52±0.102cm, 0.43±0.10cm, 0.23±0.06cm, 0.32±0.10cm ,0.20±0.06 cm and 0.18±0.06cmresperctively. The length of common hepatic artery, intrinsic hepatic artery,middle hepatic artery .right hepatic artery, anterior hepatic artery,and posterior hepatic artery was 2.53±1.27cm,1.52±0.63cm,2.13±0.15cm,2.89±0.79cm, 1.57±0.47cm and 2.03±0.21cm resperctively.(3).The angle between right hepatic artery and left hepatic artery was 66.25±33.67°. The distance from the crotch of hepatic artery and left hepatic artery to livers was 2.56±0.78cm.4. The results about portal vein were followed as:(l).The results about type of portal vein in 159 cases were followed as:In common type (89.9% of all cases) portal vein sent out left portal vein branch and right portal vein branch.(g)In this type (3.8% of all cases) portal vein sent out three branches which were left portal vein' branch .anterior right portal vein' branch and posterior right portal vein' branch. ?In this type (5% of all cases) anterior right portal vein' branch came from left portal vein' branch. (3)In this type (1.3% of all cases) posterior right portal vein' branch came from left portal vein' branch.(2).Anterior portal vein branch sent out to IV segment In 3.8% of all cases. There was more this cases in this study than that reported in literature(<10% ofall),p=0.003.(3).The diameter of portal vein , right portal vein branch , anterior right portal vein branch and posterior right portal vein branch was 0.37±0.32cm, 1.14±0.21cm, 0.81 ±0.2 lcm, 0.76±0.18cm resperctively. The length of right portal vein branch , anterior right portal vein branch and posterior right portal vein branch was 1.80±0.66cm, 1.26±0.60cm and 1.42±0.70cm respectively.(4)The angle between left portal vein branch and right portal vein branch was 134.00±26.08°. The distance of the crotch of left portal vein branch and right portal vein branch O.22±O.55cm.5 The results about amplified semi liver transplantation were followed as: (l)The branch number, the diameter and in which segment of artery, bile duct, portal vein branch in sections were followed as: The branch number of artery, bile duct, portal vein branch in sections was 2.00±1.31,2.00±1.31 and 2.00±1.31 respectively. The branch diameter of artery, bile duct, portal vein branch in cuts was 0.05±0.02cm, 0.04±0.02cm and 0.25±0.05cm respectively. The Glisson number in IV a segment and in IVb segment was 1.38±1.19 and 0.63±0.74 respectively.(2).The number, the diameter of the branch and in which segment of hepatic vein branches in sections were followed as: The branch' number and the diameter of hepatic vein branches was 1.88±1.46 and 0.31±.09cm respectively. The number of hepatic vein branch in IVa segment and in IVb segment was 0.63±0.52 and 0.25±1.28 respectively.6.The results about semi- liver transplantation were followed as:(l).The branch number, the diameter and in which segment of artery, bile duct, portal vein branch in sections were followed as: Each of the branch number of artery, bile duct, portal vein branch in sections was 1.86±0.64. The diameter of artery, bile duct, portal vein branch in sections was 0.05±0.02cm, 0.05±0.02cm, 0.17±0.10cm. The Glisson number in VI segment and in V segment was 0.88±0.35 and 1.00±0.53 respectively.(2).The branch number, the diameter and in which segment of hepatic vein branches in sections were followed as: The branch number and the diameter of hepatic vein branches was 1.50±0.756 and 0.44±0.25cm respectively. The number of hepatic vein branch in VI segment and in V segment was 0.88±0.36 and 0.88±0.64 respectively.7. The results about posterior right lobe liver transplantation were followed as: (l).The branch number, the diameter and in which segment of artery, bileduct, portal vein branch in sections were followed as: Each of the branch number of artery, bile duct, portal vein branch in cuts was 0.75±0.87. The diameter of artery, bile duct, portal vein branch in cuts was 0.05±0.00cm, 0.05±0.00cm,and 0.21±0.03cm respectively. The Glisson number in VI segment and in V segment was 0.38±0.52 and 0.38±0.52 respectively.(2).The branch number, the diameter and in which segment of hepatic vein branches in sections were followed as: The branch number and the diameter of hepatic vein branches was 1.88±1.13 and 0.38±0.16cm respectively. The number of hepatic vein branch in VI segment and in V segment was 1.00±1.31 and 0.88±0.64 respectively.8. The space position of the three ducts in the first porta hepatis were followed as: Generally, the front of right portal vein faced right hepatic artery, And the front of right portal vein faced right hepatic bile duct. When the Glissons1 sheath was cut down, the three ducts would be seen. After the Glissons' sheath entered liver parenchyma, there would be many different ways of the space position of the three ducts.9. The space position of the three ducts in the pedicel of posterior right lobe were followed as: Posterior right hepatic artery sent out superior posterior right hepaticartery, inferior posterior right hepatic artery on the anterior inferior of posterior right portal vein. Superior posterior right hepatic artery went around the superior of posterior right portal vein to the right and arrived posterior right liver lobe. Inferior posterior right hepatic artery went to the right anterior. Superior posterior right bile duct and inferior posterior right bile duct formed posterior right bile duct that went to the left almost paralleling posterior right portal vein on the back and that passed by it and converged by right bile duct on the posterior superior of right portal vein.Main conclusionl.The rates of types about hepatic vein, bile duct and hepatic artery this study are markedly different from that reported in foreign literature. This infers that the rates of types in Chinese are different from foreigners.2.The rates of types about hepatic vein, bile duct and hepatic artery this study are advantageous to partial right lobe liver transplantation.3.Most of types about hepatic vein, bile duct and hepatic artery this study are fit for partial right lobe liver transplantation.4.1t is much helpful for ensuring donors safety and promoting operation to succeed when partial right lobe liver transplantation carried through that the infrequence types about hepatic vein, bile duct and hepatic artery are found in time and dialed with correctly.5.Microsurgical technique is useful to reconstruction to the artery branch and bile duct branch and accelerates success on operation of recipients, as the artery branches and bile duct branches are small when partial right lobe liver transplantation carried through.6.1t is key factor that if surgeons are familiar to the anatomy of liver determine whether partial right lobe liver transplantation carry out or not. Because the anatomy of liver is complex.7. Most of middle hepatic veins are not in the plane formed by liver middle fissure and Most of middle hepatic veins are right excursion from liver middle fissure. The right excursioning degree of middle hepatic veins from middle hepatic fissure is14° .
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