| Background:Primary liver cancer is the most common malignant tumor in China that caused serious threat to the health of the people. Surgical treatment is preferred. Like other parts of the liver, the caudate lobe can occur benign tumor and primary or metastatic malignant tumor. In the past, because of technical reasons, the caudate lobe resection is generally together with the liver right lobe or liver left lobe resection. However, 85 per cent of hepatocellular carcinoma is on the basis of cirrhosis in China. If technical reasons, it is obviously disadvantaged to resect the liver tissue too much in the caudate lobe resection. With liver surgery technology development, there is all caudate lobe resection in the 1990s. At the same time, laparoscopic caudate lobe resection has been emphases to researchers home and abroad. Because its technical requirements and risks are great, it is a challenge for the liver surgeons. If the surgeons are familiar with the caudate lobe anatomy of the structure, the surgery is safe and feasible. In fact, the surgeons only perform the clinical anatomy in the surgery. However, the anatomic data is far away from systematic and comprehensive; especially the report of its blood vessel in China. Therefore, it is extremely necessary to conduct the research of blood vessel of the caudate lobe. With the development of micro-diagnose and treat and Three-dimensional (3D) computerized reconstructions, 3D reconstruction is widely used in the field of medicine. In the past, two-dimensional of liver imaging does not completely and really react liver and its piping system that is the 3D structure, so it is not conducive to precision positioning and Programming before operation.The study utilized gross anatomy, cast specimens and imageology to learn course of the portal branches and the hepatic veins in the caudate lobe of the liver; their adjacent relations; openings of the caudate lobe hepatic veins in the retrohepatic segment of the inferior vena cava. The results supply the human anatomical data for the security in laparoscopic caudate lobe morphology.Methods:1. Gross anatomy:①Obtained livers from 32 adult cadavers; Observed no pathological changes with the naked eye; Investigated the shape of the caudate lobe and its border.②Used the way of carving to anatomy these livers and investigated source of the portal branches and the hepatic veins of the caudate lobe,the course and the length of the free parts.③Sectioned longitudinally at the point of transition between the right and the posterior walls of the retrohepatic segment of the vena cava; Divided into 12 areas comprising four columns (posterior, left, anterior, and right) and three rows (superior, middle and inferior); Studied the position and diameter of the openings of the hepatic veins.2. Cast specimens: investigated the tributaries and source of the portal branches and the hepatic veins of the caudate lobe.3. Contrast radiography: 10 liver specimens were perfused with lead oxide-gelatine mixture, then radiography and photograph CT. The livers were examined the anatomic relationship between the caudate lobe of liver and the portal branches and the hepatic veins of caudate lobe. Three dimensional (3D) reconstructions of the blood vessel were conducted. Results:1. The length of the HIVC was (61.2±10.9)mm. The diameter of the inferior and upper cut end was (19.3±1.8)mm and (22.1±3.5)mm. The length of the field of no short hepatic veins was (9.1±7.4)mm. The left and middle hepatic veins would have a common opening or separate ones, their openings were present on the left upper area (2th area) of superior third of HIVC. The openings of the right hepatic veins were present in the anterior superior area of superior third of HIVC. The aperture of the inferior right hepatic veins was (5.7±2.4) mm. The openings of the caudate veins were located in the middle or inferior third segment of HIVC, of which (>5mm) were located in left middle area (6th area). The sties of other short hepatic veins were located in the middle or inferior third segment of HIVC.2. The venous drainage of Spiegel lobe was provided by the superior caudate hepatic vein in 11/32 (34.4%) cases, by the middle caudate vein in 29/32 (90.6%) cases, and by the inferior caudate vein in 19/32 (56.4%) cases. In 2/32(6.25%) cases there were accessory caudate veins. There was a vein for the drainage of paracaval portion and caudate process. Vein of the caudate process was present in 11/32(35%) cases. Openings of veins of caudate lobe were present on the left superior area (2th area) and the left middle area (6th area) and the left inferior area (10th area) of HIVC. The lengths of the free parts were different.3. In 12/32 (37.5%) cases there was a single branch to caudate lobe proper. In 20/32(68.9%) cases there was more than one branch, with a posterior caudate branch in 15/32 (27.5%) cases, an anterior caudate branch in 11/32(12.5%) cases, the most frequent combination detected (11/40, 27.5% of cases) was that of the posterior and anterior branches. In 11/32(34%) cases there were paracaval branches originating from the portal vein or its branches and distributed toward the paracaval portion. In 23/32 (71.9%) cases there was a single branch to caudate process. It predominantly Originated from the right branch and left branch of the portal vein.4. Three dimensional reconstructions of the portal branches and the hepatic veins of caudate lobe: 3D reconstructed models could perfectly display the relationship of the portal branches and the hepatic veins of caudate lobe, and rotating in every direction.Conclusions:The results supply the human anatomical data for the security in the anatomical surgery. |
PDF Full Text Request