| ObjectiveLiver transplantation is the effective treatment of terminal stage liver disease,especially the LDLT solve the contrary for increasingly demand of the donor liver.However,the complexity and variability in anatomy of liver blood vessel limited the development of LDLT,especially as a "double-edged sword",the anantomy of MHV has been paid closed attention to.The donor liver including MHV is beneficial to the acceptor and disadvantageous to the donor,vice versa.Therefore,grasping the anatomy information of MHV before the operation,will be helpful to plan the donor liver's volume to cut,localizate the nick,choice the cut profile of livers,and re-establish the hepatic vein of donor and acceptor.This research studied from clinical application of LDLT surgery,used comparison method to research gross anotomy and MSCT image,observed the morph rules of MHV,to mean to provide morph data of MHV for LDLT.Materials and methods1.50 non-illness adult cadaveric hepetic vein were anatomied,the anatomic form and construction typing in the main trunk and branch of MHV were deserved,the correlated data were measured and analyzed statistically.2.50 non-illness adult livers were scanned by 64-MSCT,the anatomic form and construction typing in the main trunk and branch of the MHV were deserved,the correlated data were measured and analyzed statistically, and the result was analyzed combining with the data of gross anatomy dissecs and the MHV were carried out on three-dimensional reconstruction by GE ADW4.2 Image processing system and mimics image analysis software.ResultsThe first part The morph study of MHV一The morph study of the main trunk in MHVThere was a common trunk in 80.0%(40/50) of the cases,and a alone trunk in 20.0%(10/50) of the cases.The position of MHV opening to the inferior vena cava(IVC) at 1:00 was 77.5%(31/40) in 40 common trunk cases and was 90.0%(9/10) in 10 alone trunk cases.The distance of the position opening to theⅣC between MHV and LHV was(2.00±1.15) mm, and(12.12±4.10) mm between MHV and RHV.The length of main trunk was(68.32±15.37)mm,the extrahepatic length of MHV was (6.93±2.79)mm,and the surgical trunk was(8.10±6.21)mm.The internal diameter of main trunk was(8.69±1.46) mm at the point opening to IVC, (7.29±1.41) mm at the middle point and the initiation diameter was (6.41±1.49) mm.The angle between MHV andⅣC was(50.00±9.79)°.The depth to the facies diaphragmatica hepatis at 1cm,2cm,3cm,4cm from the confluence of MHV intoⅣC and the beginning of the main trunk were(14.86±6.44)mm,(26.38±6.89)mm,(35.29±9.20)mm, (38.77±5.01)mm,(34.51±5.23)mm.The main trunk of MHV was not entirely in the guard line positioning hepatic middle fissure traditionally.二The morph study of the branch in MHVAccording to the shape and form of convergence,the MHV trunk branch could be divided into three types,there was a One-ramus type middle hepatic vein in 86.0%(43/50) of the cases,Dipl-ramus type middle hepatic vein in 12.0%(6/50) of the cases and Tri-ramus type middle hepatic vein in 2.0%(1/50) of the cases.The number of the main brabch of MHV was(5.26±1.16).The diameter of the main branch inⅡ,Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅷsegment of liver respectively was 3.00mm,(4.37±0.70)mm, (4.36±1.20)mm,(4.83±1.51)mm,(5.67±1.55)mm,(3.85±0.72)mm,the length respectively was 56.00mm,(51.75±8.73)mm,(20.83±9.87)mm, (25.89±14.21)mm,(43.83±0.70)mm,(23.57±12.71)mm.The shortest distance between the place branch ofⅧsegment of liver inflowing to MHV and the point MHV inflowing to IVCwas 0.00mm.The frequency of the main branch whose diameter was more than 5.00mm was 76.0% (38/50).The venous blood of segmentⅣwas mostly recirculated by MHV,20.0%(10/50) venous blood of segmentⅣA mostly recirculated by LHV.MHV entirely participated the recirculation of the venous blood of segmentⅤ.The rates of venous blood of segmentⅤandⅧinflowing to MHV and RHV simultaneously were 66.0%(33/50) and 88.0%(44/50), respectively,and there were 34.0%(17/50) and 2.0%(1/50) of all cases which the venous blood was recirculated only by MHV.There was 10% (5/50)of all cases that the venous blood from segmentⅢwas recirculated only by MHV.The rate of venous blood of segmentⅥinflowing to MHV was 22.0%(11/50).Among all the cases,there was 27.3%(3/11) that the venous blood from segmentⅥwas recirculated totally by MHV,72.7% (8/11) that the venous blood from segmentⅥwas recirculated partly by MHV.The second part The image study of MHV一The 64-MSCT image study of the main trunk in MHV There was a common trunk in 56.0%(28/50) of the cases,and a alone trunk in 44.0%(22/50) of the cases.The position of MHV opening to the inferior vena cava(ⅣC) at 1:00 was 60.7%(17/28) in 40 common trunk cases and was 54.5%(12/22)in 10 alone trunk cases.The position of MHV opening to theⅣC at 1:30 or 2:00 had not be seen in 10 alone trunk cases. The distance of the position opening to theⅣC between MHV and LHV was(2.20±1.55) mm,and(11.86±6.48) mm between MHV and RHV.The length of main trunk was(62.86±12.46) mm,the surgical trunk was (16.14±12.12) mm.The internal diameter of main trunk was(8.21±1.18) mm at the point opening toⅣC,(7.33±1.31) mm at the middle point and the initiation diameter was(6.29±1.41) mm.The angle between MHV andⅣC was(52.21±12.41)°.The depth to the facies diaphragmatica hepatis at 1cm,2cm,3cm,4cm from the confluence of MHV intoⅣC and the beginning of the main trunk were(13.41±4.60)mm,(24.16±4.36)mm, (32.64±4.30)mm,(38.10±4.56)mm,(34.82±7.76)mm.二The 64-MSCT image study of thebranch in MHVAccording to gross anatomy,the MHV trunk branch could be divided into three types,there was a One-ramus type middle hepatic vein in 82.0% (41/50) of the cases,Dipl-ramus type middle hepatic vein in 12.0% (6/50) of the cases and Tri-ramus type middle hepatic vein in6.0%(3/50) of the cases.The number of the main brabch of MHV was(4.14±0.81).The diameter of the main branch inⅡ,Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅷsegment of liver respectively was 3.10mm,(5.52±1.12) mm,(4.16±1.04) mm,(4.49±1.05) mm,(4.95±0.93)mm,(3.60±0.69) mm,the length respectively was 23.70 mm,(51.75±8.73) mm,(20.13±10.60) mm,(23.79±14.39) mm,(46.10±23.43) mm,(24.20±11.50) mm.The shortest distance between the place branch of Ⅷsegment of liver inflowing to MHV and the point MHV inflowing toⅣCwas4.30mm.The frequency of the main branch whose diameter was more than 5.00mm was 66.0%(33/50).The venous blood of segmentⅣwas mostly recirculated by MHV,42.0%(10/50) venous blood of segmentⅣA mostly recirculated by LHV.MHV entirely participated the recirculation of the venous blood of segmentⅤ.The rates of venous blood of segmentⅤandⅧinflowing to MHV and RHV simultaneously were 58.0%(29/50) and 88.0%(44/50),respectively,and there were 42.0% (21/50) and 8.0%(4/50) of all cases which the venous blood was recirculated only by MHV.There was 10%(5/50) of all cases that the venous blood from segmentⅢwas recirculated only by MHV.The rate of venous blood of segmentⅥinflowing to MHV was 20.0%(10/50).Among all the cases,there was 50.0%(5/10)that the venous blood from segmentⅥwas recirculated totally by MHV,50.0%(5/10) that the venous blood from segmentⅥwas recirculated partly by MHV.The comparison of gross anotomy and image of MHV showed that, The comparison results of the length of common trunk and the length of surgical trunk were P＜0.05,the numerus of MSCT was bigger than gross anotomy.The comparison results of the number of main branch in MHV,Ⅳ,Ⅴ,Ⅷsegment and the diameter inⅧsegment were P＜0.05,the numerus of MSCT was smaller than gross anotomy.Conclusions1.The form having a common trunk by MHV and LHV was majority. The position of alone trunk opening toⅣC was more forward than common trunk.2.The trunk branch of MHV with One-ramus was majority,while Dipl-ramus type and Tri-ramus type were more advantageous in taking right half liver LDLT including MHV.The main trunk of the middle hepatic vein did not entirely in the guard line of hepatic middle fissure,and to those most in their right.3.The number of the main branch was inconstant,and the morphous and construction was different.The diameter of the main branch on segmentⅤwas bigger than that on segmentⅧ.The numder of the main branch whose diameter was bigger than 5.00mm was also more than that on segmentⅧ.MHV mainly collected the venous blood fromⅣ,Ⅴ,Ⅷsegments,but it's drainage scope was effected with the drainage scope of LHV,RHV and AHV.MHV sometimes recirculated the venous blood of segmentⅡ,Ⅲ,Ⅵ.4.The observations of 64-MSCTA images and gross anatomic samples were basically in coincidence,and 64-MSCTA was a reliable clinical test facility,it could be used as a reliable clinical test method of hepatic vein to guide the planning and implementation of the operation.5.To determine whether LDLT include MHV,first,we should estimate the size and volume of the donor liver and ensure the safety of acceptors and donors;second,analysis and study personality the best program according to the confluens form of the main trunk of MHV,the type of the main branches,diameter,scope of recirculation and so on.
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