| ObjectiveFor several decades endeavour,surgical technic and treatment in Peroperative Period in liver transplantation has improved greatly. Liver transplantation has become the generally accepted effective treatment of terminal stage liver disease. Especially living donor liver transplantation(LDLT) resolved the short of liver of donor in children liver transplantation. In children LDLT,adult left lateral liver or left lobe of liver and 1 hepatic segment for less than 1 year old baby was enough, assured the safety of donor. However complicated courser and much variation of blood vessels in liver brought about much unpredictability in LDLT.So handled accurate and particular lacunar system in liver in preoperative was the antecedent of a successful LDLT. As mentioned above children LDLT just refered to left liver lobe,left lateral liver even lower outside of liver,so left hepatic vein(LHV) had the important value in children LDLT. Handled dissection data of LHV conduced to select mode of operation and reconstruct receptor hepatic veins in children LDLT.This research adopted comparison between gross anotomy and MSCT imagery to survey morphologic regularity and related data of LHV and it's branches, with the purpose of providing morphologic data of LHV in children LDLT. And the three-dimensional models of liver and hepatic veins of a donor for LDLT were reconstructed using computer three-dimensional reconstruction software for preliminary explore for virtual surgery of living donor live transplantation.Materials and methods1. 50 non-illness adult cadaveric livers were dissected, LHV was surveyed, the correlated data were collected and analyzed statistically.2. 100 non-illness adult livers were enhancedly scanned by 64-MSCT, the hepatic vein stage data were used. The hepatic vein was three-dimensional reconstructed by GE ADW 4.2 workstation of CT machine, LHV was observed, the correlated data were collected and analyzed statistically, and the results were contrast analyzed combining with the results of gross anatomy.3. The 64-MSCT enhancement scanning data of a donor's liver for living donor live transplantation were used, the three-dimensional models of liver and hepatic veins were reconstructed by Mimics medical three-dimensional reconstruction software. ResultsThe first part The morphology and CT study of LHV(1) Common trunk of LHV and middle hepatic vein(MHV) and openingIn gross anatomy specimens, rate of common trunk of LHV and MHV was 80.00%, of which 77.50% was opening to the upper part of inferior vena cava (IVC) behind liver at 1:00 o'clock; Rate of LHV opening to IVC alone was 20.00%,of which 80.00%was opening to the upper part of IVC behind liver at 2:00 o'clock,of which 20.00%was opening to the upper part of IVC behind liver at 3:00 o'clock. Distance between MHV opening to IVC and LHV opening to IVC alone was (2.00±1.15)mm, the length of common trunk vein was respectively (5.09±2.78)mm ,and the diameter at the place of common trunk vein injected to IVC were respectively (12.02±1.91)mm.In CT specimens, rate of common trunk of LHV and MHV was 59.00%, of which 44.07% and 44.07% was respectively opening to the upper part of IVC behind liver at 1:00 o'clock and 1 :30 o'clock; Rate of LHV opening to IVC alone was 41.00%,of which 46.34% and 53.66% was opening to the upper part of IVC behind liver at 2:00 and 3:00 o'clock. Distance between MHV opening to IVC and LHV opening to IVC alone was (4.73±2.75)mm, the length of common trunk vein was respectively (7.68±2.97)mm ,and the diameter at the place of common trunk vein injected to IVC were respectively (11.56±2.04)mm.(2) The extrahepatic length of LHV,surgery stem length of LHV and the bole length of LHVIn gross anatomy specimens the extrahepatic length of LHV and was (9.89±4.86)mm. In gross anatomy specimens and CT specimens,the surgery stem length of LHV which LHV and MHV had common trunk were respectively (13.75±8.11)mm and (11.22±7.34)mm, which were larger than LHV opening to IVC alone's (7.85±8.61)mm and (5.89±6.53)mm(P<0.05). In gross anatomy specimens and CT specimens, bole length of LHV were respectively (39.1±15.16)mm and (34.33±12.66)mm. In gross anatomy specimens, the diameter at the termination of LHV,at the middle point of LHV and at the starting point of LHV were respectively (8.44±1.28)mm,(6.97±1.56)mm and (6.39±1.59)mm. In CT specimens, the corresponding diameter were (8.13±1.60)mm,(6.67±1.39)mm and (5.57±1.33)mm.(3) The depth of bole of LHV to facies diaphragmatica hepatisIn gross specimens, the depth to facies diaphragmatica hepatis at 1cm, 2cm, 3cm, 4cm from the place LHV injecting to IVC (LHV opening to IVC alone) and common trunk injecting to IVC (LHV and MHV with common trunk) and the confluent beginning of the superior wall of main trunk were (5.87±3.85)mm,(12.80±4.93)mm,(17.63±5.06)mm,(20.73±5.39)mm and (24.16±5.91)mm. In CT specimens, the corresponding depth were (8.42±3.75)mm,(13.27±5.01)mm,(18.43±6.37)mm,(22.72±8.49)mm and (28.66±13.31)mm.(4) The angle between bole of LHV and falciform ligament of liver,bole of MHV and macroaxis of IVCIn gross specimens, there was 96.00% that the main trunk of LHV was at the left of falciform ligament of liver,and the average angle between them was (35.31±16.79)°. 2.00% was parallel with falciform ligament of liver, and 2.00% that the main trunk of LHV was at the right of falciform ligament of liver, and the average angle between them was 35.00°.In gross anatomy specimens and CT specimens, the angle between the main trunk of LHV and the main trunk of MHV were respectively (66.22±18.80)°and (67.96±16.25)°, the angle between the main trunk of LHV and macroaxis of IVC were (67.08±13.42)°and (47.81±16.26)°.(6) The branches of LHVAccording the amount of branches of LHV there was 3 categories of LHV. In gross anatomy specimens and CT specimens corresponding data were: with 2 branches with the percentage of 0.00% and 3.00%,with 3 branches with the percentage of 16.00% and 13.00%, with more branches with the percentage of all 84.00%.In gross anatomy specimens and CT specimens,LHV that mainly reflowedⅡ,Ⅲsegment of liver and partialⅣA andⅣB segment of liver were 46.00 and 36.00%, which mainly reflowedⅡ,Ⅲsegment of liver and partialⅣA segment of liver were 24.00%和39.00%.The second part Study of MimicsThe three-dimensional models of liver and hepatic veins were reconstructed, contour of which was smoothing and limpid. The liver and hepatic veins could be diaplayed simultaneously through adjusting the transparency of liver. The models could be viewed at any directions by amplified, zoomed down, rotated and so on. Using the simulation module of Mimics, the model could be cut at random and the plane of liver partial resection could be simulated. And the liver volume of resected or non-resected could be displayed automatically. The image of three-dimensional model could be preserved by BMP or JPEG form, or be recorded by AVI form to export for displaying dynamically. The film picture was clear and fluent.Conclusions1.LHV was studied by gross anatomy and 64-MSCTA three- dimensional reconstruction, the two methods supplied each other. The results of CT study were basically accordant to that of gross anatomy. CT was a reliable clinical examinational method, which could provide courser and variation of LHV before LDLT, to guide the selection of donor at LDLT preoperative and the cutting plane at intraoperative and the determination of anastomotic manner with LHV of donor and veins of acceptor. 2. The majority of LHV and MHV formed a common trunk before the abouchement to IVC, common trunk of LHV and MHV was grossus and short, the majority of LHV opened to left top of aft-liver section of IVC, most bole of LHV coursed premodinantly above the fissure between segments of left lateral liver that was convex to top left as arch form, the amount of branches of LHV was not constant that most had 4 branches or 5 branches.3.The three-dimensional model of hepatic veins could be recons- tructed quickly by using Mimics software and the enhanced CT scanning data of liver, but the division of liver was time consuming. The reconstructed three-dimensional models of liver and hepatic veins were helpful for anatomy teaching and designing reasonable operative scheme of LDLT, and settled basis for virtual hepatic surgery. |
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