| ObjectiveLiver transplantation is the effective treatment of terminal stage liver disease. LDLT solved the increasingly acute contradiction of demand for donor liver, especially the development of right partial LDLT solved the contradiction of liver shortage in adult patient and has become the main modus operandi in adult-to-adult LDLT. However, the complexity and variability of anatomy to intra-hepatic blood vessels in right hemi-liver brought much non-prediction for right partial LDLT. Therefore, the anatomy information of RHV should be accurately mastered before operation, which is helpful for selecting modus operandi of LDLT and the reconstruction of hepatic vein in acceptor. From the clinical application of right partial LDLT surgery, this research observed the morph rules of RHV using compared method between gross anatomy and MSCT image, to provide morph data about RHV for right partial LDLT. And the three-dimensional models of liver and hepatic blood vessels of a donor for LDLT were reconstructed using computer three-dimensional reconstruction software, which is to establish foundation for virtual surgery of LDLT.Materials and methods1. 50 non-illness adult cadaveric hepatic vein were anatomied, RHV and AHV were observed, 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, RHV and aRHV were 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 enhanced scanning data of a donor's liver for LDLT were used, the three-dimensional models of liver and hepatic blood vessels were reconstructed by medical three-dimensional reconstruction software.ResultsThe first part The morph and CT study of RHVIn the group of gross anatomy, RHV was 80.0% opening to the upper part of IVC behind liver at 10:00 o'clock. In CT group, RHV was 60.0% opening to the upper part of IVC behind liver at 9:00 o'clock. The distance between the superior border of RHV abouchement opening and vena cava slit pore in diaphragm was (10.27±6.62)mm in gross specimens. In 50 anatomied specimens, the extrahepatic length of RHV was (5.83±3.45)mm. In gross specimens and CT specimens, the surgical trunk of RHV were (6.99±5.52)mm and (13.01±6.10)mm, respectively, the compared result was P < 0.05. The main trunk of RHV were respectively (68.29±30.24)mm and (66.31±30.91)mm, the compared result was P>0.05. In gross specimens, the diameter of RHV at the confluent beginning, the midpoint of main trunk and it inflowing to IVC were (6.26±1.69)mm(,7.57±1.79)mm and (10.74±2.36)mm, respectively. In CT specimens, the corresponding diameter were respectively(6.62±1.59)mm(,7.96±1.64)mm and (10.10±2.58)mm, the compared results were all P > 0.05. In gross specimens, the depth to facies diaphragmatica hepatis at 1cm, 2cm, 3cm, 4cm from the place RHV injecting to IVC and the confluent beginning of the superior wall of main trunk were (10.81±5.33)mm,(22.67±7.00)mm,(32.91±8.28)mm,(39.69±7.78)mm and (33.43±9.79)mm. In CT specimens, the corresponding depth were ( 13.23±6.79 ) mm, ( 24.73±8.20 ) mm,(32.63±7.76)mm,(39.03±7.24)mm and (30.68±10.20)mm, respectively, the compared result at the place of 1cm was P<0.05, others were all P>0.05. In gross specimens and CT specimens, the angle between RHV and IVC were respectively ( 40.54±9.43 )°and (46.22±12.33)°, the compared result was P<0.05. The distance between RHV and MHV were (12.12±4.10)mm,(12.09±4.19)mm, respectively, the compared result was P>0.05. In the RHV types of gross specimens and CT specimens, the percentage of A1 type were 64.0% and 63.0%, the percentage of A2 type were 10.0% and 8.0%, the percentage of B1 type were 4.0% and 9.0%, the percentage of B2 type were 22.0% and 20.0%.In this study, the confluent pattern of tributaries of main trunk of RHV was divided into four types. In 50 anatomied specimens, the percentage of arborescence, dipl-ramus type and tri-ramus type were 90.0%, 8.0% and 2.0%, respectively, the alone type was not found. In 100 vivo specimens, the percentage of arborescence, dipl-ramus type and alone type were 83.0%, 11.0% and 6.0%, respectively, the tri-ramus type was not found. In two group specimens, the number of main tributaries of RHV were respectively(5.88±2.26) and (5.23±2.04), in which the number of main tributaries in type A RHV were respectively (6.76±1.89) and (5.83±1.86), the number of main tributaries in type B RHV were respectively (3.38±0.96) and (3.39±1.41). In gross specimens, the number of main tributaries of RHV in liver segmentⅤ,Ⅵ,ⅦandⅧwere (1.00±0.90),(1.04±0.86),(1.92±0.72) and (1.92±0.90), respectively. In CT specimens, the number of main tributaries of RHV in corresponding liver segment were respectively (0.87±0.74)(,1.16±0.93), (2.15±0.94) and (1.05±0.72), the compared results in type A RHV and segmentⅧwere P<0.05, others were P>0.05. In 50 anatomied specimens, the diameter of main tributaries of RHV in liver segmentⅤ,Ⅵ,ⅦandⅧwere (4.05±1.06)mm,(3.96±0.86)mm,(4.64±1.57)mm and (4.46±1.30)mm, respectively. In CT specimens, the diameter were respectively (4.69±1.26)mm,(4.57±1.15)mm,(4.61±1.18)mm and (4.58±1.15)mm, the compared results of segmentⅤandⅥwere P<0.05, the compared results of segmentⅦandⅧwere P>0.05. In gross specimens, the length of main tributaries of RHV in liver segmentⅤ,Ⅵ,ⅦandⅧwere (21.51±11.24)mm,(28.94±15.90)mm,(30.14±14.41)mm and (23.03±11.14)mm, respectively. In CT specimens, the length were respectively ( 22.71±12.32 ) mm,(23.44±14.70)mm,(26.29±11.74)mm and (19.84±8.65)mm, the compared result of segmentⅤwas P>0.05, others were all P<0.05. In gross specimens, the distance between the place of main tributaries of RHV inflowing to RHV and the place of RHV inflowing to IVC in liver segmentⅤ,Ⅵ,ⅦandⅧwere respectively (79.51±17.89)mm,(80.11±17.82)mm,(25.93±17.32)mm and(25.04±17.16)mm. In CT specimens, the distance were respectively ( 78.49±22.12 ) mm,(74.85±22.47)mm,(28.13±17.22)mm and (32.71±18.14)mm, the compared result of segmentⅧwas P<0.05, others were P>0.05. In 50 anatomied specimens, the frequency of the post-right upper tributary of RHV was 38.0%, in which there were two cases that the post-right upper tributary injected to IVC directly. The backstreaming information of each segment in right hemi-liver were observed, The rates of venous blood of segmentⅤandⅧinflowing to RHV and MHV simultaneously were 66.0% and 88.0%, respectively. The rate of venous blood of segmentⅥinflowing to MHV fully or partly was 22.0%, and the segmentⅦbeing drained only by aRHV was found in one case.In 50 anatomied specimens, the frequency of AHV was 100%, in which the frequency of aRHV was 96.0%, the frequency of aRHV the diameter exceeding 3.00mm and 5.00mm were respectively 60.0% and 32.0%, the results compared with that of gross specimens were respectively P<0.05 and P>0.05. The opening position of aRHV was principally at 7:00～8:00 o'clock in the lower part of IVC behind liver. In gross specimens, aRHV drained segmentⅥ,Ⅶ,Ⅵ+ⅦorⅧ, the corresponding diameter of aRHV were (6.30±2.20)mm,(4.49±1.22)mm,(6.38±1.45)mm,(4.30±1.56)mm, respectively. In CT specimens, aRHV also drained segmentⅥ,Ⅶ,Ⅵ+ⅦorⅧ, the corresponding diameter of aRHV were respectively (6.41±1.85)mm,(4.28±1.14)mm,(6.93±1.38)mm, 4.50mm, and the aRHV draining segmentⅤ+Ⅵ+Ⅶwas found in one case, the diameter of which was 8.00mm, the compared results were all P>0.05. In two groups, the thickest diameter of aRHV was negative correlated to the diameter of RHV (P<0.05). The second part Study of three-dimensional reconstruction and visualization of liver and intra-hepatic blood vesselsThe three-dimensional models of liver and intra-hepatic blood vessels were reconstructed, the morph of which was vivid and the anatomy signal was transparent. The models could be displayed by different colors and combined randomly. The liver and intra-hepatic blood vessels 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. Hepatic vein was studied through dissecting gross specimens and 64-MSCTA three-dimensional reconstruction, the two methods all had advantage and disadvantage, and supplied each other. The results of CT research were basically coincident to that of gross specimens. CT was a reliable clinical detecting method, which could provide concrete courser of hepatic vein before LDLT, to guide planning reasonable surgical program and handling different hepatic vein.2. RHV was mostly opening to the right wall of the upper part of IVC behind liver and the position was deep. The surgical trunk of RHV was short, the main trunk was long, and the diameter was thick. The main trunk of RHV was approximately a inclined line to post-intra- upper direction, of which the beginning and ending were superficial, the middle section was deep. The number of main tributaries of RHV was not constant, the tributaries in segmentⅦwas most and thickest.3. The draining scope of RHV was not only concerned with aRHV, but also closely relevant to MHV. Before LDLT, the right lobe liver volume and the relationship between RHV and MHV should be considered to resect the donor liver for right hemi-liver LDLT.4. The frequency of aRHV was high, aRHV was mainly concentrated at post-right wall of lower part of IVC behind liver. In the operation of LDLT, the processing to AHV should not be limited at present mode. AHV which was the only vein draining one liver segment was suggested to be reconstructed.5. The intra-hepatic blood vessels could be obtained quickly to reconstruct the three-dimensional model 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 intra-hepatic blood vessels were helpful for anatomy teaching and designing reasonable hepatic surgery, and provided condition for virtual hepatic surgery.
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