| Objective: Liver resection is the most effective treatment for the patients with hepatic carcinoma.With the development of liver transplantation,many end-stage liver diseases are curable.However,liver resection is facing a huge risk such as intraoperative bleeding due to variant intrahepatic vascular anatomy.Experts on hepatic surgery from various countries have successively emphasized the importance of hepatic vein anatomy,especially the middle hepatic vein in recent years.It's important to identified the MHV anatomy in the process of hepatic parenchyma dissection.Drain area of the hepatic vein is an important influence for the precise hepatectomy plan.In this study,anatomical features and variant types of the MHV were observed by three-dimensional reconstruction of gem energy spectrum CT,which provided lots of anatomical data for precise hepatectomy and living donor liver transplantation.Methods: 100 patients without IVC diseases,hilar diseases and ampulla diseases,history of liver surgery and liver trauma from a total of 3236 patients underwent enhanced CT scan of abdomen gem in Qingdao Municipal Hospital Hospital were admitted between January 1,2016 and October 01,2017.The clear and complete image was selected and uploaded to the 3D reconstruction platform of Shenzhen Xudong Data Co.,Ltd.High-resolution 3D reconstruction of the liver is obtained by volume reconstruction techniques.Then,the anatomical data of the MHV were observed and calculated by HD reconstruction image.Results: The three-dimensional image is high-definition,which can show the shape of the MHV,branch and intrahepatic vascular structure.Reconstructed images are suitable for anatomical studies of the hepatic veins due to their high clarity,consistent blood vessels and low cost.The length of the MHV is(71.54 ± 13.12)mm,71%(71/100)of the MHV and LHV 27%(27/100)of the MHV originate from the inferior vena cava alone.The three main hepatic vein are ratio was 2%(2/100).The maximum length of the common trunk between the MHV and the LHV is 18.41 mm,the minimum length was 1.63 mm with an average of(11.59±4.77)mm,of which 81.5%(66/81)was ?10 mm.The mean diameter of the MHV was(8.55 ± 1.34)mm when it was originated from the inferior vena cava alone.The mean diameter of the MHV was 67.96 ± 2.11 mm when common trunk with the LHV.The maximum vessel diameter was 12.23 mm with a minimum of 10.09 mm,when the three main veins were common trunk.The extrahepatic length averaged(4.11 ± 2.33)mm when the hepatic vein was originated from the inferior vena cava alone.The extrahepatic length of MHV was average(3.15 ± 2.17)mm when the MHV and LHV common trunk into the inferior vena cava.The length of extrahepatic is from 3.31 mm to 4.36 mm with the common trunk of the three main hepatic veins.The results of the study show that there are major branches of MHV in ?,? and ? segments.In the segment ? there are from 1 to 3 branches accounted for 98%(98/100).The ratio was 89%(89/100)and 86%(86/100)in the ? and V sections,respectively.The V segment has the highest proportion of 3 venous branches,accounting for 54%(54/100).The ? segment had the highest proportion of 2 venous branches,accounting for 37%(37/100).The angle of major axis of the MHV and long axis of inferior vena cava was(62.91 ± 14.85)°.The angle between the MHV and the LHV was(66.70 ± 13.43)° and the angle was(71.72 ± 15.43)°with MHV and LHV common trunk.The angle between the MHV and RHV was(32.70 ± 11.26)°.Conclusions: Clear and consistent three-dimensional images can be rendered by Gem Energy Spectrum CT 3D reconstruction technology.,It provides an important guiding value for avoiding the MHV damage and the decision wither to retain the MHV during liver resection,Through the further study of the anatomy of the MHV. |
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