A Study On Anatomy Of Three-dimensional Reconstruction Of Middle Hepatic Vein Based On Hemihepatectomy

Objective: The anatomy of the middle hepatic vein of the reconstructed liver is analyzed by three-dimensional visualization reconstruction of the liver and vessels.From a three-dimensional perspective,understanding the shape of the veins of the middle hepatic veins and the drainage sections of their branches in the liver.Summarizing the anatomical characteristics of the middle hepatic veins and the classification of variation and distribution of the branches of the middle hepatic veins,in order to provide guidance for clinical hemihepatectomy.Methods: The obtained two-dimensional data which is Among patients admitted to the Department of Hepatobiliary Surgery,Yijishan Hospital,Wannan Medical College who are due to liver occupying,pancreas occupying,and other organ occupying lesions or may be accompanied by metastasis of surrounding tissues and organs,after thin-layer enhanced CT of the upper abdomen(1mm)is processed by Using the three-dimensional reconstruction platform of Anhui Ziwei Dixing Digital Technology Co.,Ltd.and after reconstruction,A three-dimensional model of the liver that is consistent with the original DICOM data of CT is got.82 patients with space-saving effects on the inferior vena cava and middle hepatic vein,and no severe deformation or distortion of the above vein and no previous history of liver surgery are selected from all patiants who's results were consistent with the original CT images including liver parenchyma,portal vein blood vessels,hepatic artery blood vessels,hepatic vein blood vessels,inferior vena cava andother major reconstructed organs and ducts.The data following is measured by using the three-dimensional software reader to adjust the length,angle,cutting and other related functions Through the generated three-dimensional reconstruction model.1.MHV trunk and extrahepatic length,blood vessel diameter;MHV coexisting with the surrounding hepatic veins and extrahepatic Length,blood vessel diameter.2.The angle between MHV and IVC,LHV,RHV;the angle between MHV and sagittal plane when coexisting with the surrounding vein.3.The number of branches of MHV in sections IVa,IVb,?,and ?with a diameter greater than 3 mm.4.Variation of MHV.5.The liver is roughly divided into left and right half livers based on the plane of MHV and IVC.The first distance of1 cm,2cm,3cm,4cm,5cm,6cm and the vertical distance of MHV from the surface of the liver;parallel to the MHV axis,make a straight line through the highest point on the surface of the liver,the vertical distance of the highest point to MHV,and measure The vertical distance between the above points and IVC.Results: The two-dimensional data reorganized is translated to three-dimensionally constructtion through Two-dimensional images which are obtained after multi-slice spiral CT scanning and analyzed as follows.1.There are three ways to import MHV into IVC.MHV imports IVC separately,accounting for 36.58%(30/82);MHV and LHV co-import into IVC,accounting for 62.20(51/82);MHV,LHV and RHV Remittances were imported into IVC,accounting for 1.22%(1/82).2.MHV trunk length: the longest is 106.00 mm,the shortest is 61.07 mm,and the average is(71.58±10.40)mm;the extrahepatic length of MHV: the longest is 7.02 mm,the shortest is 0.80 mm,and the average is(4.26±1.75)mm;MHV blood vessel diameter close to IVC: the longest is 13.63 mm,the shortest is 6.23 mm,and the average is(9.35±2.64)mm.3.The length of co-drying of MHV and LHV: the longest is 17.42 mm,the shortest is 2.05 mm,the average is(11.76±3.67)mm;the co-drying length of MHV,LHV and RHV is 5.46mm;the longest co-drying diameter of MHV and LHV is 15.37 mm,the shortest is 6.76 mm,average(10.15±2.23)mm;MHV and LHV co-dried extrahepatic length: the longest is 6.65 mm,the shortest is 0.43 mm,theaverage is(3.47±1.20)mm;MHV and LHV,RHV The extrahepatic extrahepatic length is3.85mm;the coherent diameter of MHV,LHV and RHV is 16.98 mm.4.The angle between MHV and IVC: the maximum is 80.15 °,the minimum is 43.16 °,and the average is(60.24±11.48)°;the angle between MHV and LHV is 108.67 °,the minimum is 48.93 °,and the average is(73.45±16.98)°;The angle between MHV and RHV: the maximum is 62.00 °,the minimum is 26.35 °,and the average is(44.24±10.55)°.5.When the MHV is imported into the IVC separately,the angle between the MHV and the sagittal plane is 62.36 °,the minimum is 32.84 °,and the average is(44.18±6.06)°.The angle between the MHV and the LHV is the largest when it is co-dried with the sagittal plane.It is 72.18 °,the minimum is 36.52 °,and the average is(52.45±10.49)°.The angle between the MHV and the sagittal plane is 56.8 °when the three veins are co-stemmed.6.The number of MHV branches with a diameter greater than 3mm in the IVa segment is a maximum of 2 branches,with a minimum of no branches,and the average(0.62+0.49)branches;the MHV in the IVb segment is a maximum of 3 branches,a minimum of 1 and an average(1.53±0.61)branches;In MHV,there are at most 4 branches,at least 1 branch,with an average(2.19+0.39)branch;HMV in MHV at section V,with a maximum of 3branches,at least 1 branch,with an average(1.78+0.65)branch.7,72 cases of MHV type,accounting for 87.8%;8 cases of two types,accounting for 9.8%;2 cases of three types,accounting for 2.4%.8.MHV is near the IVC as the starting point.The vertical distance from the IMV to the liver surface is(13.59±2.65)mm,and the distance from the IVC is(10.45±2.57)mm.The distance from this 2 cm to the liver surface is(23.88±2.98)mm.The distance from the IVC is(15.02±2.68)mm;the distance from this 3cm to the liver surface is(32.95±3.29)mm;the distance from the IVC is(25.59±2.24)mm;the distance from this 4cm to the liver surface is(38.59±3.34)mm,the distance from the IVC is(28.96±3.72)mm;the distance from this 5cm to the liver surface is(44.72±2.88)mm,the distance from the IVC is(34.91±3.87)mm;the distance from this 6cm to the liver surface is(48.46±3.17)mm,the distance from the IVC is(44.88±3.24)mm;the distance from thehighest point of the liver surface to the MHV is(49.38±2.41)mm,and the distance from the IVC is(46.60±3.49)mm;the farthest distance from the MHV to the liver surface The distance is(17.07±5.75)mm,and the distance from IVC is(78.16±8.67)mm.Conclusion: The proportion of MHV and LHV co-stem is higher,but the length of the co-stem is slightly shorter and the blood vessels were thicker.When performing left hepatectomy,care should be taken to protect the co-stem veins to avoid damage to the co-stem veins that will be causing major intraoperative hemorrhage and postoperative middle hepatic veins The nutritional half-liver cut ischemic necrosis,resulting in bleeding,biliary fistula,and even a second operation.MHV has many branches in ? and ?,which are thick and thick.It should be carefully dissected during right hepatectomy to avoid damaging small branch blood vessels and affect the surgical field after hemorrhage,which makes the operation more difficult and prolongs the process.In the left hepatectomy,there are many branch vessels of MHV segment IVb,which should be carefully separated and ligated one by one.During laparoscopic anterior hemihepatectomy,it should be noted that MHV is shifted to the right in the sagittal plane,starting from the gallbladder fossa and walking from the lower right to the upper left.The distance from the surface of the liver to MHV rises and then descends.The maximum height is about 5 cm.The lower 1cm is a safe area and will not damage the MHV.