| Objective:In the clinic practice,many patients with liver disease who need to be treated by operation have liver cirrhosis.In the past,the anatomical data of MHV was often from the observation of normal livers,while the data of MHV in the patients with liver cirrhosis are few.Therefore,it is of great significance for the safety of liver surgery to correctly understand the changes of anatomical parameters of MHV in patients with cirrhosis.To investigate the anatomical changes of middle hepatic vein(MHV)and its tributaries of patients with liver cirrhosis by means of three-dimensional reconstruction technology to provide theoretical foundation for clinical middle hepatic vein-oriented hepatectomy and safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation.Methods:A retrospective analysis was made for 100 patients divided into 2 groups,50 patients without hepatic disease and 50 patients with hepatic cirrhosis by means of three-dimensional reconstruction software AW 4.7 in CT machine workstation of upper abdominal enhanced CT imaging images.The following parameters of the related MHV were observed and researched.(1)the form of MHV confluence into IVC,the classification of MHV,the distribution of major tributaries of MHV in the segment IV,V,VIII,(2)the diameter of MHV confluence into inferior vena cava(IVC),The angle between MHV and IVC,right hepatic vein(RHV),left hepatic vein(LHV)and sagittal plane were measured,(3)The length of MHV trunk,the distance from upper wall of midpoint of MHV trunk to the facies diaphragmatica hepatis,and the distance from the terminal of MHV trunk to anterior inferior border of liver.Results:The enhanced CT image of the three-dimensional reconstruction technology has the advantages of clearness,fullness,a strong three-dimensional effect,adjustability androtation angle at will.Among the 100 cases,62(62.0%)belong to type I in the major hepatic veins,38(38.0%)belong to type II in the major hepatic veins and 0 belong to type? in the major hepatic veins and 38(38.0%)belong to type I in MHV,46(46.0%)belong to type II in MHV and 16 belong to type ? in MHV respectively in this study.There were no significant differences in the angle between MHV and sagittal plane,IVC,and RHV in the patients with liver cirrhosis compared with those of in the normal group.The angle values were [(58.8±17.5)°vs(55.1±14.4)°,p=0.258],[(60.4±12.9)°vs(57.8±13.0)°,p=0.321]and[(39.0±14.6)°vs(36.1±8.6)°,p=0.624] respectively.However the angle between MHV and LHV in the patients of cirrhosis group were significantly larger than those of in the normal group [(72.1±17.3)°vs(56.5±14.7)°,p<0.001].The diameter and length of MHV trunk in the patients with cirrhosis group were significantly smaller than those of in the normal group compared with in the normal group [(7.2)±0.9)mm vs(8.8±1.5)mm,p<0.001],[(71.5±21.5)mm vs(97.3±20.6)mm,p<0.001].The distance from the upper wall of the midpoint of the MHV trunk to the facies diaphragmatica hepatis in the patients with cirrhosis group were significantly smaller than those of in the normal group compared with in the normal group[(28.6±6.8)mm vs(37.6±9.2)mm,p<0.001].ie.The distance of midpoint of the MHV trunk in the liver parenchyma was small to 9 mm with an average.The distance from the terminal of the MHV trunk to the anterior inferior margin of the liver in the patients with cirrhosis group was larger than those of in the normal group compared with in the normal group[(49.6)±17.7)mm vs(38.7±11.0)mm,p=0.003].Of the 50 patients in normal group,11 patients have not the major tributaries of MHV larger than 5mm and 39 have the major tributaries of MHV larger than 5mm as follows,major tributaries of ? segment 0(20.5%),1(64.1%),2(15.4%),major tributaries of ? segment 0(38.5%),1(56.4%),2(5.1%),major tributaries of ?segment 0(74.3%),1(23.1%),2(2.6%).There were no significant differences in the major tributaries of MHV with diameter from 3 to 5mm and larger than 5 mm in segment IV and V between the patients with liver cirrhosis compared with those of in the normal group.The tributary of MHV with diameter ?5 mm in segment VIII is rare in patients with hepatic cirrhosis with an average number of(0.06 vs 0.22,p=0.037).Conclusion:There were no significant differences in the angle between MHV and sagittal plane,IVC,and RHV in the patients with liver cirrhosis compared with those of in the normal group.The angle between MHV and LHV in the patients with cirrhosis group were significantly larger than those of in the normal group.The diameter and length of MHV trunk in the patients with cirrhosis group were significantly smaller than those of in the normal group.The distance of midpoint of the MHV trunk in the liver parenchyma in the patients with liver cirrhosis compared with those of in the normal group was smaller with an average of 9 mm.The tributary of MHV with diameter ?5 mm in segment VIII is rare in patients with hepatic cirrhosis. |
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