| Objective(s):Through field anatomy of the isolated fresh liver of liver transplantation recipients((Liver transplantation recipients,LTR)),the course of the left hepatic portal vein(Left hepativ portal vein,LHPV),the left lateral portal vein system,and the distribution of the branches of the left hepatic vein(Left hepatic vein,LHV)in cirrhotic liver were observed,and the anatomical content of the liver was enriched,To provide anatomical reference for living donor liver transplantation(Living donor liver transplantation,LDLT)and anatomical hepatectomy(Anatomical hepatectomy,AH)in liver surgery.Methods: From September 2021 to January 2023,19 patients who underwent "allogeneic liver transplantation" for end-stage liver disease in the Department of Hepatobiliary and Pancreatic Surgery of our hospital were dissected in situ.Anatomical tools were used to remove the liver tissue and Glission sac around the main and tributary branches of LHPV and LHPV,fully exposing LHPV,LHV,and their tributary vascular trunks in S2 and S3 segments.The sample selection criteria are: LHPV,LHV,and their tributaries are not affected by space occupation.Observation indicators: Route and distribution of the main and subordinate branches of LHPV,as well as the characteristics and distribution of the branches of the left lateral lobe portal vein system;The branching characteristics and drainage range of LHV.Measurement index: Liver size: Left right diameter × Upper and lower diameters × Maximum front and rear diameter;The diameter and length of the LHPV main stem(taken from the bifurcation of the left and right portal vein branches in the specimen),as well as the distance from the beginning of the LHPV main stem to the corner;The degree of the corner of the LHPV;The diameter and length of the starting point of the S2 and S3 portal veins(taken from the distance from the starting point of the segmental branch to the first branch with a diameter greater than 3mm),the angle between the S2 portal vein main stem and the transverse part of the LHPV,and the angle between the S3 portal vein main stem and the deformed part of the LHPV;The distance between the root of the S2 and S3 portal veins on their main extension line and the left edge of the liver;The diameter of the LHV starting point and the length of the main stem(taken from the distance from the LHV starting point to the first branch with a diameter greater than 3mm on the specimen);The diameter and length of the upper and lower branches of the left outer lobe(taken from the distance from the bifurcation of the branch to the first branch with a diameter greater than 3mm);The distribution of left posterior superior venous branches and left interlobular fissure venous branches.The unit of length is centimeters(mm),and the unit of angle is degrees(°)。Results: In 19 cases of LTR,due to cirrhosis and hepatocellular carcinoma,the liver surface formed nodules of different sizes and shapes.Liver size minimum 192× seventy-three × 77 mm,max 229 × one hundred and ninety-eight × 121 mm,average(220.0 ± 12.2)×(171.8±18.7)×(89.1±13.4)mm。 The diameter of the starting point of the LHPV trunk is at least 6mm,at most 14 mm,with an average of(10.4 ± 2.0)mm;The minimum length of the LHPV trunk is 30 mm,the maximum length is 65 mm,and the average length is(40.3 ± 11.9)mm;The angle of the LHPV has a minimum of 55 °,a maximum of 143 °,and an average of(108.9 ± 21.6)°.The initial diameter of S2 portal vein is minimum 4mm,maximum 8mm,and average(5.6 ± 1.3)mm;The shortest and longest length of S2 portal vein trunk is 6 mm and 31 mm,with an average of(14.9 ± 7.3)mm;The angle between the root of S2 portal vein and the superior portal vein is at least 80 °,at most 140 °,with an average of(108.1 ± 15.6)°;The distance from the root of the S2 portal vein to the left edge of the liver on the extension line of the main trunk is 76 mm at the shortest,125 mm at the longest,with an average of(100.8 ±13.4)mm;The diameter of the starting point of the S3 portal vein is minimum 3 mm,maximum 9 mm,and average(5.9 ± 1.6)mm;The shortest length of the main portal vein in S3 is 5 mm,the longest is 23 mm,with an average of(11.9 ± 5.7)mm;The angle between the root of the third segment portal vein and the superior portal vein is minimum 91 °,maximum 147 °,and average(112.8 ± 18.7)°;The distance from the root of the S3 portal vein to the left edge of the liver on the extension line of the main artery was the shortest 69 mm,the longest 123 mm,and the average distance was(89.5 ± 13.0)mm.The morphology of LHV can be mainly divided into three types: S2 and S3 hepatic veins merge into a main trunk,which is a combined trunk type(13 cases,68%);The venous branches are arranged in a radial pattern,which is radiation type(4cases,21%);Most branches merge into a main branch,with the main trunk type(2cases,11%).The minimum diameter of the LHV trunk is 5mm,the maximum is12 mm,and the average diameter is(8.0 ± 1.0)mm;The minimum length of the LHV trunk is 6mm,the maximum length is 36 mm,and the average length is(19.0 ±7.9)mm;The diameter of the upper branch of the left lateral lobe is minimum 3mm,maximum 7mm,and average(5.1 ± 1.3)mm;The length of the upper branch of the left lateral lobe is 8mm at the longest and 20 mm at the longest,with an average of(12.4 ± 3.6)mm;The diameter of the lower segment branch of the left lateral lobe is minimum 4mm,maximum 8mm,and average(5.9 ± 1.1)mm;The length of the lower branch of the left lateral lobe is the shortest 5mm,the longest 48 mm,and the average is(19.9 ± 11.3)mm;Among them,there were 4 cases(21%)with left posterior superior venous branches,which shortened the length of the LHV main trunk when it merged into the LHV;5 cases(26%)of left interlobular fissure vein merging into LHV;There were 2 cases(10%)of simultaneous presence of left posterior superior venous branch and left interlobular fissure venous branch.It was found in the lower segment of the left lateral lobe of the liver that the branch of the small vein did not inject LHV and its subordinate branches,but directly injected into the middle hepatic vein.It was inferred that the left lateral lobe venous blood blood was not completely drained by LHV.Conclusion(s):1.The length of the liver LHPV trunk in LTR is affected to varying degrees due to liver lesions,and there are individual differences in its shape and distribution of tributaries;The corners of the LHPV are mostly approximate right angles and obtuse angles,with occasional small angles.When performing accurate hepatectomy,it is important to pay attention to this difference to avoid vascular damage.2.There are anatomical variations in the left posterior superior margin branch and left interlobular fissure vein branch of the left hepatic vein.This situation should be fully considered before formulating the surgical method,and a personalized liver vein harvesting method should be made to reduce postoperative complications. |
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