Anatomy And Three-Dimensional Of The Hepatic Portal Vein And Visualization Study

Objective and SignificanceWith liver surgery and surgical LDLT continuous improvement and development, anatomy of the liver are increasingly high demands. In the traditional concept, generally considered there are less variation of the hepatic portal vein which usually as a symbol of Glisson system structure, and accordingly liver leaf segments. However, in recent years has been reported variation of the hepatic portal vein is not uncommon, especially when the variation of the trunk and main branches of hepatic portal vein, resulting the segment of Couinaud can not be a true reflection of the internal anatomy of the liver, leading to positioning errors and the impact liver surgery program development and precise implementation. Therefore, the master of the morphological data of the hepatic portal vein is necessary, especially in the distribution of hepatic portal vein variation, it is significance to liver surgery. The study follow to the application of liver surgery, using gross anatomy and MSCT images, observing the morphological characteristics and variation of hepatic portal vein trunk and main branches, and quantitative analysis, to supply related morphological information for the clinical diagnosis and treatment of liver surgery. On this basis, use of computer software, three-dimensional reconstruction 1 model of the donor liver and liver vascular, to lay the foundation for virtual surgery of LDLT.Materials and methods1 50 non-illness adult cadaveric livers,anatomy of the hepatic portal vein, embranchment of the hepatic portal vein were observed, the main trunk of portal vein and correlated data were measured and analyzed statistically.2 The data of 100 non-illness adult 64-MSCT enhanced scan portal venous phase, using CT comes with GE ADW 4.2 workstation on three-dimensional reconstruction of portal vein, embranchment of the hepatic portal vein were observed, the main trunk of portal vein and correlated data were measured and analyzed statistically, combined with the results measured by gross anatomical specimens were analyzed.3 The data of 1 case of the donor liver 64-MSCT enhanced scan, using medical three-dimensional reconstruction software Mimics, three-dimensional reconstruction model of the liver and hepatic vessels.ResultsThe first part General Morphology and CT Hepatic Portal VeinAnatomy samples, diameter of hepatic portal vein near porta hepatic were(10.86±2.01)mm,CT samples were(11.20±1.48)mm; comparative analysis P﹥0.05. 54﹪showed distribution by away from liver parenchyma, the perpendicular distance of bifurcation to porta hepatis were(8.94±3.17)mm; 34﹪)showed distribution by tight liver parenchyma. In anatomy and CT samples, angle of left branch and right branch by the bifurcation were(105.59±13.82)°and(93.58±24.03)°, comparative analysis P﹤0.05. In anatomy and CT samples, the length of pars transverses on the left stems were(23.90±5.29)mm and (29.50±6.51)mm, comparative analysis P﹤0.05; the midpoint diameters were(7.43±1.09)mm and (7.70±1.55)mm, comparative analysis P﹥0.05; the length of pars sagitalis on the left stems were(24.02±4.mm and (18.74±4.22)mm,comparative analysis P﹤0.05; the midpoint diameters were(7.07±1.36)mm and(6.98±1.41)mm, comparative analysis P﹥0.05; the pars angularis were(114.18±22.59)°and(118.16±13.73)°,comparative analysis P﹥0.05. In anatomy and CT samples, the length of the right stems of hepatic portal vein were(20.63±6.59)mm and (21.77±10.35)mm, comparative analysis P﹥0.05; the midpoint diameters were(9.26±1.77)mm and(9.10±1.66)mm, comparative analysis P﹥0.05.Anatomy samples, the length of left lat. superior segmental branch were(48.57±17.51)mm, the diameter of beginning, midpoint and distal end were (3.72±1.16)mm,(3.08±0.91)mm,(2.53±0.77)mm; CT samples, the length of left lat. superior segmental branch were(36.31±16.87)mm, the diameter of beginning, midpoint and distal end were(3.32±0.88)mm,(2.93±0.87)mm,(2.52±0.89)mm;comparative analysis the length of left lat. superior segmental branch and the diameter of beginning P﹤0.05,there were significant differences, others P﹥0.05。Anatomy samples, the length of left lat. inferior segmental branch were(39.42±14.57)mm,the diameter of beginning, midpoint and distal end were (3.98±1.05)mm,(3.40±0.98)mm,(2.87±1.11)mm; CT samples, the length of left lat. inferior segmental branch were ( 28.46±13.56 ) mm, the diameter of beginning, midpoint and distal end were(3.70±0.91)mm,(3.21±0.87)mm,(2.74±0.87)mm;comparative analysis the length of left lat. inferior segmental branch P﹤0.5, others P﹥0.05。Anatomy samples, 20.0%pars sagitalis on the left stems were covered by liver parenchyma, the range were(25.00±11.89)mm , the depth were (19.30±5.96)mm. In anatomy and CT samples, the length of anterior segmental branch of right stems were(27.64±7.64)mm and(24.18±6.39)mm, comparative analysis P﹤0.05; the midpoint diameters were(6.52±1.37)mm and(6.37±1.31)mm, comparative analysis P﹥0.05. The length of posterior segmental branch of right stems(24.41±10.89)mm和(30.35±14.26)mm,comparative analysis P﹤0.05; the midpoint diameters wer(e5.91±1.20)mm and (5.97±1.18)mm,comparative analysis P﹥0.05.There were 8 types for the hepatic portal vein, typeⅠ, appeared normal distribution of the portal vein; typeⅡ, trifurcation,left,anterior and posterior segmental branch of right stems; typeⅢ, showed a right posterior branch arising from the main portal vein first and then the right anterior and left portal vein originated from the ascending main portal vein; typeⅣ, showed a right posterior branch arising from the main portal vein and right anterior branch arising from the left portal vein; typeⅤ, absent the horizontal segment of the left portal vein. In anatomy and CT samples, the frequency discern were 80.0﹪(40 cases)and 87.0%(87 cases);6.0﹪(3 cases)and 4.0%(4 cases);4.0﹪(2 cases)and 3.0%(3 cases);2.0﹪(1 case)and 1.0%(1 case);CT samples no typeⅤ, anatomy samples there were 2.0﹪(1 case).TypeⅥ, in anatomy were 4.0﹪(2cases),in CT samples were5.0﹪(5cases);typeⅦ, right posterior and left branch rising from main portal vein which to last right anterior branch, in anatomy were 2.0﹪(1case),in CT samples were1.0﹪(1cases); no typeⅧ.There were 6 types for posterior segmental branch of right stems which provide CouinaudⅥ,Ⅶsegment, in 50 anatomy cases, 6.0% portion ofⅥsegment provided by anterior segmental branch, 2.0% the whole come from anterior segmental branch. The anterior segmental trunk provideⅤ,Ⅷsegment, 36.0%Ⅴsegment provided by posterior segmental, 6.0% anterior segmental branch toⅣsegment. In 100 CT cases, 6.0% portion ofⅥsegment provided by anterior segmental branch, 4.0% the whole come from anterior segmental branch. 16.0 %Ⅴsegment provided by posterior segmental, 8.0%provided by anterior segmental branch,7.0% anterior segmental branch toⅣsegment. CT enhanced scan data of liver and liver vascular, import into three-dimensional model of the hepatic artery, portal vein, hepatic vein and liver which Mimics software built, realistic geometry and obvious anatomical landmark, can be displayed of different colors, any combination, by adjusting the transparency of the liver, can be simultaneously displayed liver and intrahepatic vessels. The model can a full range observed by zoom in, zoom down, rotate and so on. Using the simulation module of Mimics can arbitrarily cut the model, simulating partial hepatectomy plane, automatically display removal or not parts of the liver volume. Three-dimensional model can be saved as BMP or JPEG image format, or dynamic display of recording into AVI format movie, the broadcast screen is clear and smooth.Conclusion1. Study of hepatic portal vein through the anatomy samples and 64-MSCTA general three-dimensional reconstruction, both methods have advantages and disadvantages and complement each other; basically the same result of CT and general observations, CT is a reliable method for clinical detection, can provide a walk line and associated data of hepatic portal vein before liver surgery, guiding make reasonable surgery and treatment for different types hepatic portal vein.2. There are many anatomic variations of hepatic portal vein, in anatomy and CT samples, there are20% and 13%, according to the situation hepatic portal vein can be divided into eight types.3. There are large scope of diameter and angle of the portal vein of left, the branching to supply left hemiliver and right anterior; the portal branches in the caudate lobe of the liver main originate from the left branches of the portal vein. The distribution of left branch in the left lobe directly related to the delimitation of left hemiliver。4. There were 6 ypes for right branch of hepatic portal and influence segmenting of right hemiliver.5. Using enhanced CT scan data of liver, Mimics software can quickly get out the liver blood vessel, three-dimensional reconstruction intrahepatic vessels model; it can help anatomy teaching and develop a reasonable program of liver surgery, provide further conditions for virtual liver surgery.