| Objective To discuss the applied anatomy on anterior approach hepatic resection by liver hanging maneuver. Methods Twenty five liver specimens of embalmed adult cadavers were used, then inferior vena cava(IVC) was incised along its posterior wall in order to expose the ostia of the hepatic veins,and we measured the size and position of the ostia. The retrohepatic inferior vena cava(RHIVC)was divided into four portions and each part of the length was measured, and the blood vessels tending to the second and third hepatic hilum were counted. The route between the medial margin of inferior right hepatic vein (IRHV)and the incisure of liver superior vein is designed to the standard pathway of establishing etrohepatic tunne,and the route between the left anterolateral wall of IVC in the plane of liver inferior brder and the incisure of liver superior vein is designed to the left pathway,and the route between the right anterolateral wall of IVC in the plane of liver inferior brder and the incisure of liver superior vein is designed to the right pathway. While establishing three operation pathways along the retrohepatic tunnel,the number of blood vessels possibily injured were counted and compared,then the length and the diameter of injured blood vessels of each pathway were measured and compared .the course of the middle hepatic vein(MHV) was traced and the porta hepatis was dissected. Results There were most larger diamater of the hepatic vein tending to the second hepatic hilum while the third was smaller. There was relatively non-vascular area in the tunnel between the retrohepar and the anterior surfuse of the retrohepatic portion of IVC. Three pathways including the left,right and the standard pathway were designed by liver hanging tape placed through the tunnel,and the number of blood vessel injured possibily while establishing three pathways of the retrohepatic tunnel were(1. 04±0.8),(0. 68±0.76),(0. 88±0.74),Then the number of blood vessels injured possibily were compared. There was statistically significant difference between the left and the right pathway(P﹤0.05),There were no statistically significant difference among the rest data(P > 0.05);the diameter of injured blood vessels were(2.1±0.5) mm,(2.3±0.6)mm,(1.9±0.5)mm ,and they were compared ,There was statistically significant difference between the standard and the right pathway(P﹤0.05),There were no statistically significant difference among the rest data(P > 0.05);the length of three pathways were (66. 10±8.90)mm,(64.30±8.80)mm,(65. 50±9.50)mm,There were no statistically significant difference among these data(P > 0.05);The depths of middle hepatic vein(MHV) to diaphragm side at the sites of 2cm,5cm,10cm point around postcava were measured and the result was (18. 4±2. 3)mm,(43.1±4.5)mm,(50.7±5.3)mm. The left and right branch of the hepatic artery and portal vein(PV)were long enough to pass liver hanging tape through porta hepatis feasibly and safely. Conclusions To establish the retrohepatic tunnel along three pathways are relatively safe;The blood vessels injured possibily while establishing left side pathway are more than the right pathway,and the diameter of injured blood vessels along the right pathway is larger than the standard pathway. The experimental results are certainly significant to select the suitable pathway for anterior approach hepatic resection by liver hanging maneuver:1.Passing through the standard or right pathway is better than the left pathway while the right half hepatectomy is carried out;2. Passing through the standard pathway is better than the left and standard pathway while the left half hepatectomy is carried out ;3. Passing through the right pathway is better than the other pathways while the left trisegmentectomy is carried out;4. Passing through the left pathway is better than the other pathways while the right trisegmentectomy or hepatic caudate lobectomy is carried out.
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