Fischer Lars, Thorn Matthias, Neumann Jan O, Schöbinger Max, Heimann Tobias, Grenacher Lars, Meinzer Hans P, Friess Helmut, Büchler Markus W
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Eur J Radiol. 2005 Feb;53(2):245-55. doi: 10.1016/j.ejrad.2004.02.003.
To investigate and describe the volume, position and shape of venous segments within the human liver and define their spatial correlation to the Couinaud segments (CS) and to the portal vein segments (PVS).
This study was based on 64 routinely acquired CT scans of patients undergoing hepatic surgery. The final analysis included 19 patients. All 19 CT data sets were transformed into 3D liver models. Three venous segments were postulated reflecting the left, middle, and right hepatic vein. Each venous segment was furthermore divided in two venous subsegments. Volume, position and shape of these venous segments/subsegments were calculated and, finally, compared with the volume, position and shape of the Couinaud segments and the portal vein segments.
The right hepatic vein covers with 539.8 +/- 119.5 ml (47.1%) the largest part of total liver volume followed by the middle hepatic vein 372.7 +/- 151.1 ml (32.5%) and the left hepatic vein 248 +/- 75.9 ml (20.4%). The Couinaud liver segments and portal vein segments 2, 3, 5, 7, and 8 have consistent positional assignments within the three venous segments. Only the CS 4a, 4b, and 6 showed significantly different positions compared to the PVS 4a, 4b, and 6 (P < 0.03). The venous subsegments have a broad volumetric distribution reaching from 79 to 337 ml. There is no positional correlation of venous subsegments compared to Couinaud segments or portal vein segments at all (kappa < 0.75). In contrast, the venous segments/subsegments which can be assigned to either liver halve and either liver lobe have an identical volume, shape and position compared to the corresponding Couinaud liver segments (kappa > 0.75).
The venous segments distinguish liver areas divided by the left and middle hepatic vein in exactly the same pattern as Couinaud segments and portal vein segments do. However, the comparison of shape and position of venous subsegments showed no correlation with both liver segmental approaches.
研究并描述人体肝脏内静脉段的体积、位置和形态，并确定它们与库氏肝段（CS）和门静脉段（PVS）的空间相关性。
本研究基于64例接受肝脏手术患者的常规CT扫描。最终分析纳入19例患者。所有19例CT数据集均被转化为三维肝脏模型。假定三个静脉段分别反映肝左静脉、肝中静脉和肝右静脉。每个静脉段又进一步分为两个静脉亚段。计算这些静脉段/亚段的体积、位置和形态，最后与库氏肝段和门静脉段的体积、位置和形态进行比较。
肝右静脉覆盖的肝脏总体积最大，为539.8±119.5 ml（47.1%），其次是肝中静脉，为372.7±151.1 ml（32.5%），肝左静脉为248±75.9 ml（20.4%）。库氏肝段和门静脉的2、3、5、7和8段在三个静脉段内具有一致的位置对应关系。只有CS 4a、4b和6段与PVS 4a、4b和6段相比位置有显著差异（P<0.03）。静脉亚段的体积分布范围较广，为79至337 ml。静脉亚段与库氏肝段或门静脉段之间完全没有位置相关性（kappa<0.75）。相反，可归属于肝脏任何一半和任何一叶的静脉段/亚段与相应的库氏肝段相比，体积、形态和位置相同（kappa>0.75）。
静脉段划分肝脏区域的方式与库氏肝段和门静脉段完全相同，都是根据肝左静脉和肝中静脉进行划分。然而，静脉亚段的形态和位置与两种肝脏分段方法均无相关性。
