Torzilli Guido, Montorsi Marco, Palmisano Angela, Del Fabbro Daniele, Gambetti Andrea, Donadon Matteo, Olivari Natale, Makuuchi Masatoshi
3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy.
Am J Surg. 2006 Nov;192(5):690-4. doi: 10.1016/j.amjsurg.2005.10.022.
Limiting backflow bleeding from the hepatic veins is a priority when performing hepatectomy. However, hepatic vein encirclement is difficult, especially in re-resection. We verified the presence and trajectory of the right inferior phrenic vein (RIPV), which could be a useful anatomic landmark to guide surgeons in targeting the extrahepatic right hepatic vein (RHV) before dissection.
Between May 2001 and January 2005, 100 consecutive patients with liver tumors were enrolled and underwent hepatectomy: 77 patients underwent surgery for tumors located in the right hemiliver.
RIPV was detected in all but 1 patient (99%), and its trajectory was always guided toward the extrahepatic RHV. The only patient in whom RIPV was not detected had undergone prior liver resection and interstitial therapies for colorectal cancer liver metastases.
Apart from exceptional conditions, detection of the RIPV is always feasible and allows safe surgical dissection while approaching the extrahepatic RHV before hepatic resection.
在进行肝切除术时，限制肝静脉的逆流出血是首要任务。然而，肝静脉环绕术难度较大，尤其是在再次切除时。我们证实了右下膈静脉（RIPV）的存在及其走行，它可能是一个有用的解剖标志，可在解剖前引导外科医生定位肝外右肝静脉（RHV）。
在2001年5月至2005年1月期间，连续纳入100例肝肿瘤患者并接受肝切除术：77例患者因位于右半肝的肿瘤接受手术。
除1例患者外，其余所有患者（99%）均检测到RIPV，其走行始终指向肝外RHV。唯一未检测到RIPV的患者曾接受过肝切除术及针对结直肠癌肝转移的间质治疗。
除特殊情况外，RIPV的检测总是可行的，并且在肝切除术前接近肝外RHV时允许进行安全的手术解剖。
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