Wu Te-Chang, Lee Rheun-Chuan, Chau Gar-Yang, Chiang Jen-Huey, Chang Cheng-Yen
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Comput Assist Tomogr. 2007 May-Jun;31(3):475-80. doi: 10.1097/01.rct.0000243448.41233.75.
To investigate and describe the segmental ramification patterns of the right portal vein (RPV) according to the Couinaud system.
Between February 2004 and June 2005, 127 patients with hepatic tumors underwent computed tomography during arterial portography with a 16-slice multidetector computed tomography. The final analysis included 90 patients without RPV thrombosis or obvious vascular distortion. The ramification patterns of RPV were verified by 3-dimensional portograms using volume-rendering technique.
Seventy-five patients (83.3%) had bifurcation of the main portal vein, 12 (13.3%) had trifurcation, and 3 (3.3%) had the right posterior portal vein (RPPV) arising from main portal vein. A total of 5 segmental types and 3 subsegmental subgroups of RPV ramification patterns were clarified: type I, the classic ramification pattern with right anterior portal vein (RAPV) branching to S8/S5 and RPPV branching to S7/S6 (63; 70%); II, two separate segmental branches to S7 and S6 without a definite main stem of RPPV (18; 20%); III, "whisk-like" ramification pattern of RPV (2; 2.2%); IV, RAPV branching to S8 alone and RPPV to S5, S6, and S7, consecutively (5; 5.6%); and V, RPV first branching to S8/S5 and then to S7/S6 after a common path (2; 2.2%); subgroup a with dorsocranially directed branches arising from P8 and supplying S8 posterior to the right hepatic vein (28; 31.1%); subgroup b with RPPV branching to the dorsal part of S5 (11; 12.2%); and subgroup a + b, combination of the aforementioned 2 subgroups (45; 50%). In most patients, RAPV had dorsocranially directed branches posterior to the right hepatic vein (73; 81.1%), and RPPV gave off branches to the dorsal part of S5 (56; 62.2%).
Recognition of these ramification patterns could be helpful for more accurate anatomical resection of right hemiliver and preoperative planning, although some variants are present.
根据Couinaud系统研究并描述右门静脉（RPV）的节段分支模式。
2004年2月至2005年6月期间，127例肝肿瘤患者在动脉门静脉造影期间接受了16层多排螺旋计算机断层扫描。最终分析纳入了90例无RPV血栓形成或明显血管变形的患者。使用容积再现技术通过三维门静脉造影验证RPV的分支模式。
75例患者（83.3%）主门静脉呈二叉分支，12例（13.3%）呈三叉分支，3例（3.3%）右后门静脉（RPPV）发自主门静脉。共明确了5种节段类型和3个亚节段亚组的RPV分支模式：I型，经典分支模式，右前门静脉（RAPV）分支至S8/S5，RPPV分支至S7/S6（63例；70%）；II型，分别向S7和S6发出两个节段分支，无明确的RPPV主干（18例；20%）；III型，RPV呈“须状”分支模式（2例；2.2%）；IV型，RAPV单独分支至S8，RPPV依次分支至S5、S6和S7（5例；5.6%）；V型，RPV先分支至S8/S5，然后在共同路径后分支至S7/S6（2例；2.2%）；亚组a，由P8发出背向头侧的分支，供应右肝静脉后方的S8（28例；31.1%）；亚组b，RPPV分支至S5的背侧部分（11例；12.2%）；亚组a + b，上述两个亚组的组合（45例；50%）。在大多数患者中，RAPV在右肝静脉后方有背向头侧的分支（73例；81.1%），RPPV向S5的背侧部分发出分支（56例；62.2%）。
认识这些分支模式有助于更准确地进行右半肝解剖性切除和术前规划，尽管存在一些变异情况。
