Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan,
Surg Today. 2014 Apr;44(4):662-7. doi: 10.1007/s00595-013-0710-6. Epub 2013 Aug 23.
The hepatic vein (HV) can be removed during hepatectomy if there is an effective intrahepatic veno-venous shunt (vv-shunt). We evaluated the efficacy of vv-shunt detection by three-dimensional (3D) venography reconstructed from multidetector-row computed tomography (MDCT) during angiography.
3D venography was reconstructed using computer software in 88 patients with intrahepatic tumors.
We found that 12 patients had one shunt [4 right hepatic vein (RHV)-middle hepatic vein (MHV) and 12 RHV- inferior right hepatic vein (IRHV)] and 1 patient had 2 shunts (RHV-MHV and -IRHV), confirming a clinically efficient vv-shunt in 14.8% of the patients. In one patient with an RHV-IRHV shunt, the preserved RHV-IRHV shunt worked well and prevented congestion of the postero-caudal subsegment after central bisegmentectomy with partial resection of the RHV ventral trunk for huge hepatocellular carcinoma (HCC).
Although the vv-shunt detection rate by 3D venography is low, a visualized vv-shunt proved to be efficient. Thus, invasive occlusion venography is avoidable if a vv-shunt is seen on 3D venography.
如果存在有效的肝内静脉-静脉分流（vv-shunt），可以在肝切除术中切除肝静脉（HV）。我们评估了通过血管造影术中多排 CT（MDCT）重建的三维（3D）静脉造影术检测 vv-shunt 的效果。
对 88 例肝内肿瘤患者使用计算机软件重建 3D 静脉造影术。
我们发现 12 例患者存在 1 条分流[4 例右肝静脉（RHV）-中肝静脉（MHV）和 12 例 RHV-下右肝静脉（IRHV）]，1 例患者存在 2 条分流（RHV-MHV 和 -IRHV），这 14.8%的患者存在临床有效的 vv-shunt。在 1 例存在 RHV-IRHV 分流的患者中，保留的 RHV-IRHV 分流工作良好，防止了因巨大肝细胞癌（HCC）而对 RHV 腹侧干进行中央半肝切除术和部分切除后后尾亚段的充血。
尽管 3D 静脉造影术检测 vv-shunt 的检出率较低，但可视化的 vv-shunt 证明是有效的。因此，如果在 3D 静脉造影术上看到 vv-shunt，则可以避免侵入性闭塞静脉造影术。
