[Three-dimensional reconstruction of individual hepatic veins and portal veins system in hepatectomy].

OBJECTIVE

To study the imaging characteristics and variations of individual digitized hepatic vein and portal vein which were reconstructed by medical image three-dimensional visualization system (MI-3DVS), assess the value of MI-3DVS assisted hepatectomy.

METHODS

From June 2008 to September 2012, the clinical data of 81 patients who underwent hepatectomy with the assist of MI-3DVS were retrospectively reviewed. There were 61 male and 20 female patients, and their age were 12-81 years (median 46 years). The patients with malignant tumors were in 69 cases and with benign tumors in 12 cases. The characteristics and variations of individual digitized hepatic vein and portal vein were observed.Omnidirectional rotation of the three-dimensional (3D) model to observe the distribution of intrahepatic venous system as well as the relationship between the tumor and the veins. 3D models were then simulated resection by the Freeform modeling system.

RESULTS

Of all the 81 3D models of the patients, greater posterior hepatic veins appeared in 10 (12.3%) cases, segment VI hepatic vein appeared in 34 (41.9%) cases. The portal vein was separted with the left branch and the right branch in the hilar in 64 cases, the portal trunk was divided into the left branch of portal vein, the right anterior portal branches, the right posterior portal branches trifurcated in 10 cases, the branch of right anterior portal vein start from the left trunk and the branch of right posterior portal vein start from the main trunk independently in 6 cases, there was 1 case, lack of left branch of portal vein. 81 patients underwent hepatectomy with the assist of MI-3DVS, minor hepatectomy in 57 cases, major hepatectomy in 24 cases (comparatively-reduced major hepatectomy in 12 cases). R0-resection was achieved in all of the patients. Both the inflow and the outflow were maintained in the residual liver after the completion of hepatectomy. Postoperative liver failure was observed in none of the patients.

CONCLUSIONS

MI-3DVS in liver resection was the best choice of surgical approach provides an intuitive basis, and it could reduce the risk of surgery to prevent postoperative hepatic failure.