Xiang Canhong, Liu Zhe, Dong Jiahong, Sano Keiji, Makuuchi Masatoshi
Hospital & Institute of Hepato-Biliary Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Int J Surg Case Rep. 2014;5(12):924-6. doi: 10.1016/j.ijscr.2014.10.041. Epub 2014 Oct 25.
Anatomical resection of the ventral part of Segment VIII (S8vent) is demanding and there are no accurate methods to identify the demarcation line inside the liver. The current authors have proposed a method to solve the problem.
The tumor was located in the S8vent and was 4cm in size. One tributary of the middle hepatic vein (MHV), designated V8i, was running between S8vent and the dorsal part of Segment VIII (S8dor). Another tributary of the MHV, designated V8-5i, was running between S8vent and the ventral part of S5 (S5vent). About 5ml of indigo carmine dye was injected into the proximal part of P8vent. After the small tributary of V8-5i was exposed, it was followed all the way to the main trunk of the MHV. The portal pedicle of S8vent was then ligated and divided. Next, the V8i was gradually exposed from the distal MHV to its trunk.
A recent study showed that the subsegmental border visualized between the ventral and dorsal region always coincided with the plane of V8i, so the subsegmental plane can be divided along with V8i by preserving the very small tributaries near the liver surface and following them to determine where they meet as they run into V8i. Also, the landmark vein of V8-5i in the transverse S8-S5 intersegmental plane was determined for the first time.
Proposed here is a more accurate method of dividing the liver parenchyma along the intersegmental and intersubsegmental demarcation.
肝VIII段腹侧部分（S8vent）的解剖性切除要求较高，且目前尚无准确方法来确定肝内的分界线。本文作者提出了一种解决该问题的方法。
肿瘤位于S8vent，大小为4厘米。肝中静脉（MHV）的一条分支，命名为V8i，走行于S8vent与肝VIII段背侧部分（S8dor）之间。MHV的另一条分支，命名为V8 - 5i，走行于S8vent与肝V段腹侧部分（S5vent）之间。向P8vent近端注入约5毫升靛胭脂染料。暴露V8 - 5i的小分支后，沿其一直追踪至MHV主干。然后结扎并切断S8vent的门静脉蒂。接下来，从MHV远端逐渐暴露V8i直至其主干。
最近一项研究表明，腹侧和背侧区域之间可见的亚段边界总是与V8i平面一致，因此可以通过保留肝表面附近的非常小的分支并追踪它们以确定它们汇入V8i的汇合处，沿着V8i划分亚段平面。此外，首次确定了横断的S8 - S5段间平面中V8 - 5i的标志性静脉。
本文提出了一种沿段间和亚段间分界线更准确地划分肝实质的方法。
