Macchi Veronica, Porzionato Andrea, Morra Aldo, Zanon Giovanni Franco, De Caro Raffaele
Department of Molecular Medicine, Institute of Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy.
Surg Radiol Anat. 2015 Jul;37(5):463-71. doi: 10.1007/s00276-015-1440-9. Epub 2015 Feb 3.
Branching variations of the left portal vein can be managed but they may require technical adaptation. The aim of the present study was to investigate the pattern of ramification of the left portal vein in vascular casts and in radiological images.
50 vascular casts and 200 computed tomography (CT) angiographies of the upper abdomen were analyzed. Analyses of the vascular casts and of the radiological images were conducted to evaluate the morphology of the left liver, the modality of division of the portal vein, and the number of branches destined for segments 2, 3, 4.
In the vascular casts the portal vein presented bifurcation in 75%, trifurcation in 20%, and quadrifurcation in 5%, whereas in the radiological study the portal vein presented bifurcation in 90% and trifurcation in 10% of the cases. For segment 2 in the vascular casts, in their CT and in the radiologic in vivo study a number from 1 to 3 branches was found, coming from the medial or posterior aspects of the left portal vein. For segment 3 in the vascular casts, in their CT and in the radiologic in vivo study a number from 1 to 6 branches was found, coming from the posterior and medial aspects of the left portal vein and its the cul-de-sac. For segment 4 in the vascular casts, in their CT a number from 5 to 9 branches was found (in the radiologic in vivo study from 4 to 9), coming from the posterior and ventral aspects of the left portal vein and from its cul-de-sac. No branches were found to come from the lateral aspect of the left portal vein. Moreover, the modality of branching of the left portal vein correlated with the morphology of left liver.
Knowledge of the pattern of branching of the left portal vein is important for surgical purpose. CT angiography is a valuable preoperative examination to visualize the branching pattern of adult patients.
左门静脉分支变异可以处理，但可能需要技术调整。本研究的目的是研究血管铸型和放射影像中左门静脉的分支模式。
分析50个血管铸型和200例上腹部计算机断层扫描（CT）血管造影。对血管铸型和放射影像进行分析，以评估左肝的形态、门静脉的分支方式以及供应第2、3、4段的分支数量。
在血管铸型中，门静脉出现二分叉的占75%，三分叉的占20%，四分叉的占5%；而在放射学研究中，门静脉出现二分叉的占90%，三分叉的占10%。对于第2段，在血管铸型、CT及放射学活体研究中，发现左门静脉内侧或后侧发出1至3支分支。对于第3段，在血管铸型、CT及放射学活体研究中，发现左门静脉后侧、内侧及其盲端发出1至6支分支。对于第4段，在血管铸型及CT中发现左门静脉后侧、腹侧及其盲端发出5至9支分支（放射学活体研究中为4至9支）。未发现有分支发自左门静脉外侧。此外，左门静脉的分支方式与左肝形态相关。
了解左门静脉分支模式对手术具有重要意义。CT血管造影是术前观察成年患者分支模式的有价值检查。
