Benkö T, Sgourakis G, Molmenti E P, Peitgen H O, Paul A, Nadalin S, Schroeder T, Radtke A
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Department of Surgery, Furness General Hospital, Dalton Ln, Barrow-in-Furness, Cumbria, LA14 4LF, UK.
World J Surg. 2017 Mar;41(3):817-824. doi: 10.1007/s00268-016-3791-8.
The venous vascular anatomy of the caudate lobe is exceptional. The purpose of this study was to assess portal inflow and venous outflow volumes of the caudate lobe.
Extrahepatic (provided by the first-order branches) versus intrahepatic (provided by the second- to third-order branches) portal inflow, as well as direct (via Spieghel veins) versus indirect (via hepatic veins) venous drainage patterns were analyzed in virtual 3-D liver maps in 140 potential live liver donors.
The caudate lobe has a greater intrahepatic than extrahepatic portal inflow volume (mean 55 ± 26 vs. 45 ± 26%: p = 0.0763), and a greater extrahepatic than intrahepatic venous drainage (mean 54-61 vs. 39-46%). Intrahepatic drainage based on mean estimated values showed the following distribution: middle > inferior (accessory) > right > left hepatic vein.
Sacrifice of extrahepatic caudate portal branches can be compensated by the intrahepatic portal supply. The dominant outflow via Spieghel veins and the negligible role of left hepatic vein in caudate venous drainage may suggest reconstruction of caudate outflow via Spieghel veins in instances of extended left hemiliver live donation not inclusive of the middle hepatic vein. The anatomical data and the real implication for living donors must be further verified by clinical studies.
尾状叶的静脉血管解剖结构独特。本研究旨在评估尾状叶的门静脉流入量和静脉流出量。
在140例潜在活体肝供体的虚拟三维肝脏图谱中，分析肝外（由一级分支提供）与肝内（由二级至三级分支提供）门静脉流入情况，以及直接（通过膈下静脉）与间接（通过肝静脉）静脉引流模式。
尾状叶的肝内门静脉流入量大于肝外门静脉流入量（平均分别为55±26%和45±26%：p = 0.0763），且肝外静脉引流大于肝内静脉引流（平均分别为54 - 61%和39 - 46%）。基于平均估计值的肝内引流显示出以下分布：中肝静脉 > 下（副）肝静脉 > 右肝静脉 > 左肝静脉。
肝外尾状叶门静脉分支的牺牲可由肝内门静脉供应代偿。通过膈下静脉的主要流出以及左肝静脉在尾状叶静脉引流中的可忽略作用，可能提示在不包括中肝静脉的扩大左半肝活体肝移植情况下，通过膈下静脉重建尾状叶流出道。解剖学数据及其对活体供体的实际意义必须通过临床研究进一步验证。
