Kobayashi Tomoki, Ebata Tomoki, Yokoyama Yukihiro, Igami Tsuyoshi, Sugawara Gen, Mizuno Takashi, Yamaguchi Junpei, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Surgery. 2017 Jun;161(6):1536-1542. doi: 10.1016/j.surg.2016.12.020. Epub 2017 Jan 23.
The segmentation of the right anterior sector of the liver still is debatable due to the lack of an anatomic landmark of the boundary between Couinaud segments V and VIII (cranio-caudal segmentation). Some authors have proposed the concept of a ventro-dorsal segmentation. The aim of this study was to evaluate which concept of segmentation better reflects the anatomy.
Using 3-dimensional computed tomography software, the ramification pattern of the right anterior portal vein was examined in 100 patients. A thick, hepatic, venous branch that passes through Couinaud segment VIII was termed V8, and its course was investigated using a virtual hepatectomy.
Regarding the anatomy of the portal vein in the right anterior sector, the cranio-caudal type was found in 53 patients, the ventro-dorsal type in 23 patients, and the trifurcation type in 13 patients. The remaining 11 patients had miscellaneous patterns of ramification. In the cranio-caudal type, the volume of the cranial segment was greater (P < .001) than that of the caudal segment. In the ventro-dorsal type, the volume of the ventral segment was greater (P = .007) than that of the dorsal segment. The V8 was identified in 81 of the 89 (91%) patients analyzed. The proportion of cases in which the V8 functioned as a landmark of the border between the ventral and dorsal segments was 63% (56/89 patients).
Regarding the segmentation of the right anterior sector of the liver, the cranio-caudal segmentation introduced by Couinaud is dominant (53%), while ventro-dorsal segmentation is less common (23%). Therefore, universalization of the concept of the ventro-dorsal segmentation is unrealistic.
由于缺乏库氏肝段V和VIII之间边界（颅尾叶划分）的解剖学标志，肝右前叶的划分仍存在争议。一些作者提出了腹背叶划分的概念。本研究的目的是评估哪种划分概念能更好地反映解剖结构。
使用三维计算机断层扫描软件，对100例患者的肝右前门静脉分支模式进行了检查。一条穿过库氏肝段VIII的粗大肝静脉分支被称为V8，并通过虚拟肝切除术研究其走行。
关于肝右前叶门静脉的解剖结构，53例患者为颅尾型，23例患者为腹背型，13例患者为三叉型。其余11例患者有其他分支模式。在颅尾型中，颅侧段的体积大于尾侧段（P <.001）。在腹背型中，腹侧段的体积大于背侧段（P =.007）。在89例分析患者中的81例（91%）中识别出了V8。V8作为腹侧和背侧段边界标志的病例比例为63%（56/89例患者）。
关于肝右前叶的划分，库氏提出的颅尾叶划分占主导地位（53%），而腹背叶划分较少见（23%）。因此，将腹背叶划分概念普遍化是不现实的。
