Shen Xue-Yin, Wang Hee-Jung, Kim Bong-Wan, Hong Sung-Yeon, Kim Mi-Na, Hu Xu-Guang
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Hepatobiliary Surgery, Jiangxi Cancer Hospital, Jiangxi, China.
Ann Surg Treat Res. 2019 Sep;97(3):124-129. doi: 10.4174/astr.2019.97.3.124. Epub 2019 Aug 29.
Complete removal of the caudate lobe, which is sometimes necessary, is accomplished via isolated caudate lobectomy or hepatectomy that includes the caudate lobe. It is impossible, however, to confirm the right and ventral margins of the caudate lobe by preoperative imaging. This study was undertaken to determine whether we could identify the right and ventral margins of the caudate lobe preoperatively using Synapse 3D visualization software.
Ninety-four preoperative 3-dimensional (3D) computed tomographic images (1-mm slices) of the liver from candidate donors were examined. The images of the caudate lobe were subjected to a counter-staining method according to Synapse 3D to delineate their dimensions. We first examined whether the right margin of the caudate lobe exceeded the plane formed by the root of the right hepatic vein (RHV) and the right side of the inferior vena cava (IVC). Second, we determined whether the ventral margin of the caudate lobe exceeded the plane formed by the root of the middle hepatic vein (MHV) and the root of the RHV.
For the right margin, 17 cases (18%) exceeded the RHV-IVC plane by a mean of 10.2 mm (range, 2.4-27.2 mm). For the ventral margin, 28 cases (30%) exceeded the MHV-RHV plane by a mean of 17.4 mm (range, 1.2-49.1 mm).
Evaluating the anatomy of caudate lobe using Synapse 3D preoperatively could be helpful for more precise anatomical resection of the caudate lobe.
有时需要完整切除尾状叶，可通过孤立性尾状叶切除术或包括尾状叶的肝切除术来完成。然而，术前影像学检查无法确定尾状叶的右侧和腹侧边缘。本研究旨在确定能否使用Synapse 3D可视化软件在术前识别尾状叶的右侧和腹侧边缘。
对94例候选供体肝脏的术前三维（3D）计算机断层扫描图像（层厚1mm）进行检查。根据Synapse 3D对尾状叶图像采用反染色法来描绘其尺寸。我们首先检查尾状叶的右侧边缘是否超过由右肝静脉（RHV）根部和下腔静脉（IVC）右侧形成的平面。其次，我们确定尾状叶的腹侧边缘是否超过由肝中静脉（MHV）根部和RHV根部形成的平面。
对于右侧边缘，17例（18%）超过RHV-IVC平面，平均超出10.2mm（范围2.4-27.2mm）。对于腹侧边缘，28例（30%）超过MHV-RHV平面，平均超出17.4mm（范围1.2-49.1mm）。
术前使用Synapse 3D评估尾状叶的解剖结构有助于更精确地进行尾状叶的解剖性切除。
