Department of Anatomy and Embryology, Universidad Complutense de Madrid, Spain.
Radiology Department, Hospital Clinico de Madrid, Spain.
Ann Anat. 2021 Sep;237:151740. doi: 10.1016/j.aanat.2021.151740. Epub 2021 Apr 22.
Anatomic variations in the hepatic venous system are the least understood aspect of hepatic anatomy. The variations are diverse, and data are lacking with respect to the population of Spain and methods of detection. The objective was to examine morphological patterns of variations in hepatic venous vascularization using cadaveric dissections vs. radiological imaging, and to analyze the findings with respect to Spain and to published studies.
Thirty-one livers were anatomically dissected and analyzed for their hepatic venous anatomy and then compared to the venous anatomy of livers examined in 216 CT scans from 119 men and 97 women, ranging between 27 and 89 years of age. Statistical analysis was done using the Chi squared and Fisher homogeneity tests.
The hepatic portal vein showed morphological variations in cadavers vs. CT of 67.3% vs. 67.6% (p-I), 29% vs. 12.2% (p-II), 0% vs. 14.6% (p-III), 0% vs. 14.6% (p-IV), 3.2% vs. 0.5% (p-V) and 6.5% vs. 1.9% (p-VI), respectively in cadavers vs. CT. Hepatic vein pattern variation were found in 64.5% vs. 50.7% (h-I), 32.2% vs. 31.5% (h-II), 0% vs. 2.3% (h-III), 0% vs. 4.7% (h-IV), respectively in dissections vs. CT). In Accessory Hepatic Veins the frequency in pattern variation was 64.5% vs. 18.8% (a-2.1), 29.0% vs. 8.0% (a-2.2), 58.1% vs. 11.3% (a-2.3), 9.7% vs. 0.9% (a-2.4), 67.7% vs. 16.9% (a-2.5), 9.7% vs. 4.2% (a-2.6) and 0% vs. 0.5% (a-2.7), respectively, in cadavers vs. CT. CT showed in 27.2% no accessory hepatic veins. Sex was not a factor influencing patterns of variation.
Anatomical variants of the hepatic portal vein, the hepatic vein and accessory hepatic veins are very diverse and show greater variability in the specimens compared to those detected with radiological images, finding a wider spectrum of variations as it allows the clinician to have a more precise definition of the vasculature. A higher precision in the definition of anatomical variations is warranted for surgical planning in liver resection and transplantation.
肝静脉系统的解剖变异是肝解剖中最不被理解的方面。这些变异是多种多样的，而且缺乏关于西班牙人口和检测方法的数据。目的是使用尸体解剖和放射影像学检查来检查肝静脉血管化的形态模式，并分析与西班牙和已发表研究相关的发现。
对 31 个肝脏进行解剖分析，研究其肝静脉解剖结构，然后将其与 119 名男性和 97 名女性的 216 次 CT 扫描中的肝脏静脉解剖结构进行比较，年龄在 27 至 89 岁之间。使用卡方和 Fisher 同质性检验进行统计分析。
肝门静脉在尸体解剖与 CT 中的形态学变异分别为 67.3%对 67.6%（p-I）、29%对 12.2%（p-II）、0%对 14.6%（p-III）、0%对 14.6%（p-IV）、3.2%对 0.5%（p-V）和 6.5%对 1.9%（p-VI）。肝静脉模式变异分别为 64.5%对 50.7%（h-I）、32.2%对 31.5%（h-II）、0%对 2.3%（h-III）、0%对 4.7%（h-IV）。在副肝静脉中，模式变异的频率分别为 64.5%对 18.8%（a-2.1）、29.0%对 8.0%（a-2.2）、58.1%对 11.3%（a-2.3）、9.7%对 0.9%（a-2.4）、67.7%对 16.9%（a-2.5）、9.7%对 4.2%（a-2.6）和 0%对 0.5%（a-2.7）。在尸体解剖与 CT 中，性别不是影响变异模式的因素。
肝门静脉、肝静脉和副肝静脉的解剖变异非常多样化，在标本中比在放射影像学图像中显示出更大的变异性，发现了更广泛的变异谱，因为这可以让临床医生更精确地定义脉管系统。为了肝切除术和肝移植的手术规划，需要更精确地定义解剖变异。
