Wang Jiaguo, Xu Jie, Lei Kai, You Ke, Liu Zuojin
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China.
Updates Surg. 2023 Oct;75(7):1941-1948. doi: 10.1007/s13304-023-01637-x. Epub 2023 Aug 26.
Although Segment 6(Sg6) and Segment 7(Sg7) are two independent units, there are currently no clear anatomical boundary markers between Sg6 and Sg7. This study aimed to identify intersegmental veins (ISV) in the intersegmental plane of Sg6 and Sg7, and evaluate the prevalence of ISV, and its clinical significance in anatomical hepatectomy. We analyzed data from 180 patients undergoing abdominal computed tomography (CT) examination, and simultaneously performed 3D reconstruction models of the liver for each patient. The right posterior portal vein was analyzed and re-typed. Furthermore, the existence of ISV was defined, and prevalence and confluence patterns of ISV were analyzed. The author attempted to apply ISV to laparoscopic S6/S7 segmentectomy. We sorted data from the right posterior portal vein and divided it into six types. The ISV could be identified in 82.2% (148/180) of the patients, which were derived from the right hepatic vein (RHV) (91.9%) and right posterior inferior vein (IRHV) (8.1%). Ten ISV-guided laparoscopic Sg6/Sg7 segmentectomy were successfully carried out, seven patients underwent Sg6 segmentectomy, and three patients underwent Sg7 segmentectomy. There was no perioperative mortality. The median operative time was 223 min (range 181-260 min). The median blood loss was 200 ml (range 150-310 ml). The R0 resection rate was 100%. The ISV may be a candidate vessel to distinguish the boundary of the right posterior sector; it is expected to be a landmark in the liver parenchyma of anatomical hepatectomy.
虽然肝段6（Sg6）和肝段7（Sg7）是两个独立的单元，但目前Sg6和Sg7之间尚无明确的解剖边界标记。本研究旨在识别Sg6和Sg7节段间平面内的节段间静脉（ISV），评估ISV的发生率及其在解剖性肝切除术中的临床意义。我们分析了180例接受腹部计算机断层扫描（CT）检查患者的数据，并同时为每位患者构建了肝脏的三维重建模型。对右后门静脉进行了分析和重新分型。此外，定义了ISV的存在，并分析了ISV的发生率和汇合模式。作者尝试将ISV应用于腹腔镜S6/S7段切除术。我们对右后门静脉的数据进行了分类，分为六种类型。82.2%（148/180）的患者可识别出ISV，其起源于右肝静脉（RHV）（91.9%）和右后下静脉（IRHV）（8.1%）。成功实施了10例ISV引导的腹腔镜Sg6/Sg7段切除术，7例患者接受了Sg6段切除术，3例患者接受了Sg7段切除术。围手术期无死亡病例。中位手术时间为223分钟（范围181 - 260分钟）。中位失血量为200毫升（范围150 - 310毫升）。R0切除率为100%。ISV可能是区分右后叶边界的候选血管；有望成为解剖性肝切除术肝实质中的一个标志。
