Liu Zhicheng, Xia Feng, Guo Bin, Leng Chao, Zhang Erlei, Xu Lei, Chen Xiaoping, Zhu Peng
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China.
Updates Surg. 2025 Jan 24. doi: 10.1007/s13304-025-02064-w.
The liver segmentation method proposed by Couinaud is widely accepted by surgeons because of its convenience and practicality. However, this conventional eight-segment classification does not reflect realistic details of the liver and thus requires further adjustments to promote improvements in surgical strategies. This study aimed to explore the ramification patterns of the hepatic vasculature comprehensively. A total of 197 eligible patients meeting the study criteria were enrolled for three-dimensional reconstruction analysis. In the left hemiliver, the portal vein bifurcated into P2 and umbilical portion (UP) in 172 (98.3%) patients. The P4b of 103 patients (103/172, 59.9%) whose P4b branched from the right horn of the left portal vein (LPV) diverged from the main trunk of the UP. In the right paramedian sector (RPMS), the entire portal trunk directly bifurcates into P8vent and P8dor. Simple branching of P5 off the trunk of the RPMS was observed in 78 patients (78/130, 60%). The anterior fissure vein (AFV) was identified in 86 (86/148, 58.1%) patients. V8d entered the right hepatic vein (RHV) in all the patients. In 75.3% (113/150) of all the patients, V5d joined the RHV. In the right lateral sector (RLS), more than half (71/133, 53.4%) of the patients had an arch-like type. We summarize different patterns of liver vascular branches, providing a valuable reference for clinical surgery and liver transplantation. Cranio-caudal segmentation is more common than ventral-dorsal segmentation. The AFV can be regarded as a reliable anatomical landmark for subsegmentation in segment 8. In addition, the absence of AFV was associated with the P8 pattern.
库奥纳提出的肝脏分段方法因其便利性和实用性而被外科医生广泛接受。然而，这种传统的八段分类法并未反映肝脏的实际细节，因此需要进一步调整以促进手术策略的改进。本研究旨在全面探索肝血管系统的分支模式。共有197名符合研究标准的合格患者被纳入进行三维重建分析。在左半肝中，172例（98.3%）患者的门静脉分为P2和脐部（UP）。103例患者（103/172，59.9%）的P4b从左门静脉（LPV）右角分支，其P4b从UP主干分出。在右旁正中扇形区（RPMS），整个门静脉主干直接分为P8vent和P8dor。78例患者（78/130，60%）观察到P5从RPMS主干简单分支。86例患者（86/148，58.1%）发现了肝门前静脉（AFV）。所有患者中V8d均汇入右肝静脉（RHV）。所有患者中有75.3%（113/150）的V5d汇入RHV。在右外侧扇形区（RLS），超过一半（71/133，53.4%）的患者为弓状类型。我们总结了肝脏血管分支的不同模式，为临床手术和肝移植提供了有价值的参考。头尾分段比腹背分段更常见。AFV可被视为第8段亚分段的可靠解剖标志。此外，AFV的缺失与P8模式相关。
