Liao Ke-Xi, Cao Li, Guo Rui, Wang Bao-Lin, Wang Jin-Ao, Zhang Guang-Shen, Zheng Shu-Guo, Wang Xiao-Jun
Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, Gaotanyan Road 30, Shapingba District, Chongqing, 400038, China.
Updates Surg. 2025 May 6. doi: 10.1007/s13304-025-02080-w.
Laparoscopic anatomical hepatectomy (LAH) of segments 5 and 8 (LAHSg5/Sg8) for hepatocellular carcinoma (HCC) remains one of the most challenging procedures due to the difficulty in exposing the main vascular structure. The aim of our study was to investigate the anatomical characteristics of inter-SVs based on the three-dimensional (3D) visualization technology exploring its safety and feasibility during LAHSg5/Sg8. A total of 110 patients who underwent LAHSg5/Sg8 in our center between January 2019 and August 2022 were enrolled and analyzed retrospectively. During the operation, the inter-SVs of the first 10 patients were observed. Subsequently, 100 patients were included based on the previous intraoperative understanding. The anatomical parameters of inter-SVs and the perioperative outcomes were recorded and evaluated. The safety and short-term efficacy of LAHSg5/Sg8 were assessed. All the patients underwent preoperative 3D processing software analysis. Of the included patients, 74.6% had inter-SVs in Sg5/Sg8, which could be classified into three types: trunk type, double branch type and multi branch type, accounting for 35.4%, 22.2% and 17.0%, respectively. The concordance between pre-operation and intra-operation in terms of portal vein territory of Sg5/Sg8 was 82 ± 31%. The inlet point diameter was 3.3 ± 1.0 mm. The distance between the inter-SVs in Sg5/Sg8 and P8, point "B" were 17.7 ± 6.2 mm, 6.1 ± 17 mm, respectively. The confluence of inter-SVs in Sg5/Sg8 at "point B" and below accounted for 10.2%. Preoperative 3D reconstruction and personalized surgical planning based on individual anatomical variations are crucial for successful LAHSg5/Sg8. Inter-SVs between Sg5/Sg8 as a landmark along the ISP during LAHS for HCC may be safe and feasible.
由于暴露主要血管结构困难，腹腔镜下对肝细胞癌（HCC）进行5段和8段肝切除术（LAHSg5/Sg8）仍是最具挑战性的手术之一。我们研究的目的是基于三维（3D）可视化技术研究肝段间静脉（inter-SVs）的解剖特征，探讨其在LAHSg5/Sg8手术中的安全性和可行性。回顾性纳入并分析了2019年1月至2022年8月在本中心接受LAHSg5/Sg8手术的110例患者。手术过程中，观察了前10例患者的肝段间静脉。随后，根据之前的术中认识纳入100例患者。记录并评估肝段间静脉的解剖参数和围手术期结果。评估LAHSg5/Sg8的安全性和短期疗效。所有患者均接受术前3D处理软件分析。纳入患者中，74.6%在Sg5/Sg8有肝段间静脉，可分为三种类型：主干型、双分支型和多分支型，分别占35.4%、22.2%和17.0%。Sg5/Sg8门静脉区域术前与术中的一致性为82±31%。入口点直径为3.3±1.0毫米。Sg5/Sg8肝段间静脉与P8、“B点”之间的距离分别为17.7±6.2毫米、6.1±17毫米。Sg5/Sg8肝段间静脉在“B点”及以下汇合的占10.2%。基于个体解剖变异的术前3D重建和个性化手术规划对于成功实施LAHSg5/Sg8至关重要。在肝癌的LAHS手术中，Sg5/Sg8之间的肝段间静脉作为沿肝中静脉（ISP）的一个标志可能是安全可行的。
