Zheng Jun, Wang Zhihua, Hu Xiaojun, He Xiang, Fan Yingfang
Department of Hepatobiliary Surgery, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2025 May 20;45(5):1047-1055. doi: 10.12122/j.issn.1673-4254.2025.05.18.
To establish a three-dimensional (3D) visualization-based classification of the left hepatic portal vein (LHPV) and left hepatic vein (LHV) systems using 3D reconstruction technology to facilitate precise segmental/subsegmental resection of left liver lesions.
Thin-slice contrast-enhanced CT datasets from 244 patients were reconstructed using MI-3DV Works software. The spatial anatomy (origins, branching patterns, and spatial relationships) of the LHPV and LHV branches was analyzed to determine their 3D classifications and segmental liver divisions for guiding surgical planning for anatomical left liver resections.
The 3D models of the third- and fourth-order branches of the LHPV and LHV were successfully reconstructed for all the 244 patients. Two types of the LHPV system were identified, where the LHPV either had independent origins [242 cases (99.1%)] or had right anterior portal branches arising from the LHPV trunk [2 cases (0.9%)]. 3D classifications identified two types of the Segment II of the LHPV (based on branch number), 3 types of the Segment III (by spatial distribution of the branches), compact vs dispersed types of the left lateral lobe (determined by Segment II/III branches proximity), 3 types of the Segment IV (by branch number and origin), and 3 types the fourth hilar vessels (transverse branches of the left portal vein) for their supplied segments. The LHV system had two drainage types into the inferior vena cava, and the umbilical fissure veins were classified into 3 types by drainage patterns and distance to the venous roots. These classifications combined with liver segmentations allowed individualized surgical planning for segment-specific resections.
The 3D classification of the LHPV and LHV provides valuable clinical guidance for precise anatomical resections of left liver lesions using liver segments or subsegments as anatomical units to enhance surgical accuracy and improve the outcomes of hepatobiliary surgery.
利用三维重建技术建立基于三维可视化的左肝门静脉（LHPV）和左肝静脉（LHV）系统分类，以促进左肝病变的精确节段性/亚节段性切除。
使用MI-3DV Works软件重建244例患者的薄层增强CT数据集。分析LHPV和LHV分支的空间解剖结构（起源、分支模式和空间关系），以确定其三维分类和肝段划分，为解剖性左肝切除的手术规划提供指导。
成功重建了所有244例患者的LHPV和LHV三级和四级分支的三维模型。确定了两种类型的LHPV系统，其中LHPV要么有独立起源[242例（99.1%）]，要么有右前门静脉分支起源于LHPV主干[2例（0.9%）]。三维分类确定了LHPV第二段的两种类型（基于分支数量）、第三段的三种类型（根据分支的空间分布）、左外叶的紧密型与分散型（由第二段/第三段分支的接近程度决定）、第四段的三种类型（根据分支数量和起源）以及第四肝门血管（左门静脉的横向分支）的三种类型及其供血段。LHV系统有两种向下腔静脉的引流类型，脐裂静脉根据引流模式和与静脉根部的距离分为三种类型。这些分类与肝段划分相结合，可为特定节段切除的个体化手术规划提供依据。
LHPV和LHV的三维分类为以肝段或亚肝段为解剖单位精确解剖性切除左肝病变提供了有价值的临床指导，以提高手术准确性并改善肝胆手术的疗效。
