Lin Zhiyu, Xia Xin, Luo Yuchuan, Lei Huan, Liang Hongyin, Zhang Hui, Jiang Zhiwei, Wang Tao
Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan, China.
Front Surg. 2025 May 16;12:1598774. doi: 10.3389/fsurg.2025.1598774. eCollection 2025.
Laennec's capsule serves as a crucial anatomical landmark in liver surgery, yet imaging-based morphometric studies of this fibrous membrane remain limited. This study introduces a novel 3D reconstruction technique to visualize and measure the hepatic pedicle via Laennec's capsule, with validation focused on the left portal branch and development of a 3D-printed model for surgical planning.
30 patients undergoing left hemihepatectomy were recruited to validate the accuracy of a Laennec's capsule-based 3D reconstruction system (Hisense CAS). Preoperative measurements of the left branch length, diameter, and the angle between the main trunk and the hepatic pedicle were compared with intraoperative findings. Additionally, 100 adults without hilar lesions underwent 3D reconstruction for comprehensive morphological classification and statistical analysis of the hepatic pedicle trunk and main branches.
No statistically significant differences emerged between the 3D reconstruction data and intraoperative measurements, confirming the method's accuracy. Four distinct branching patterns were identified, with Type I accounting for 88% of cases. At the first hepatic hilum, the mean outer diameter of the hepatic pedicle was 24.10 ± 6.16 mm. The left and right main branches demonstrated considerable variability in length (20.59 ± 6.38 mm vs. 21.99 ± 7.97 mm) and outer diameter (18.04 ± 4.48 mm vs. 21.18 ± 4.23 mm). The angle between the left and right main branches was 140.81 ± 16.72°. Furthermore, a 3D-printed liver model was developed to aid in surgical planning and education.
Three-dimensional reconstruction based on Laennec's capsule accurately reflects hepatic pedicle anatomy and its variations. The predominance of Type I branching underscores the need for precise classification during liver surgery. This approach provides valuable morphological data for individualized surgical planning, improves intraoperative safety, and sets the stage for further research integrating alternative imaging modalities and larger patient cohorts.
兰氏囊是肝脏手术中一个关键的解剖标志，但对这种纤维膜基于影像学的形态计量学研究仍然有限。本研究引入一种新型三维重建技术，通过兰氏囊可视化并测量肝蒂，验证主要集中在左门静脉分支，并开发用于手术规划的三维打印模型。
招募30例行左半肝切除术的患者，以验证基于兰氏囊的三维重建系统（海信CAS）的准确性。将术前测量的左支长度、直径以及主干与肝蒂之间的角度与术中结果进行比较。此外，对100例无肝门病变的成年人进行三维重建，以对肝蒂主干和主要分支进行全面的形态学分类和统计分析。
三维重建数据与术中测量结果之间未出现统计学上的显著差异，证实了该方法的准确性。识别出四种不同的分支模式，I型占病例的88%。在第一肝门处，肝蒂的平均外径为24.10±6.16毫米。左、右主支在长度（20.59±6.38毫米对21.99±7.97毫米）和外径（18.04±4.48毫米对21.18±4.23毫米）方面表现出相当大的变异性。左、右主支之间的角度为140.81±16.72°。此外，还开发了一个三维打印肝脏模型，以辅助手术规划和教学。
基于兰氏囊的三维重建准确反映了肝蒂的解剖结构及其变异。I型分支的优势突出了肝脏手术中精确分类的必要性。这种方法为个体化手术规划提供了有价值的形态学数据，提高了术中安全性，并为整合替代成像模式和更大患者队列的进一步研究奠定了基础。
