Abstract
Objective: The current study aimed to examine the anatomical structure of the hepatic vein of segment IV liver (S4) of the liver using three-dimensional (3D) visualization technology in order to explore the surgical value of the middle hepatic vein (MHV) manipulation and highlight the importance of current research in hepatic surgery.Methods: Between January 2014 and December 2019, 52 patients with abdominal diseases(not including hepatic disease) were selected for multiphasic computed tomography-enhanced scans of the upper abdomen. A 3D visualization system was utilized to display the structural details of the hepatic veins in S4 of their livers. Couinaud's eight-segment classification system was used to denote the liver' sections.Results: The constructed 3D model clearly displayed vascular morphological characteristics and their location in the liver, hepatic artery and vein system, and portal vein system. Of the 52 patients, 43 had an umbilical fissure vein (UFV) (82.7%), 19 had an accessory S4 liver vein (36.5%), 16 had both a UFV (30.8%) and an accessory S4 liver vein, and 6 had neither (11.5%). A total of 79% of the patients with a UFV and 74.2% of those with an accessory S4 liver vein had venous blood returning into the left hepatic vein.Conclusion: 3D visualization technology was used to determine hepatic venous return of S4 hepatic veins and was found to improve the safety of evaluation in hepatic surgery.
Highlights
The middle hepatic vein (MHV) is a very important vein in the liver: it returns the venous blood of segments 5, 6, and 8 (S5, S6, and S8) [1], and occasionally it drains the venous blood from S6
It is still debated whether MHV ligation causes congestion or even necrosis in segment 4 of the liver in cases of a right lobe tumor invading the MHV or during living-donor transplantation of the right half of the liver [4,5,6,7,8], both of which involve the anatomy of S4 hepatic veins and their drainage
Nineteen patients (36.5%) had an accessory S4 liver vein (Figures 1D,E), 16 (30.8%) had both a umbilical fissure vein (UFV) and an accessory S4 liver vein (Figure 1F), and six (11.5%) had neither (Figure 1G)
Summary
The middle hepatic vein (MHV) is a very important vein in the liver: it returns the venous blood of segments 5, 6, and 8 (S5, S6, and S8) (using Couinaud’s eight-segment classification system) [1], and occasionally it drains the venous blood from S6. Part of the hepatic caudate lobe vein flows into the MHV [2, 3]. In hepatic surgery, it is still debated whether MHV ligation causes congestion or even necrosis in segment 4 of the liver in cases of a right lobe tumor invading the MHV or during living-donor transplantation of the right half of the liver [4,5,6,7,8], both of which involve the anatomy of S4 hepatic veins and their drainage. Perspective, scaling, and other functions, the positional relationship between each vessel and liver segment can
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