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World J Surg (2012) 36:120124 DOI 10.1007/s00268-011-1297-y
Anatomical Variations of Hepatic Veins: Three-Dimensional Computed Tomography Scans of 200 Subjects
Chi-Hua Fang Jin-Hua You Wan Yee Lau
Eric C. H. Lai Ying-Fang Fan Shi-Zhen Zhong
Ke-Xiao Li Zhi-Xiang Chen Zhong-He Su Su-Su Bao
Published online: 6 October 2011 Socit Internationale de Chirurgie 2011
AbstractBackground The impact of hepatic venous anatomic variations on hepatic resection and transplantation is the least understood aspect of liver surgery.
Methods A prospective three-dimensional computed tomography study was undertaken on 200 consecutive subjects with normal livers to determine the prevalence of surgically signicant hepatic venous anatomic variations. Results The prevailing pattern of the three hepatic veins in these subjects was a right hepatic vein (RHV) and a common trunk for the middle (MHV) and left (LHV) hepatic veins (122/200, 61%). The remaining patients had the RHV, MHV, and LHV draining independently into the inferior vena cava (IVC). In 39% of patients, the RHV was small and was compensated by a large right inferior hepatic
vein (21.0%), an accessory RHV (8.5%) or a well-developed MHV (6.5%). A segment 4 vein was seen in 51.5% of patients. This segment 4 vein joined the LHV (26%), the MHV (17.5%), or the IVC (8%). An umbilical vein and a segment 4 vein were seen in 3.5% of patients. These two veins joined either the LHV (2.0%) or the MHV (1.5%). Conclusions Knowing the variations of hepatic veins before surgery is useful during both partial hepatectomy and donor operations for living related liver transplantation.
Introduction
Accurate knowledge of the anatomy of the hepatic veins and their relation to the inferior vena cava (IVC) is indispensible for safe liver surgery including partial hepatectomy, liver transplantation, and hepatic trauma [1]. Not only can catastrophes of massive bleeding or air embolism due to laceration of major veins be minimized, but maintenance of adequate outow of the liver after surgery can be maintained.
The impact of hepatic venous outow obstruction on hepatic function is the least understood aspect of hepatic surgery. Maintenance of adequate venous outow is widely recognized to be essential in avoiding hepatic dysfunction or failure from various degrees of hepatic venous outow obstruction. However, what constitutes adequate hepatic venous outow after liver surgery remains controversial [2].
Ligation of...