Surg Radiol Anat DOI 10.1007/s00276-014-1290-x
Anatomic Bases of Medical, Radiological and Surgical Techniques
Applied anatomy of small branches of the portal vein in transverse groove of hepatic hilum Pei‑ning Yan · Wei‑feng Tan · Xin‑wei Yang · Chuan‑sen Zhang · Xiao‑qing Jiang
Received: 25 October 2013 / Accepted: 31 March 2014 © Springer-Verlag France 2014
Abstract Purpose The objective of this study was to provide the morphological details on small branches of the portal vein in transverse groove of hepatic hilum. Methods According to the surgery significance, the small branches of portal vein in transverse groove of hepatic hilum were named as “Short hepatic portal veins (SHPVs)”. SHPVs were minutely dissected in 30 adult cadaveric livers. The number, diameter, length, origin points, and entering liver sites of SHPVs were explored and measured. Results There were 181 SHPVs in 30 liver specimens, including 46 % (83/181) from the left portal vein, 31 % (56/181) from the bifurcation, and 23 % (42/181) from the right portal vein. At the entering liver sites of SHPVs, 22 % (40/181) supplied for segment IV, 9 % (17/181) for segment V, 4 % (7/181) for segment VI, 23 % (41/181) for segment VII, and 42 % (76/181) for segment I (caudate lobe). There were 6.0 ± 2.4 branches per liver specimen with range 3–12. The mean diameter of SHPVs was 2.25 ± 0.89 mm. The average length of SHPVs was 4.86 ± 2.12 mm. Conclusions SHPVs widely existed in each liver specimen. The detailed anatomical study of SHPVs could be useful to avoid damaging the short portal branches during
Pei-ning Yan, Xin-wei Yang and Wei-feng Tan have contributed equally to this paper. P. Yan · W. Tan · X. Yang · X. Jiang (*) Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai 200438, China e-mail: [email protected] C. Zhang (*) Department of Anatomy, Second Military Medical University, Xiangyin Road 800, Shanghai 200438, China e-mail: [email protected]
hepatic operations, such as isolated or combined caudate lobectomy. Keywords Short portal vein · Anatomy · Caudate lobe · Liver segment · Surgery
Introduction Caudate lobectomy has long been considered technically difficult. The deep location of this lobe and its proximity to great vessels may lead to high operative risks and excessive intraoperative blood loss [1, 6, 19]. Progress in medical knowledge and technology has made caudate lobectomy safe [4, 17]. In our previous study [18], we found that early control of short hepatic portal veins (SHPVs) in isolated or combined caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery. “Early control of SHPVs” means dissecting their branches before hepatectomy, and this technology will reduce the technical difficulty of caudate lobectomy. However, occasional damage to the small branches of the portal vein which mainly supply the caudate lobe can result in excessive bleeding. These small branches arise from the portal venous system in the porta hepatis and enter directly into adjacent liver tissues to supply segment I (caudate lobe), and parts of segments IV, V, VI, and VII. These small branches of the portal vein in transverse groove of hepatic hilum were named as “SHPVs” [18]. During operation, these small branches require fine dissection to avoid uncontrollable bleeding [1]. There are many researches about small branches of the portal vein in hepatic hilum, supplied for caudate lobe [19]. However, small branches of the portal vein supplied for segments IV, V, VI, and VII have not been paid enough attention. This research adopts
13
Table 1 Diameter, number (mean ± SD and range), and dissociation length of SHPVs from different origin points (n = 30)
Surg Radiol Anat Origin points (n = 30)
Cases
Diameter (mm)
N
%
Left portal vein Bifurcation
27 24
90 80
Right portal vein
24
80
an engraving method to perform detailed anatomy on liver specimens to observe the small branches of the portal vein in transverse groove of hepatic hilum from anatomical-surgical aspect. As the location of right anterior and posterior branches, the corner, sagittal, and bursa of left portal vein was not included in hepatic hilum transverse groove, these anatomic sites were excluded in this study. The objective of the present study was to analyze and propose a new nomenclature for the distribution of SHPVs from their origin in the portal vein to their termination inside the hepatic lobe.
Number
Dissociation length (mm)
Mean ± SD
Range
2.11 ± 0.66 2.34 ± 0.90
2.8 ± 1.6 1.9 ± 1.2
0–5 0–5
5.82 ± 2.06 4.31 ± 2.10
2.41 ± 1.21
1.4 ± 0.9
0–3
3.69 ± 1.29
was done using Student’s t test for parametric data and the Mann–Whitney U test for non-parametric data. The Chi square test was used for categorical data. A P value
Anatomic Bases of Medical, Radiological and Surgical Techniques
Applied anatomy of small branches of the portal vein in transverse groove of hepatic hilum Pei‑ning Yan · Wei‑feng Tan · Xin‑wei Yang · Chuan‑sen Zhang · Xiao‑qing Jiang
Received: 25 October 2013 / Accepted: 31 March 2014 © Springer-Verlag France 2014
Abstract Purpose The objective of this study was to provide the morphological details on small branches of the portal vein in transverse groove of hepatic hilum. Methods According to the surgery significance, the small branches of portal vein in transverse groove of hepatic hilum were named as “Short hepatic portal veins (SHPVs)”. SHPVs were minutely dissected in 30 adult cadaveric livers. The number, diameter, length, origin points, and entering liver sites of SHPVs were explored and measured. Results There were 181 SHPVs in 30 liver specimens, including 46 % (83/181) from the left portal vein, 31 % (56/181) from the bifurcation, and 23 % (42/181) from the right portal vein. At the entering liver sites of SHPVs, 22 % (40/181) supplied for segment IV, 9 % (17/181) for segment V, 4 % (7/181) for segment VI, 23 % (41/181) for segment VII, and 42 % (76/181) for segment I (caudate lobe). There were 6.0 ± 2.4 branches per liver specimen with range 3–12. The mean diameter of SHPVs was 2.25 ± 0.89 mm. The average length of SHPVs was 4.86 ± 2.12 mm. Conclusions SHPVs widely existed in each liver specimen. The detailed anatomical study of SHPVs could be useful to avoid damaging the short portal branches during
Pei-ning Yan, Xin-wei Yang and Wei-feng Tan have contributed equally to this paper. P. Yan · W. Tan · X. Yang · X. Jiang (*) Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai 200438, China e-mail: [email protected] C. Zhang (*) Department of Anatomy, Second Military Medical University, Xiangyin Road 800, Shanghai 200438, China e-mail: [email protected]
hepatic operations, such as isolated or combined caudate lobectomy. Keywords Short portal vein · Anatomy · Caudate lobe · Liver segment · Surgery
Introduction Caudate lobectomy has long been considered technically difficult. The deep location of this lobe and its proximity to great vessels may lead to high operative risks and excessive intraoperative blood loss [1, 6, 19]. Progress in medical knowledge and technology has made caudate lobectomy safe [4, 17]. In our previous study [18], we found that early control of short hepatic portal veins (SHPVs) in isolated or combined caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery. “Early control of SHPVs” means dissecting their branches before hepatectomy, and this technology will reduce the technical difficulty of caudate lobectomy. However, occasional damage to the small branches of the portal vein which mainly supply the caudate lobe can result in excessive bleeding. These small branches arise from the portal venous system in the porta hepatis and enter directly into adjacent liver tissues to supply segment I (caudate lobe), and parts of segments IV, V, VI, and VII. These small branches of the portal vein in transverse groove of hepatic hilum were named as “SHPVs” [18]. During operation, these small branches require fine dissection to avoid uncontrollable bleeding [1]. There are many researches about small branches of the portal vein in hepatic hilum, supplied for caudate lobe [19]. However, small branches of the portal vein supplied for segments IV, V, VI, and VII have not been paid enough attention. This research adopts
13
Table 1 Diameter, number (mean ± SD and range), and dissociation length of SHPVs from different origin points (n = 30)
Surg Radiol Anat Origin points (n = 30)
Cases
Diameter (mm)
N
%
Left portal vein Bifurcation
27 24
90 80
Right portal vein
24
80
an engraving method to perform detailed anatomy on liver specimens to observe the small branches of the portal vein in transverse groove of hepatic hilum from anatomical-surgical aspect. As the location of right anterior and posterior branches, the corner, sagittal, and bursa of left portal vein was not included in hepatic hilum transverse groove, these anatomic sites were excluded in this study. The objective of the present study was to analyze and propose a new nomenclature for the distribution of SHPVs from their origin in the portal vein to their termination inside the hepatic lobe.
Number
Dissociation length (mm)
Mean ± SD
Range
2.11 ± 0.66 2.34 ± 0.90
2.8 ± 1.6 1.9 ± 1.2
0–5 0–5
5.82 ± 2.06 4.31 ± 2.10
2.41 ± 1.21
1.4 ± 0.9
0–3
3.69 ± 1.29
was done using Student’s t test for parametric data and the Mann–Whitney U test for non-parametric data. The Chi square test was used for categorical data. A P value
