南方医科大学学报2025，Vol.45Issue(5)：1047-1055,9.DOI:10.12122/j.issn.1673-4254.2025.05.18
左肝内血管可视化3D分型及其在精准肝切除术的临床应用
3D visualization-based classification of left intrahepatic vessels and its application in precision hepatectomy
摘要
Abstract
Objective 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.Methods 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.Results 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.Conclusion 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.关键词
门静脉左支/肝左肝静脉/三维可视化/3D分型Key words
left portal vein/left hepatic vein/three-dimensional visualization/3D classification引用本文复制引用
郑俊,王志华,胡小军,何翔,范应方..左肝内血管可视化3D分型及其在精准肝切除术的临床应用[J].南方医科大学学报,2025,45(5):1047-1055,9.基金项目
广东省自然科学基金(2023A1515012906,2024A1515011531) （2023A1515012906,2024A1515011531）
广州市科技计划重点项目(202206010093) （202206010093）
