Indication of Hepatic Vein Reconstruction after Partial Hepatic Resection Based on Hepatic Vein Branch Distribution by Using Three-dimensional Computed Tomography

Ryoichi Shizawa (Director: Prof. Hiroshi Shimada)

The Second Department of Surgery, Yokohama City University, School of Medicine

Recently high-speed helical scanning computed tomography has been developed which enables us to make an accurate three-dimensional image. The purpose of this study was to determine the clinical usefulness of three-dimensional computed tomography (3D-CT). We performed CT during arterial portography in forty preoperative patients with liver tumor (24 with metastatic liver tumor, 16 with hepato-cellular carcinoma) and reconstructed 3D-CT imaging from its volumetric data. A clinical and practical nomenclature is proposed for hepatic vein branches, named from the main trunk and the draining area of each branch. For example, the branch of the middle hepatic vein which drains segment 4 is called MV4. LHV was classified as LV2, LV3 and LV4, and it was observed in 100%, 100% and 27.5% of the patients, respectively. Similarly, MHV was classified as MV4 (100%), MV5(77.5%) and MV8 (92.5%), RHV as RV5 (82.5%), RV6 (97.5%), RV7(9.5%) and RV8 (100%), IRHV as IRV6 (25%) and IRV7 (5%). When carcinoma involves the confluence of the right hepatic vein and the inferior vena cava, resection of segments 7 and 8 combined with right hepatic vein resection is required. The hepatic vein draining the remaining segments 5 and 6 was classified into seven types. Cases without MV5 or IRV6 were 82.5%, for which it was necessary to reconstruct RHV. The remaining 17.5% of the patients, which had both MV5 and IRV6, it was unnecessary to reconstruct RHV. Using preoperative 3D-CT enabled us to decide the necessity of hepatic vein reconstruction preoperatively.

Key words
hepatic vein reconstruction, malignant liver tumor, hepatectomy, three-dimensional computed tomography, hepatic vein branch

Reprint requests
Ryoichi Shizawa Second Department of Surgery, Yokohama City University School of Medicine 3-8 Fukuura, Kanazawaku, Yokohama, 236-0004 JAPAN

Accepted
March 23, 2000

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