Anatomical variations of hepatic veins: three-dimensional computed tomography scans of 200 subjects.

BACKGROUND: 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 significant 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.

[Study on the clinical application of abdominal medical image proceeding system in extended hepatectomy].

OBJECTIVE: To study the applied value of abdominal medical image proceeding system (AMIPS) in extended hepatectomy. METHODS: Sixty-four-slice spiral computer tomography (CT) scan data of 32 cases treated from September 2007 to July 2009 (15 male, 17 female; mean age 52 years old) with liver tumor was collected, among which there were 9 cases with huge liver tumor. The data was imported into AMIPS for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into virtual system of AMIPS for digital hepatic segment partition and extended hepatectomy analysis for huge liver tumor of 9 cases. According to the calculated data, suitable modus operandi were selected. RESULTS: In the AMIPS, the 3D models could show the relationships between the lesions to the surrounding tissue more intuitively and the type of blood supply. Digital hepatic segment partition made localize lesions more exactly. It was possible to hepatic segmentectomy and analysis of extended hepatectomy by calculating the relative volume of hepatic segment of huge liver tumor. Huge liver tumor of 9 cases performed different modus operandi, including two cases with right hemi hepatectomies, five cases with hepatic segmentectomy of S6 and S7, two cases with hepatic segmentectomy of S5-7 and part of the S8. There were margin-free tumor cells and no complications such as liver failure in all cases. The average hospitalization time was 21 d. CONCLUSION: AMIPS is helpful in the diagnosis of hepatic disease and in the optimizing surgical plans which can decrease surgical risk and help prevent postoperative hepatic failure.

[Application of the medical image three-dimensional visualization system of abdomen in diagnosis and evaluating resectability of pancreatic tumors].

OBJECTIVE: To study the value and the clinical application of the Medical Image three-dimensional Visualization System of Abdomen (MI-3DVS) in diagnosis and evaluating resectability of pancreatic tumor. METHODS: Twelve patients with pancreatic tumor were tested with 64-slice helical CT (64-MSCT) angiography, and the CT data was reconstructed with MI-3DVS from November 2008 to August 2009. The 3D findings were adopted in diagnosis and evaluating resectability, and the results were compared with surgical operation and the pathological finding. There were 7 male and 5 female, aged from 14 to 83 years. Within the 12 cases, there were 4 cases with pancreatic carcinoma, 5 cases with pancreatic solid pseudopapillary tumor, 2 cases with pancreatic serous cystadenoma, 1 case with pancreatic cyst (ductal epithelial papillary hyperplasia). RESULTS: Nine tumors which had been regarded as removable pre-operatively with MI-3DVS were removed successfully. Three patients who were considered unresectable by other hospitals with CT were operated successfully with MI-3DVS. The other 3 patients' tumors were actually not able to be removed as pre-operative evaluation. CONCLUSION: MI-3DVS plays an important role in diagnosis and assessment of resectability of pancreatic tumor.

[Clinical application of digitized three-dimensional image reconstruction for surgical simulation in living-related kidney transplantation].

OBJECTIVE: To study the application of digitized three-dimensional (3D) image reconstruction in living-related kidney transplantation. METHODS: The image data of 16-slice spiral CT in 5 cases of living-related kidney transplantation were collected to reconstruct the 3D model of the donor and recipient, which were then imported in the FreeForm Modeling System. The optimal surgical approach for each individual case was planned and simulated for verification. During the actual surgeries, the surgical findings were compared against the reconstructed model and the results of simulated surgery. RESULTS: The 3D model clearly displayed the anatomy of the kidney and the variation of the related vessels. The optimal surgical approaches were planned through the simulated surgery. The anatomy of the kidney and the related vessels found in the actual surgeries were consistent with that displayed by the reconstructed 3D model. All the operations were completed successfully according to the surgical plan, and the patients recovered uneventfully without obvious complications. CONCLUSION: Three-dimensional reconstruction and simulated surgery allow optimization of the surgical approaches of living-related kidney transplantation to ensure successful operation and minimize the surgical risks.

[Application of three-dimensional visualization technology in precise diagnosis and treatment for hepatolithiasis].

OBJECTIVE: To assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis. METHODS: The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube. RESULTS: When the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency (100%) was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% (2/27) after the operation. CONCLUSION: The 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery.